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Heart Disease (Expert Forum)
Mitral Valve Replacement - perivalvar MR
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Mitral Valve Replacement - perivalvar MR
by dalelisa4, Jun 18, 2001 12:00AM
My 59 y.o. mother had MV replacement 3 years ago (St Judes Valve). She had a very complicated recovery (chylothorax,shocked kidney with dialysis,shocked liver, coded x 2 - to name a few). She somehow survived and has been doing okay until recently. Apparantly her MV placement is causing a lot of problems. The most recent echo reads: Normal LV function with moderate LVH and proximal septal thickening. Severe LV outflow tract obstruction, peak gradient 85 mm Hg appears to be due to both septal hypertrophy and the placement of the MVR (this is down from 117 in Dec. 2000). SJ MVR appears to have perivalvar MR. There is severe tricuspid regurgitation (4+). Recommend TEE if clinically indicated. Compared to prior study of 12/5/00, severe LV outflow tract obstruction is again noted. Probable perivalvar MR is new. (This is exactly as typed on echo report - I have a copy)
The physicians here say that we can't do anything at this point. They feel we shouldn't do anything until my mother goes into CHF and then they would consider MV replacement again. Clinically she has become very tired lately and admits to DOE. She often sounds winded. She is still carrying on her ADL's, but in our opinion she is not looking good. Do we really just wait until she goes into CHF before doing anything for her? We had a consultation with Dr Brian McGovern (From Boston - he comes to Albany 2 x's a month) in March and he said if everything stayed stable, then we just take a wait and see attitude. That was before the Tricuspid Regurg was a 4+ and before there was what appears to be a perivalvar leak. Mom was also not having much SOB and fatigue at the time. Is it time to get another opinion? She is understandable terrified after the 90 days she spent in ICU three years ago (and so are we). We feel helpless just waiting for the worst to happen. Is this really the best course of action right now? What options does she have? Is heart transplant an option? Would she now need both valves repaired? We would appreciate any advise you could give us. We would also be willing to travel to Cleveland for an evaluation. I should also mention she had to have a pacemaker placed 3 years ago and the battery is running low already. She is currently taking Procrit every other week because of hemolysis of the RBC's from the valve. I don't have a list of the other meds available right now, but I could get it. Please advise. Which type of Doctor do we need - Cardiology or Cardiothoracic Surgeons?
The physicians here say that we can't do anything at this point. They feel we shouldn't do anything until my mother goes into CHF and then they would consider MV replacement again. Clinically she has become very tired lately and admits to DOE. She often sounds winded. She is still carrying on her ADL's, but in our opinion she is not looking good. Do we really just wait until she goes into CHF before doing anything for her? We had a consultation with Dr Brian McGovern (From Boston - he comes to Albany 2 x's a month) in March and he said if everything stayed stable, then we just take a wait and see attitude. That was before the Tricuspid Regurg was a 4+ and before there was what appears to be a perivalvar leak. Mom was also not having much SOB and fatigue at the time. Is it time to get another opinion? She is understandable terrified after the 90 days she spent in ICU three years ago (and so are we). We feel helpless just waiting for the worst to happen. Is this really the best course of action right now? What options does she have? Is heart transplant an option? Would she now need both valves repaired? We would appreciate any advise you could give us. We would also be willing to travel to Cleveland for an evaluation. I should also mention she had to have a pacemaker placed 3 years ago and the battery is running low already. She is currently taking Procrit every other week because of hemolysis of the RBC's from the valve. I don't have a list of the other meds available right now, but I could get it. Please advise. Which type of Doctor do we need - Cardiology or Cardiothoracic Surgeons?
Doctor's Answer
by CCF-M.D.-CRC, Jun 18, 2001 12:00AM
Dear dalelisa,
I am very concerned about this story. It is never easy to second guess someone who has evaluated all the data personally but I would tend to agree with you that perhaps something should be done sooner rather than later. I don't think transplant is an option at this point. She proably does need a TEE to better evaluate the perivalvular leak. The mitral and tricuspid could be repaired at the same time and the septal hypertrophy could also be repaired.
By all means please do come to Cleveland for a second opinion. I would recommend seeing Dr. Harry Lever. He is a conservative cardiologist here who is an international expert in septal hypertrophy. He will not push for surgery unless it is really necessary. You can make an appointment with him by calling the number below. Please be sure to bring copies of all her records and test results. We are used to dealing with high risk patients such as your mother and if there is something that can be done we can help.
I am very concerned about this story. It is never easy to second guess someone who has evaluated all the data personally but I would tend to agree with you that perhaps something should be done sooner rather than later. I don't think transplant is an option at this point. She proably does need a TEE to better evaluate the perivalvular leak. The mitral and tricuspid could be repaired at the same time and the septal hypertrophy could also be repaired.
By all means please do come to Cleveland for a second opinion. I would recommend seeing Dr. Harry Lever. He is a conservative cardiologist here who is an international expert in septal hypertrophy. He will not push for surgery unless it is really necessary. You can make an appointment with him by calling the number below. Please be sure to bring copies of all her records and test results. We are used to dealing with high risk patients such as your mother and if there is something that can be done we can help.
Member Comments (3)
by Tedily, Jun 19, 2001 12:00AM
To: Dalelisa
PLEASE take your mother to Cleveland Clinic now,considering that you said that you could.She is only 59 years old.The Dr. was really concerned and so am I.Good Luck--tedisurg
by Ela, Jun 29, 2001 12:00AM
Do go to Cleveland. A friend of mine heard the same story locally. (There is nothing we can do.) A trip to Cleveland proved otherwise. I have also been to Cleveland, due to a mistake that was done in mitral valve surgery at a local hospital. I saw Dr. Lever at Cleveland and Dr. Cosgrove for the new surgery. How I wish that I went to Cleveland first!
