Mitral Valve Surgery - Questions

[ChristianH]

My wife siffers from severe mitral regurgitation (3-4+) due to a "myxomatous prolapsing mitral valve" with "redundancy involving both leaflets, more the anterior than the posterior leaflet, with a posterior jet direction" and "mild anterior leaflet prolapse."  She's asymptomatic.  Currently no heart enlargement (though she's borderline).  EF ~ 60%.

We're debating early surgery after reading the recently published reports that indicate better long term results in Class I/II patients.  

To make this decision (early or not), we need to determine her chance of repair (rather than replacement).  She's has stress echos once per year for several years.  

My questions:

1.  Have repair techniques improved over the last few years with respect to valve problems like hers?  How commonly are such valves repaired?

2.  Would a TEE provide a "better picture" so that her physicians could more accurately predict the results of her repair?

3.  Has it been established that waiting reduces a chance of successful, durable mitral valve repair?

4.  Would a subsequent pregnancy (post-repair) increase the risk that the repair could fail?

5.  I noticed (from your web site statistics) that the CCF is using far more bioprosthetic valves in the mitral position.  Is this because of the recent introduction of the Carpentier Edwards Perimount Pericardial Mitral Valve? Are you transplanting this valve in younger (~ 30 years) patients?

[CCF-M.D.-CRC]

Dear Christian,

The timing of mitral valve repair is really more art than science.  You do raise some interesting questions which I will try to address but the best opinion can only come after reviewing the data and preferences of the patient.  

Q: Have repair techniques improved over the last few years with respect to valve problems like hers? How commonly are such valves repaired?
A:   In general techniques have improved but mitral valve repair is highly dependent upon the technical skill of the surgeon so it ultimately depends on who is the surgeon.  Mitral valve prolapse is the most commonly repaired and the anterior leaflet is generally easier to repair than the posterior leaflet.

Q: Would a TEE provide a "better picture" so that her physicians could more accurately predict the results of her repair?
A: Yes.

Q: Has it been established that waiting reduces a chance of successful, durable mitral valve repair?
A: Not necessarily.  However, waiting too long can result in damage to the heart.  We are tending to do repairs earlier these days.

Q: Would a subsequent pregnancy (post-repair) increase the risk that the repair could fail?
A: There would be some increased work-load on the heart but it should not cause the repair to fail.

Q: I noticed (from your web site statistics) that the CCF is using far more bioprosthetic valves in the mitral
     position. Is this because of the recent introduction of the Carpentier Edwards Perimount Pericardial Mitral Valve?
     Are you transplanting this valve in younger (~ 30 years) patients?
A: I think the use reflects the preference of the surgeons to avoid anticoagulation and our younger patient population.  In general we like to avoid coumadin if possible.  If you do wish to come to the Cleveland Clinic I would recommend Dr. Cosgrove to do the repair if needed.  You can make an appointment by calling 1-800-223-2273.

[ChristianH]

Thanks for the prompt reply.

We're already being seen at CCF, and locally.  We intend to have Dr. Cosgrove perform the surgery -- we're hoping that gives her the best shot at repair.

Christian

[debra21784]

Go for it .Better elective than emergent.My repair was not done at CCF( done at Hopkins), but prior to my surgery I spoke with Dr.Cosgrove at length via phone and he was kind enough to answer all my questions. He helped me in finding a cardiac surgeon who has a high sucess rate of repair.Dr.Cosgrove does indeed  has a high success rate for repairs and that is what is important in choosing a cardiac surgeon.

[msbea]

i an 55 years of age and i have a mitral valve prolaps, i have had it sence 1979 and it seems to get worse the olded i get. i feel tired all of the time and i also want to sleep all of the time to is this normal. i take tenormin also. my doctor keeps putting my sergery off can you tell me why
                                thank you bonnie amrine

[poneken]

Debra,

I am in Maryland.  Doctor said I may need to think about valve surgery after my last Echo.  Could you please let me know which doctor did your repair surgery at John Hopkins University?!  You can mail to me at ***@****.  Thanks much.

[schuyler]

Just a note to mention that sixteen days ago I had mitral valve repair surgery performed at the International Heart Institue in Missoula, Montana by Drs. Carlos Duran and Stephen Tahta.  Dr. Duran is a pioneer in the area of the mitral valve repair procedure (and invented the widely-used ("Duran ring)) and, though now getting on in years, scrubs in and assists with repair surgeries.  I'm 47 and suffered from a "universal Barlow" valve deformity so bad that no Denver surgeon would touch it and the cardiologist in Montana told the surgeons there that they would likely not be able to repair it.  However, they not only successfully repaired my mitral valve, but slapped a "Duran ring" around my tricuspid valve while they were at it.  I was out of the hospital five days after the surgery.  I'm already back at work (I'm a federal prosecutor) and feeling great, though my sternum still twinges.  Six weeks from now I'll be off the hated Coumadin and back to a normal life.
   I make these comments to suggest that anyone seeking a mitral valve repair should consider the International Heart Institute in Missoula in addition to Clelevand or other places.  The care I received there, from the nursing staff to the surgeons, was unbelievably good and the surgeons themselves are extremely informative, friendly and non-arrogant.  The Institute's number is 406-728-4558.
    If you are having this surgery anytime in the future, I hope you have as much good luck and excellent medical care as I've had.  Should anyone wish to contact me about my experience, my  e-mail address at work is "robert.***@****"
   -Bob Anderson, Denver.

[JLB]

My fiance is 34 years old and scheduled to have Mitral valve repair this month.  The doctor is Eric Peper.  He is from Nebraska, I believe, but now in CO. Does anyone have any knowledge to this doctors abilities?  My fiance has had ASD correction twice.  Once at 18 and then again at 30.  The cardiologist also said they need to repair the Tricuspid valve.  He has also been told he will remain on the coumaden.  Is there any chance that wouldn't be necessary?  He is very into sports and this causes a big change for him.  Are these surgeries normally a one time deal or could he be facing additional repairs to the Mitral valve.  He was out two months with the previous surgery.  Should he expect the same now?