Multiple Cardiac Problems is Mitral Valve Surgery an Option?

Morning. I am a 51 year old female whose AV Mobitz Level 2 congenital heartblock deterriorated into complete heart block which required the insertion of a pacemaker. The x-ray and echo tests at the time of the procedure revealed my mitral valve was reguritating blood into the left ventricle at a rate of 2. The left ventricle also suffers from mild cardiomyopathy.

Am I a candidate for valve replacement? If my heartblock is considered ischemic will my reguritation be better treated through medicine? Can anything be done at all? What if I decide to wait to see if my regimin of toprol 25mg/day will impact the valve problem?

I was searching available papers/studies online and found very little about mitral valve regurtiation secondary to chronic heartblock; or is my whole heart just shot?

PLEASE ADVISE!

Many thanks. Rita

[Forum-M.D.-MM]

Hi Rita,

Am I a candidate for valve replacement?

The decision to replace a valve is dependent on many factors like symptoms, response of pulmonary pressures to exercise, and the type of valve leaking that you have (ie what is wrong with your valve and can it be repaired).  The most important information is the decision tree is does the leaking valve cause you symptoms.  2+ MR is usually not symptomatic, but this is a subject you and doctor need to talk about.  If you have a significant decrease in heart function, that is also an indication for heart valve surgery.  These can be difficult decisions and a second opinions are appropriate if you are concerned.

If my heartblock is considered ischemic will my reguritation be better treated through medicine?

It is not ischemic

Can anything be done at all?

If you do not need surgery (and 2+ usually does not), usual medical care is appropriate -- treating high blood pressure if present, etc.

What if I decide to wait to see if my regimin of toprol 25mg/day will impact the valve problem?

If you have symptomatic MR, the most appropriate intervention is surgery.  Waiting can cause irreversible damage to your heart.  If you are not having symptoms, waiting is the best approach.

I was searching available papers/studies online and found very little about mitral valve regurtiation secondary to chronic heartblock. or is my whole heart just shot?

Many people have leaking heart valves (1-2+, even 3+) and never need surgery.  I would not say your heart is shot. If surgery is the right answer, it can often improve heart function and slow or stop and decline.  Second opinions are always a good option.

I hope this helps.  Thanks for posting.

[EchoTech]

The short answer is not yet, if at ever at all.  Doctors like to see 3/3+ regurgitation with symptoms before they operate since it is a taxing surgery.  You are  not near that level of valvular dysfunction.  You could very well go on for years and years if you even would need valve surgery down the road.  Good night and good luck.

[Momto3]

In your experience, does 2-3+ mitral regurgitation generally progress?  I had a TEE at CCF in 2000 and the regurg. was said to be 2-3+. I am asymptomatic, and have routine checkups.  Surgery has been mentioned by a few doctors as a definite possibility at some time. Although it's really anyone's guess as to which valves will progress to the point of surgery, I was just wondering what your experience has been when watching valvers over a period of time. I've known about the valve for about 20-25 years, but don't know the early measurements.

Thanks for any insight from your perspective.

[EchoTech]

Generally speaking, the valve either stays the same or gets worse.  It almost never gets better physiologically.  They can reduce some of the regurgitation with beta blockers ( I think, I can't remember if they use beta blockers or another class of drugs) but it doesn't solve the problem.

As far as predicting if it will progress, no one can tell the future.  I believe you are on the right course with watching it and getting check ups.  If you become symptomatic between check ups, then I would contact the cardiologist immediately.  It might not mean time for a new valve, but there would be a high probability for it if you were symptomatic.

Good luck.

[Momto3]

Thanks so much for the response.  I am on an ace inhibitor which keeps BP optimal and the valve happy (at least for now).  Thanks again!

[PikaPika88]

Would all Valve problems cause high blood pressure? My last BP is 110/70.  I wasn't on heart med/beta blocker nor blood thinner.

Rita, I've RBBB & PAT (wpw) diagnosed in 15 years old.  The pacemaker pacing at RA & RV.  Causing my LBBB.  Pacemaker failed in 1994 and end up with complete heart block.  Recently (2007) echo shows inferior infarction, mild mitral and moderate tricuspid regurgitation, severe hypokinesis of the basal inferior wall and mild left atrial enlargement.  Second opinion cardio said it can due to 3 factors.

1.  Pacemaker
2.  Ablation
3.  Blood flow lack of oxygen (Less likely)

I wonder would the echo make a mistake because my BP always in the good range and never above 140/90!  How do you find out your mitral valve regurgitation?

[BerrysGirl]

My mitral valve reguritation showed up in the Echo my cardiologist ordered during the course of treating my complete heart block. The echo was of sub-optimal quality, however the radilogist noted mild congestive heart failure and reguritation of 2+.

At my post-procedure outpatient appointment my cardiologist did not mention the regurgitation or mild heart failure. He did not discuss symptoms I should be careful of. He told me to return in a year. (with quarterly pacemaker checks- no pacemaker interrrogation).

I have not been able to find a correlation between the heart block and the regurgitation. It appears, in my opinion, to be a seperate problem. I don't know what is causing the mitral valve regurgitation- but I know I don't want it to get worse.

Does anyone know why my cardiologist wants to see me in a year, not sooner?

Many thanks all, for posting!
Rita

[BerrysGirl]

Dopey me-

I am sorry I don't know what syndrome led to your heart block (just know about my AV Sinus Problems). My heart block presented with low BP. I never experienced high blood pressure. Tests show no arterial disease. I never had rheumatic fever. I don't belive my valve problems were congenital or chronic (less tham 7 years duration?). Cardiac Tests in 1994 and again in 1997 did not note reguritation in the left ventricle. Did I just get middle aged and began falling apart before the big 50?
How old are you? Was the condition that led you to need a pacemeker and subsequent heart block congenital?

Rita

[EchoTech]

The short answer to your question is no, not all valve problems cause high blood pressure.  

If you have mild mitral reguritation, then that is nothing really to worry about.  I would imagine it is secondary to the inferior wall hypokinesis. The echo wouldn't really make a mistake, at least as I see it, but I'm not sure in what frame of reference that you mean a mistake was made.  Go live you life in full force.

The doctor doesn't need to see you again for a year because it would be a waste of your time at this point in your health picture from the information that you've provided so far.  They check up yearly to make sure the pacemaekr is firing and how long of a charge it has left on the battery life and to make sure that the heart murmur doesn't get worse in it's intensity.  If you have any symptoms that develop, call the cardiologist in an immediate fashion.

Good luck and good night.

[Juneface]

My 42 year old son had Hodgkins Disease with radiation in the paracardial area 20 years ago. (this resulted in heart valve problems).  On Dec. 1st he had a valve replacement and single bypass surgery.  Since that time he has had to have fluid drained from his right lung on two occasions; the last time they gave him steroids and things improved.  He just called and said the lung is full again and must be drained again in a couple of days (after going off the Cumadin (coumadin)).

I am terrible worried that this is horribly serious; he can't seem to get any answers and he is in a huge metropolitan area with University Medical center treatment.  It's been 3 months and still having complications - this can be good.  He is otherwise a very healthy individual - not overweight, etc.- was a hiker and biker before the surgery.