Waiting on Valve Repair

[Steve L.]

My doctor (who labels himself conservative) says i can wait a year for the surgery.
I've had a TE echo and the cords are reportedly very good.  i'll be checked again in january. Leakage is moderate to severe.  I exercise 20min/5 days/week on a step climbing machine without feeling very fatigued.  Can i wait a year?  My reason for wanting that is just having begun to enter into a very stressful process that may take up to ayear to complete (divorce).

[Chris Benavidez]

I would just like to say that I was diagnosed in November of 1996
with level 3-4 regurgitation of the aortic valve.  The day before
the physical I went mountain biking.  As you can see I had no symptoms prior to my physical, however, when the Dr.'s had seen
how much my valve was leaking they sent me for a Cath in Jan of 97, and I ended up having surgery in May of 97.  My surgeon told me I could wait until Oct, however, I decided to get it over as soon as I could.  Don't put it off, if you have to have the surgery do it as soon as possible, the wait will drive you crazy just thinking about it all the time!

[Chris S.]

Dear Steve,

I was diagnosed with 4+ Mitral valve regurgitation in Nov,99 after a routine physical and had no symptoms. My left atrium and ventricle were enlarged but not significantly. TEE in 1/00 showed no problems with the chordae. My cardiologist was 50/50 on surgery at that time. However, in less than a month I had some a-fib and a Cardiac Cath in 3/00 showed marked enlargmentof the Left atrium. By the time of my repair in May,2000 (scheduling with a good surgeon may take more than 4 weeks)symptoms had progressed substantially. I waited a couple of months only. I have done very well since surgery and returned to a stressful healthcare job in 2 months. The effect of enlarged heart chambers and a-fib are real long-term dangers. I would encourage you to consider surgery and then complete the divorce.

[Wanda Boerio]

I believe you should try and get the valve done as soon as possible- my husband waited and as a result did more damage. Although a divorce is stressful- heart surgery is not a total piece of cake- try to see if you can rap it up quickly and get into surgery before it's too late!

[Stan H]

I can't believe we're now getting medical spam on this board.  This has to be a new low.

[CCF CARDIO MD - DLB]

That is a hard question to answer. My feeling is that, generally, once a problem is identified, it is better to fix it as soon as possible. This is true of valves, which are better fixed before damage to the heart has occurred. However, it usually takes a while for a leaking valve to cause damage and your doctor is right that waiting will probably be OK as long as you are not having any symptoms, but this cannot be guaranteed.

[DENISE]

Dear Steve,

I had successful MVP repair on 6/18/99 at the Cleveland Clinic.  I had severe +4 regurgitation and was only allowed to wait 4 months for surgery - they wanted me to go in two months but I work at a school and they let me wait awhile.  But, I have to tell you, I was ready when the time came.  I could not exercise and was not allowed to even carry a laundry basket up stairs, etc.  The way it was explained to me by my local cardiologist is that if you wait too long, you risk your heart enlarging and then eventually needing a transplant.  Now, you don't sound anywhere near that, but I would keep in close contact with your doctor due to the stress you're under and will continue to be with your divorce.  It certainly would not hurt to get a second opinion and at the Cleveland Clinic, if possible, or another very well know hospital with a good heart department.  You don't want to damage anything in the interim of the divorce.  I'd be happy to help answer any questions if you're interested.  Please email me at ***@****.  Take care - Denise.

[Gary]

I had +1 then + 2-3 leak in the mitral valve for many years. I could not use a stairmaster or anything thing like it but I was able to put off surgery for quite a long time. (Which, in the end, wound up being the Aortic Valve that was replaced. The Mitral leak is still there, as they did not want to tamper with it, hoping the leak might close or narrow to trivial on its own as the LV reduced in size).

I'd say your Dr. is right that you do have a window of time to elect surgery next year. If it were me I'd get the domestic issue resolved as best it can be first, lighten up the load on the LV over the next year by not overdoing the stairmaster and then 'taking on' Open heart surgery.  

You may not want to be 'vulnerable' during a divorce proceeding. The first 3-6 months after OHS are going to be stressful enough
even without allowing for any arrythmias, other possibilities or complications.

[Stan H]

I went several years with moderate to severe regurg before surgery was recommended.  The recommendation is usually based on heart chamber size...if the size of the left ventricle or atrium starts to increase surgery will be called for.  Pulmonary pressure is another measurement closely monitored, as is the onset of any symptoms.  I went into surgery when my lv and la started to show enlargement...I still did not exhibit any symptoms except for the onset of PVCs.  At the time, my cardiologist was an advocate of early surgical intervention...before any significant enlargement or any symptoms.  In retrospect, I would agree that early surgical repair has much to recommend it.

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