Mitral and Aorta Valve Replacement

  Hello,
  My mom is 60 and is told that she will need a mitral and aorta
  valve replacement in the near future.  Her mitral valve is
  already mechanical, she had that replaced when she was 33 years
  old.  Her damage to her heart was due to having rheumatic fever
  six times between the ages of 13 - 28.  Her heart is also enlarged.
  Her surgeon is out of Aultman Hospital in Canton, Ohio.  He
  also wanted to test her carotid artery, is that usual?  Also,
  she of course will have a heart catheter test done, and she's
  nervous because when she had one before her first surgery, it
  was very painful, and she doesn't complain about anything.  Has
  procedures changed in the last 27 years to make it more comfortable?
  She has bad veins.  Also, she's been on coumadin for the past 27
  years and she's in excellent health, except for her heart.  I have
  two other main questions though:
  1 - Her heartbeat races sometimes, and it doesn't settle very easily,
      2 years ago, she had to be hospitalized because of it and they
      gave her a heart shock.  Now, her doctors are trying to control
      it by medication, but it still races sometimes.  Why does this
      happen and is there anything she can do, besides rest, to make
      it slow down?  It can happen anytime, even if she is only resting.
  2 - Her surgeon made it sound like the double valve replacement
      surgery is very risky because she has a lot of scar tissue.  He
      is not sure when he wants to operate and says that she should
      try to enjoy life now and not operate until it's a life or
      death situation.  But she's in excellent health and we want her
      around for a long time.  Could you give me any percentages of
      risk that would be a range for her situation and operation.
  Any information would be very much appreciated.  The more that I
  know, the less I'm nervous about this.  Thank you very much.

[CCF Cardio MD-SGM]

_-
Dear Marie,
Two valve replacement is indeed riskier than single valve replacement.  A second
surgery replacing  both the mitral and aortic valves carries approximately 10-15% mortality,
depending on the condition of the left ventricle and the presence of other medical conditions such
as lung or kidney disease.  Given such a mortality rate, it is customary to wait until
patients with two valve disease have significant symptoms of breathlessness or decreased
exercise capacity before operating.  It is important, as well, not to wait so long
that continued, irreversible damage to the left ventricle occurs.  Such damage would
increase the risks of future surgery further.  My advice to you and your mother is to obtain
a second opinion from a surgeon with extensive experience related to repeat cardiac surgeries
and double-valve replacement operations.  I can't comment on the skills of the group in
Canton, but I'd like you to know that our surgeons at the Cleveland Clinic perform the largest
number of valve replacement surgeries and total cardiac surgeries, (approximately
1200 and 5000, respectively)  of any institution in the country.    We have vast experience in
precisely this sort of situation, and can provide your mother with the best results currently
available.
Regarding the catheterization, I think that a good cardiologist could perform this with minimum
discomfort.  This procedure is now almost routine.   Only very rarely is serious discomfort
experienced by the patient.  Such severe discomfort would be quite unusual.  
Testing the carotids is reasonable prior to extensive cardiac surgery.  This would reveal any
serious carotid disease that could increase the risk for stroke during the heart operation.
On the subject of the arrhythmia, I suspect that your mother has atrial fibrillation, a common
disorder of heart rhythm is patients with rheumatic mitral disease.  There are many treatments
to reduce the palpitations that occur from atrial fibrillation.  These include medications-- especially
beta blockers and also digoxin.  Sometimes, patients treated with digoxin alone can experience
substantial racing of the heart beat with minimal activity.  Thus, if beta blockers are not contraindicated
(for example in the setting of heart failure, severe asthma-like symptoms), then
they should be strongly considered.   Finally, if medications fail to control the symptoms of
atrial fibrillation, various catheter-based solutions exist to correct this problem.  They
may involve placement of a pacemaker, however.
I wish you both the best.  If you're interested in a second opinion, please make an appointment
at 1-800 CCF CARE to see Dr. Brian Griffin or Dr. William Stewart,  both cardiologists
with extensive experience in valvular heart disease, at the Cleveland Clinic, Desk F15.
Information in the forum is for general purposes.  Specific diagnoses and therapies can only be
provided by your physician.