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Heart Disease (Expert Forum)
Re: Mitral Valve Repair
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Re: Mitral Valve Repair
by Cleveland Clinic, MD, Jan 01, 1995 12:00AM
, Jan 01, 1995 12:00AM
Posted By CCF CARDIO MD - CRC on October 21, 1998 at 11:41:30:
In Reply to: Mitral Valve Repair posted by Kathleen on October 20, 1998 at 15:13:41:
I am a 43 year old female diagnosed three years ago with "severe" mitral valve regurgitation. Complicating matters is the fact that I was born with tetrology da fallot and have had two prior chest operations. The first operation was a "closed heart" procedure done in 1958 at the age of 3. The more recent surgery was done twenty-five years ago by Dr. John Kirkland at the University of Alabama Medical Center (at the age of 18). Unitl the mitral valve diagnosis, I l led a productive "normal" life. I am now seen every six months at the University of Pennsylvania Medical Center, located in Philadelphia. I have complete faith in the doctor following my case. However, it is becoming apparent in recent months that I am not going to be able to avoid surgery too much longer. I am becoming increasingly tired and find myself automatically avoiding activities that I know will wear me out. On the other hand, I'm not ready to hop on an operating table for a third chest operation because I am tired. I am scheduled for a trans-esophageal echo-cardiogram on October 30th, which will probalby be followed with a cardiac cath. My cardiologist's philosphy is, that if the mitral valve looks like a good canidate for a repair, then he would recommend I have the surgery now, rather than wait until I do become more symptomatic and risk additional damage to an already damaged heart. On the other hand, if the test reveal that the valve is more than likely going to have to be replaced, he would suggest waiting as long as possible, because of the obvious problems associated with an artificial valve. He is also not suggesting that I automatically have it repaired (or repalced) at the University of Pennsylvania Medical Center, but is more than happy to assist me in the "where" decision pending the outcome of the echo and cath.
My overall general health is good. In addition to the two heart operations, I have three spinal fusions for a curvature of the spine. My heart made it though three fusions, which is not a pretty operation, without any complications. So, I'm hoping this is a good sign.
I have been unable to find anyone my age with a similar medical background who is now facing additional heart problems, and would appreciate hearing from anyone my age with a similar problem. Also, the Cleveland Clinic has come up in several conversations and I would like to know who is doing this type of surgical repair at the Cleveland Clinic.
Any information or comments are greatly appreciated.
---------------------------------------------------------------------------------------------
Dear Kathleen,
Topic Area: Mitral Valve
Thank you for your questions. In general it is better to fix the valve before any damage to the heart occurs. If you are considering coming to Cleveland I would recommend Dr. Cosgrove to perform your surgery. You case will be more complex because of your prior surgery but it should be possible. I have enclosed other questions from patients below. They may not all apply to you. Hope this helps.
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: You should be hearing from us soon concerning an appointment. If you have not heard anything check with your doctor on the progress. 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 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.
Mitral Valve
In Reply to: Mitral Valve Repair posted by Kathleen on October 20, 1998 at 15:13:41:
I am a 43 year old female diagnosed three years ago with "severe" mitral valve regurgitation. Complicating matters is the fact that I was born with tetrology da fallot and have had two prior chest operations. The first operation was a "closed heart" procedure done in 1958 at the age of 3. The more recent surgery was done twenty-five years ago by Dr. John Kirkland at the University of Alabama Medical Center (at the age of 18). Unitl the mitral valve diagnosis, I l led a productive "normal" life. I am now seen every six months at the University of Pennsylvania Medical Center, located in Philadelphia. I have complete faith in the doctor following my case. However, it is becoming apparent in recent months that I am not going to be able to avoid surgery too much longer. I am becoming increasingly tired and find myself automatically avoiding activities that I know will wear me out. On the other hand, I'm not ready to hop on an operating table for a third chest operation because I am tired. I am scheduled for a trans-esophageal echo-cardiogram on October 30th, which will probalby be followed with a cardiac cath. My cardiologist's philosphy is, that if the mitral valve looks like a good canidate for a repair, then he would recommend I have the surgery now, rather than wait until I do become more symptomatic and risk additional damage to an already damaged heart. On the other hand, if the test reveal that the valve is more than likely going to have to be replaced, he would suggest waiting as long as possible, because of the obvious problems associated with an artificial valve. He is also not suggesting that I automatically have it repaired (or repalced) at the University of Pennsylvania Medical Center, but is more than happy to assist me in the "where" decision pending the outcome of the echo and cath.
My overall general health is good. In addition to the two heart operations, I have three spinal fusions for a curvature of the spine. My heart made it though three fusions, which is not a pretty operation, without any complications. So, I'm hoping this is a good sign.
I have been unable to find anyone my age with a similar medical background who is now facing additional heart problems, and would appreciate hearing from anyone my age with a similar problem. Also, the Cleveland Clinic has come up in several conversations and I would like to know who is doing this type of surgical repair at the Cleveland Clinic.
Any information or comments are greatly appreciated.
---------------------------------------------------------------------------------------------
Dear Kathleen,
Topic Area: Mitral Valve
Thank you for your questions. In general it is better to fix the valve before any damage to the heart occurs. If you are considering coming to Cleveland I would recommend Dr. Cosgrove to perform your surgery. You case will be more complex because of your prior surgery but it should be possible. I have enclosed other questions from patients below. They may not all apply to you. Hope this helps.
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: You should be hearing from us soon concerning an appointment. If you have not heard anything check with your doctor on the progress. 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 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.
Mitral Valve
