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Re: Mitral Regurgitation and Exercise
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Re: Mitral Regurgitation and Exercise

Posted By Linda on August 05, 1999 at 11:20:17
I have mitral regurgitation as the result of torn cords.  My doctor recommended that I exercise so I use a treadmill 3X, 30 minutes each per week for a total of 1 1/2 hours since January, 1999.  I try to keep my heart rate around 120 which is about 70 to 75% of my maximum heart rate for my age but out of boredom, I have lately been doing intervals of jogging, running, increasing the incline, walking faster etc. which increases my heart rate to around 130 or 140. I take 25mg atenolol and 10mg Prinivil.  My recent echocardiogram showed a change so that my doctor now recommends surgery to repair the valve.  I will have another TEE in two weeks.
Did I overdo the exercise?
Should I continue to exercise but take it slower?
How long is the wait for Dr. Cosgrove if I have the surgery performed at the Cleveland Clinic?
How long is the hospital stay and the recovery time?
I live in Philadelphia--Can you recommend any surgeons in my area that do this kind of surgery?
Thanks!
Linda





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Posted By CCF CARDIO MD - CRC on August 05, 1999 at 11:40:10
Dear Linda,
Thank you for your questions.
Q: Did I overdo the exercise?
A: Probably not.  A range of 60-80 % of maximum heart rate is the recommended range for exercise.
Q:How long is the wait for Dr. Cosgrove if I have the surgery performed at the Cleveland Clinic?
A: 3-5 months for elective procedures.  If you would like to be placed on the waiting list you or your doctor can contact the surgical scheduling office at (216)444-2113 or call 1(800)CCF-CARE and ask to make an appointment with one of the "valve" cardiologists (e.g. Dr Griffin, Dr. Stewart. More information about Dr. Cosgrove can be found at http://www.ccf.org/heartcenter/staff/cosgrove.htm
Q: How long is the hospital stay and the recovery time?
A: About 1 week in the hospital and then 2-3 weeks at home before returning gradually to work.  After about 6 months most people feel back to 100%.
Q: I live in Philadelphia--Can you recommend any surgeons in my area that do this kind of surgery?
A: I don't know of any in particular but would start with one of the university hospitals.
I have enclosed other questions from patients below.  They may not all apply to you. Hope this helps.
Q: Is replacement or Repair of the MV better?
A: In general it is better to repair the valve if possible.  If not possible replacement is the next best option.
Q:  If surgery is helpful but not required, then how close/frequent follow up is required?
A: This would depend upon the particular case and varies from monthly to yearly.
Q: What symptoms can I expect in the next few years?
A: Hopefully you will have an operation before you develop symptoms.  Once symptoms develop damage has been done to the heart that can not be reversed.
Q: How does the doctor decide when is the best time for an operation?
A: Usually serial echocardiograms are performed and the ventricular function and valve function are watched very closely.  Once there is any sign of worsening surgery is recommended.
Q: Also, I have read about minimally invasive surgery. Is such surgery possible for mitral valve repairs? Are the results for minimally invasive surgery different from regular open-heart surgery?
A: Minimally invasive mitral valve repair has been pioneered at the Cleveland Clinic and is highly successful in properly selected patients.  If you are considering coming to Cleveland I would recommend Dr. Cosgrove to perform your surgery.  
Q:  I don't have any symptoms (shortness of breath, pain, etc.,), and wonder what would happen if I waited until symptoms started.
A: Once symptoms develop it is often too late to reverse the damage done.  Thus we operate before symptoms start.
Q:  If surgeons at the Cleveland Clinic can perform the procedure, how soon could I get in?
A:  The wait for a surgical time will depend somewhat on the surgeon with Dr. Cosgrove having the longest wait for elective procedures of about 3-5 months.
Q:  They say my cordae is torn, is that serious and is that possible to repair and is that possible via "keyhole"?
A:  Yes and yes however the particular surgical approach will depend upon the specifics of your case.
Q: I am 41 years old, very active phyiscally and have played basketball weekly since high school. Upon doctors orders I have stopped, will I be able to resume basketball?
A: Most people are able to resume their previous activities after surgery.
Q:  Do you have any suggestions on how to break this news to my you children (ages 5 & 9) that Daddy has to go to Cleveland for a heart operation?
A:  I would be straightforward and explain things in terms they can understand.  
Q: How do I know if I am a candidate for repair of the mitral valve vs. replacement?
A: Repair of the mitral valve vs. replacement with a bioprothesis or mechanical valve can only be determined in the operating room.  If the damage is not repairable then it is replaced.  The bioprothesis valve is from either a pig or cow and lasts about 10 years.  The advantage is that long-term anticoagulation is not required.  The disadvantage is that it will need replaced.  The mechanical valve (usually a St. Jude's) lasts for a lifetime but requires anticoagulation with coumadin.
Q: Does MVP get worse?
A: Yes,  MVP can worsen with time.  
Q: What will a heart cath show?
A: Cath is the "gold standard" to determine the degree of mitral regurgitation and also will determine if blockages in the coronary arteries exist that need bypass surgery at the same time.
Q:  Is surgery necessary if there is no other  leak besides the MVP?
A: It may be necessary depending upon the degree of regurgitation.
Q: Do you at the Clinic recommend valve repair surgery to everyone with MVP or is it only for those with certain problems?
A: It is better to repair the valve if technically feasible.  
Q:  For the surgery, do you have to crack open the rib cage to get to the damaged area? On
average, how long does the surgery take? -
A: Some surgeons are performing "mini" mitral valve repairs where a smaller incision is used and the breast bone is not cracked.  The use of this approach will depend upon the specific case.  Surgery usually takes from 2 to 4 hours.
Q: How long (approximately) is recovery time?
A: Usually 5 to 7 days in the hospital and 4 to 6 weeks at home.
Q:  Are there any dietary or other restrictions before/after the surgery we should know about? -
A: Limit salt intake to help cut down on fluid overload.  Otherwise no restrictions except what your doctor tells you.
Q: Statistically, how many patients diagnosed with mitral valve disorders are treated with repair versus replacement surgeries, and what are some of the advantages/disadvantages to both types of surgeries?
A:  About 85% of persons with Mitral Valve Prolapse will get repair.
Further information can be found at:
Dr. Cosgrove's Bio.
http://www.ccf.org/heartcenter/staff/cosgrove.htm
CCF Information about Mitral Valve Surgery
http://www.ccf.org/heartcenter/patinfo/patguide/heartva.html
Other sites:
http://www.hs.washington.edu/locke/vislab/proj/cardio.html
http://www.emedicine.com/EMERG/topic314.htm
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.











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Mitral Regurgitation and Exercise M. Blanco 8/08/1999
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Re: Mitral Regurgitation and Exercise CCF CARDIO MD - CRC 8/09/1999
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