Re: Mitral Valve Surgery and Recommendations

[Kirk-]

Posted By Kirk  on April 27, 1999 at 19:35:40
I am 31 years old and have moderate to severe mitral valve regurgitation.  Currently, I am under the care of a cardiologist at Duke University and although I am completely asymptomatic their recommendation is to proceed with a surgical repair of the mitral valve.  Their philosophy appears to be that they can fix a damaged valve but can not fix a damaged heart and if the valve is left untreated the heart may enlarge ultimately leading to heart failure.  This philosophy makes a lot of sense and wanted to know what Cleveland Clinic's position is in this type of situation.  Agree or disagee?  Also Dr. Donald Glower is the surgeon who will perform the surgery and everything I have heard about him is very good and he appears to be an expert in these type of procedures.  Would you concur with this assessment?  Please elaborate with additional info. on Dr. Glower.(In other words, does Dr. Glower meet the Clinic's high standards)
     Your response is greatly appreciated.

[Stan__0]

Posted By Stan on April 28, 1999 at 16:50:41
I've had moderate (3+) mr that's been monitored for the last three years and my cardiologist recommended surgery at the onset.  (The mr was found 3 years ago, although I've probably had it many years).  My heart functions were all normal although I exhibited mild lv dilation.  After a cath and TEE at Dartmouth-Hitchcock Medical Center (NH), the surgical staff recommended no surgery at that time.  I was not yet on their "surgical curve."  A March echo showed my mr had increased to severe, and I am now showing increased dilation in the left ventricle and left atrium.  All my heart functions are still normal, but surgery is now strongly recommended because of the negative changes.  Because no one can predict the often slow progression of mr, I have found the surgeons much more reluctant to operate on early cases than I would have thought.  The debate over what is the "right" time can be quite heated.  Because I am experiencing a degeneration in my valve function, I have scheduled a May 17th date for what will hopefully be a minimally invasive valve repair at Brigham and Women's Hospital in Boston.  (My original May 3rd date has been delayed by a common cold).  I chose Dr. Lawrence Cohn to do my surgery...along with Dr. Cosgrove, one of the best in the field.  I suggest you get the opinion of at least two surgeons to see if you've entered the "curve."  If you choose not to have elective surgery now, make sure you are monitored at least every six months.  I hope my own experience has been of some help.  Good luck.
Stan

[kd__0__0]

Posted By kd on April 28, 1999 at 21:28:42

These are interesting questions.  I have a 3+ mitral valve regurgitation and my CCF cardiologist says no surgery until the heart muscle begins to deteriorate.  Yet, most CCF cardiologists here seem to differ.  I'm really interested to see the answer.  Do either of you have any calcification in the heart (aorta, etc.)?  I wonder if that makes a difference.

[Stan__0]

Posted By Stan on April 29, 1999 at 10:35:54
I show no calcification...just a prolapsed anterior leaflet and a ruptured chord.  Typically, with an otherwise healthy heart, surgery is recommended when something changes for the worse.  Before my mr worsened, the most compelling advice I got was from a cardiac surgeon who said, "..there's a 1 or 2% chance I'll kill you during surgery, and no chance you'll die from your present condition...which odds do you want to go with?"  I chose to wait, and my condition was stable for another two years.  Of course, if I had known then that I would need the surgery in only two years, I might have opted to do it then...but I didn't know and no one else could predict it.  Early intervention versus the risks of surgery is an endless debate and one which you ultimately have to resolve on your own.  Good luck to all of us.
Stan

[shanon-m]

Posted By shannon m. on April 29, 1999 at 13:43:20
Interesting -- I think there is also some geographic skew.  I'm in Utah, and the cardiologists and cardiothoraric surgeons seem to be of the opinion that doing surgery is best done before there is significant functional heart changes. The thinking is to do the surgery that is inevitable before the surgical mortality odds are worse -- e.g., when the patient is sicker because of worsening cardiac symptoms.  My surgery was done when I was a 3+/4- (on a bad day!) seven weeks ago.  (They also found a small hole between the atria of my heart.)  Although I didn't feel significantly diminished prior to surgery, looking back from where I am now, I can see that I was losing ground slowly.  
Anyway, I've a complication free recovery (aside from a broken sternal wire) and am feeling quite a lot better than I did before the surgery.  So I'm glad I opted for the early intervention.
Good luck to all of you.  If you have any questions about my experience with recovery, minimally invasive vs. median sternotomy, or anything else, please feel free to e-mail me.
Shannon

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on April 29, 1999 at 14:45:07
Thanks for bringing a "west coast" view to the debate.  In general at the Cleveland Clinic we too are repairing sooner rather than later.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist

[Kirk__0]

Posted By Kirk on April 29, 1999 at 19:56:26
I wanted to thank everyone for their input and also provide some additional information.  I have been followed for approximately 5 years for my MR and while I am presently asymptomatic  the Duke physicians have made it clear that from a medical standpoint there is no clear way to tell when the heart muscle and resulting function will deteriorate to a point causing irreparable harm.  Basically, there is no way to tell by the time I have my next 6 month follow up whether or not significant changes will have taken place or none at all.  This concerns me.  In any event, I am going to schedule surgery in the latter part of this year and would like to talk with those of you who responded to my posting about surgery and related matters.  Shannon, I know you said you could be emailed with questions but did not see your address.  If anyone would like to discuss mitral valve issues further please email me at "***@****"  Look forward to hearing from you

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on April 30, 1999 at 07:31:03

Glad you have found some additional information and some people who have gone through the same things.  Best wishes.
CRC

[shanon-m]

Posted By shannon m. on May 01, 1999 at 02:26:33
Kirk --  I've sent you an e-mail so you can send back any specific questions or thoughts you might be having.
Basically, I think you might want to ask your doctor for an earlier follow-up date.  I was uncomfortable with waiting six months after my Dec. echo, and talked with my cardiologist about it.  He then scheduled me for an exercise stress echo in mid-February.  The results of that echo were a recommendation for immediate surgery, which I had in mid-March.  The key is communication, and trust, in your medical team.  Mine was phenomenal and I know it has made all the difference for me and my family.
Please let me know if there's any way I can help, especially in sharing my process and experience.
Shannon

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 03, 1999 at 09:40:44
Thanks for you comments.  Trust is very important and the best doctors will weigh the preferences of the patient into the timing of the surgery.
CRC










Follow Ups:


Mitral Valve Surgery and Recommendations Annie 5/17/1999
(1)

Re: Mitral Valve Surgery and Recommendations CCF CARDIO MD - CRC 5/18/1999
(0)