Aa
Mital and Aortic Valve Replacement
My partner is scheduled to have a double valve replacement on the 15th of March 2000. Alex was diagnosed with having mitral stenosis and aortic incompetence in 1992 (8 years ago). He has been managing his health condition with medication for the past three years. However, a recent visit to his cardiologist (Prof. P. Manga)confirmed that his heart had enlargened significantly, necessitating valve replacement asap. We've met with the surgeon, Dr Martin Sussman (Milpark Clinic, Johannesburg, South
Africa), and he has recommended a mechanical valve for the mitral valve and a bioprosthetic (pig)valve in the aortic position. We are concerned about his valve choices as Alex is only 30 years old, and we understand that the prosthetic valve will require replacement in about 5-10 years time, which we would like to avoid if possible. We do understand that Alex will have to be on Waffarin for the rest of his life, but he has been taking this for the past 3 years with no associated problems. Furthermore, this medication will be necessary as he is to have a mechanical valve in the mitral position.
Please answer/comment on the following:
1. The use of two mechanical valves instead of the proposed machanical + bioprosthetic valves.
2. The use of St Judes bileaflet valves for both valve replacements.
3.We are very encouraged by the work done by the Cleveland doctors on minimal invasive surgery and would prefer this method to the standard surgery. But is it advisable in the case of double valve replacement? NB! repair of the mitral seems remote.
4. If he opts for two mechanical valves would the dosages of Waffarin be significantly increased?
Thank you. Looking forward to your response.
Vanessa
Africa), and he has recommended a mechanical valve for the mitral valve and a bioprosthetic (pig)valve in the aortic position. We are concerned about his valve choices as Alex is only 30 years old, and we understand that the prosthetic valve will require replacement in about 5-10 years time, which we would like to avoid if possible. We do understand that Alex will have to be on Waffarin for the rest of his life, but he has been taking this for the past 3 years with no associated problems. Furthermore, this medication will be necessary as he is to have a mechanical valve in the mitral position.
Please answer/comment on the following:
1. The use of two mechanical valves instead of the proposed machanical + bioprosthetic valves.
2. The use of St Judes bileaflet valves for both valve replacements.
3.We are very encouraged by the work done by the Cleveland doctors on minimal invasive surgery and would prefer this method to the standard surgery. But is it advisable in the case of double valve replacement? NB! repair of the mitral seems remote.
4. If he opts for two mechanical valves would the dosages of Waffarin be significantly increased?
Thank you. Looking forward to your response.
Vanessa
I am a 78 year old male & had an aortic valve replaced with a pigs valve in March 1984. I am told by my cardiologist there is now a considerable amount of leaking. What are my chances and how urgent is surgery at this time? Thank you.
My 77 year-old mother-in-law was informed several months ago that her mitral valve is severely clogged. She had rheumatic fever as a child. She is very frightened about valve replacement and doesn't know what to do. What exactly is involved with mitral valve replacement, how long is recovery time, and how long will she need to be on blood thinners after surgery. Mind you, my mother-in-law would just like to let things be and she hopes nothing bad happens to her in the meantime. Can anyone help by letting me know what I should tell her?
Thanks so much!
Patty
***@****
Thanks so much!
Patty
***@****
Thank you for responding, Jean and Harvey. I very much appreciate it. It doesn't seem possible to post questions any longer - the site always seems to say it can't take any more questions. I guess they just can't have time for everything.
I've been to many places on the Web for information, and a lot of it is contradictory. However, I think I'm looking at a homograft or other biological, regardless of the reoperation. I don't think I'd thrive on the warfarin, although I can see why many people might choose the mechanical. I guess it's the lack of connection to expert help and advice (cardiologist/clinic) and the unknown of the rate of progression that keep me off-balance.
I'm not thrilled that the Dr. and (apparently) the cardiologist are looking at this as *ho-hum*, no big deal. It IS a big deal. I need to be as prepared as possible to make those decisions that I will need to make. I don't want to wind up taking a certain path just because that's what that particular doctor is used to doing, and just assumes will be best for you. Some doctors seem to feel that if you are under 50, you should automatically go for the mechanical, and just adjust your life to the coumadin. All fixed. Go home.
