Re: Mitral Valve repair

Posted By CCF CARDIO MD - MTR on December 21, 1998 at 22:27:15:

In Reply to: Mitral Valve repair posted by Annie McCallum on December 21, 1998 at 13:29:41:






I was diagnosed as having a mitral valve prolapse at 4 years old, i am now
27 years old and i'm scheduled for a mitral valve repair/replacement in
beginning of January 1999.
Here are my stats:
Mitral valve Regurgitation :   4/4 P2 type
Tricuspid valve Regurgitaiton: 1/4
Left ventricule:   65 mm
Left atrium:       50 mm
Right ventricule : 30 mmHG
Aortic valve :     1.0 m/s
80% of blood regurgitation in pulmonary veins with chordea breakage.

My first question is: Would it be possible for me to get a surgery using
the minimally invasive cardiac surgery techniques ?  What would be the
benefits of that surgery.  I can't seem to find any hospital that perform
that kind of surgery in Canada.
Second question:  How would you qualify my heart problem, in terms of
importance or gravity ?
Third question: Will my tricuspid valve regurgitation result in another
operation someday ?  Does it usually ?
Fourth question:  I have frequent symptoms of Arrhythmia and very rapid
successive heart beats, also have heart/chest pain that irradiates to my
left arm and sometimes it causes me to faint, during those ''crisis''
i feel better if i bend forward with my shoulders pointing inwards.
Does that relate to my mitral valve problem ? If yes in what sense ?
Will it disapear after the surgery ?
I really appreciate the time you will take to answer my question.
Best regards, Annie.



  ________
Dear Annie, thank you for your question.   I'll answer each of your questions in order.
My first question is: Would it be possible for me to get a surgery using the minimally invasive cardiac surgery techniques ?  
Minimally invasive surgery is advantageous because it shortens post-operative recovery time and pain.  You certainly sound like a good candidate for a minimally invasive mitral valve repair.  I don't know of any hospitals that perform this surgery in Canada, but I'm happy to help you arrange a referral to Cleveland Clinic if that's possible.  Our cardiac surgeons have pioneered minimally invasive mitral valve repair and are uniquely qualified to help you.  If you can't come to Cleveland, then call 1-800-CCF-CARE and ask for Dr. Cosgrove's office.  Dr. Cosgrove is the chairman of cardiac surgery and one of his assistants may be able to help you find a hospital in Canada that performs this type of surgery.
Second question:  How would you qualify my heart problem, in terms of importance or gravity ?
You have a serious cardiac problem that needs to be addressed now because if the mitral regurgitation is not fixed surgically, your left ventricle will continue to dilate and may become irreversibly damaged.  
Third question: Will my tricuspid valve regurgitation result in another operation someday ?  Does it usually ?
Your tricuspid valve regurgitation (TR) is caused by the mitral regurgitation (MR) and is only mild (1/4) in severity.  Thus, I doubt that your tricuspid valve will need to be repaired and that you will need future tricuspid valve surgery after your MR is surgically corrected.
Fourth question:  I have frequent symptoms of Arrhythmia and very rapid
successive heart beats, also have heart/chest pain that irradiates to my
left arm and sometimes it causes me to faint, during those ''crisis''
i feel better if i bend forward with my shoulders pointing inwards.
Does that relate to my mitral valve problem ? If yes in what sense ?
Will it disapear after the surgery ?
The arrhythmia may be paroxysmal atrial fibrillation which is very common in patients with MR and a dilated left atrium (like yours is).   The chest pain can be related to mitral valve prolapse and is very unlikely to be caused by blockages in the coronary arteries given your young age.  The arrhythmias should improve after mitral valve repair, but it's hard to say what will happen with the chest pain.  Some physicians theorize that abnormal neural connections to the heart can explain the chest pain that is seen with mitral valve prolapse. Whatever the cause, this chest pain is not life threatening and is more of a nuisance than anything else.  

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.  Good luck!
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.