Interestingly, apart from those who found out at a very early age, or who have age-related heart problems, there seems to be a common thread of people who are very active, perhaps used to carrying heavy weights, etc. This would seem to be a factor in abusing the valve, particularly if it were bicuspid. I wonder what the percentage is of bicuspid vs. tricuspid valves found in initial surgery.
I've been to many places on the Web for information, and a lot of it is contradictory. However, I think I'm looking at a homograft or other biological, regardless of the reoperation. I don't think I'd thrive on the warfarin, although I can see why many people might choose the mechanical. I guess it's the lack of connection to expert help and advice (cardiologist/clinic) and the unknown of the rate of progression that keep me off-balance.
I'm not thrilled that the Dr. and (apparently) the cardiologist are looking at this as *ho-hum*, no big deal. It IS a big deal. I need to be as prepared as possible to make those decisions that I will need to make. I don't want to wind up taking a certain path just because that's what that particular doctor is used to doing, and just assumes will be best for you. Some doctors seem to feel that if you are under 50, you should automatically go for the mechanical, and just adjust your life to the coumadin. All fixed. Go home.
Interestingly, apart from those who found out at a very early age, or who have age-related heart problems, there seems to be a common thread of people who are very active, perhaps used to carrying heavy weights, etc. This would seem to be a factor in abusing the valve, particularly if it were bicuspid. I wonder what the percentage is of bicuspid vs. tricuspid valves found in initial surgery.
To Bob,
Bob, Jean gave you good advice. I too had a homograft put in 5 weeks ago, I didnt have a waiting period at all. The new stentless porcine valve is the only other valve that I would have picked if I didnt get the Homograft. The mechanicals I hear are noisey. And you have to take blood thinner for the rest of your life. I am 45 and I am back to work already. It is not as bad as you think. Harvey, ***@****.
Bob, Jean gave you good advice. I too had a homograft put in 5 weeks ago, I didnt have a waiting period at all. The new stentless porcine valve is the only other valve that I would have picked if I didnt get the Homograft. The mechanicals I hear are noisey. And you have to take blood thinner for the rest of your life. I am 45 and I am back to work already. It is not as bad as you think. Harvey, ***@****.
I have been diagnosed with endocoditis and I am currently being treated with antibiodic every 4 hours, for the next 6 weeks. After I had an ecocardiogram, the doctor found that I had a murmur on the aortic vale. The recommendation is that I will need a valve replacement of the aortic valve, since my valve is at.8.
I also have the infection on the Mital valve.
A friend of mine had surgery done by Dr.Cosgrove, I believe last year and he is doing very well.
I would like to get your thoughts on my condition and if I can make an oppointment with Dr. Cosgrove for his opinion.
Thank you! My e-mail is ***@****
I also have the infection on the Mital valve.
A friend of mine had surgery done by Dr.Cosgrove, I believe last year and he is doing very well.
I would like to get your thoughts on my condition and if I can make an oppointment with Dr. Cosgrove for his opinion.
Thank you! My e-mail is ***@****
Bob,
I am one of the many on this site who have gone the same route you are facing and if nothing else can offer some "I understand what you are feeling " comments but also offer a little info and thoughts from one who has been there.
I discovered I had the congenital bicuspid aortic valve when I was 36...not bad then and was told it may never get so bad I would have to have anything done...let them know if I got bad shortness of breath etc. Well, it happens slow, and in the meantime you know you get older. I didn't really think about it until it really dumped me last July. Family doctor thought it was my asthma and tried a couple of things for that. Went into congestive heart failure. Finally insisted I see a cardiologist. He got that bout of chf under control and found my aorta working at about 25% or less. SURGERY. I chose the Cleveland Clinic for just the same reasons you did, plus my cardiologist was all for it. I am 56 now and am basically pretty fit other than the heart deal.
I dug into all the knowledge I could find on the situation and remedies and choices. I always knew that I did not want a mechanical -- coumadin is rat poison -- my life style, I eat veggies, have wine, and farm and ride a motorcycle. I didn't think I would be willing to make the lifestyle changes a mechanical would require , plus I knew people often had to have resurgeries even with mechanical valves. I opted for a homograft. I too was worried about the availability, had no problems. They are cleansed and cyrogenically (?) stored at the facilities that have them. The CC is a fantastic place to go to...the people from technicians up to surgeons are fantastic and the facilities are wonderful.
Get all the info you can now...just be a resource hog. Settle on a plan A and a plan B, trust in your higher power, get the best medical team you can and relax as much as you can. I know that is the hardest thing for you to do right now. But it is what everyone told me and THEY WERE RIGHT. The pain is managed so well that it is really low, low on the list of problems. Sneezes were my bit buggaboo. I was released from the Clinic on day 5 with only Tylenol for pain. Never had a bod problem. When you are home, take it very easy but do WALK, WALK, WALK like they tell you to. I am 9 weeks post surgery and virtually doing everything only even better because I can breath and have no pain. I'm on some blood pressure medicine to help my heart realize it doesn't have to work so hard. I hope that will pass too and I can be like my 77 year old Dad and take only a daily vitamin.
I'd say go for the homo like you're thinking, find a place to do it and worry about resurgery in 20 years...who knows what the options will be then...maybe the grow your own will be commonplace by then...maybe they can zap us with their fixer and not even have to operate!
Good luck. If you'd like to chat my Email is ***@****
I am one of the many on this site who have gone the same route you are facing and if nothing else can offer some "I understand what you are feeling " comments but also offer a little info and thoughts from one who has been there.
I discovered I had the congenital bicuspid aortic valve when I was 36...not bad then and was told it may never get so bad I would have to have anything done...let them know if I got bad shortness of breath etc. Well, it happens slow, and in the meantime you know you get older. I didn't really think about it until it really dumped me last July. Family doctor thought it was my asthma and tried a couple of things for that. Went into congestive heart failure. Finally insisted I see a cardiologist. He got that bout of chf under control and found my aorta working at about 25% or less. SURGERY. I chose the Cleveland Clinic for just the same reasons you did, plus my cardiologist was all for it. I am 56 now and am basically pretty fit other than the heart deal.
I dug into all the knowledge I could find on the situation and remedies and choices. I always knew that I did not want a mechanical -- coumadin is rat poison -- my life style, I eat veggies, have wine, and farm and ride a motorcycle. I didn't think I would be willing to make the lifestyle changes a mechanical would require , plus I knew people often had to have resurgeries even with mechanical valves. I opted for a homograft. I too was worried about the availability, had no problems. They are cleansed and cyrogenically (?) stored at the facilities that have them. The CC is a fantastic place to go to...the people from technicians up to surgeons are fantastic and the facilities are wonderful.
Get all the info you can now...just be a resource hog. Settle on a plan A and a plan B, trust in your higher power, get the best medical team you can and relax as much as you can. I know that is the hardest thing for you to do right now. But it is what everyone told me and THEY WERE RIGHT. The pain is managed so well that it is really low, low on the list of problems. Sneezes were my bit buggaboo. I was released from the Clinic on day 5 with only Tylenol for pain. Never had a bod problem. When you are home, take it very easy but do WALK, WALK, WALK like they tell you to. I am 9 weeks post surgery and virtually doing everything only even better because I can breath and have no pain. I'm on some blood pressure medicine to help my heart realize it doesn't have to work so hard. I hope that will pass too and I can be like my 77 year old Dad and take only a daily vitamin.
I'd say go for the homo like you're thinking, find a place to do it and worry about resurgery in 20 years...who knows what the options will be then...maybe the grow your own will be commonplace by then...maybe they can zap us with their fixer and not even have to operate!
Good luck. If you'd like to chat my Email is ***@****
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