Re: Mitral valve replacement

Posted By CCF CARDIO MD - DLB on November 12, 1998 at 10:10:36:

In Reply to: Mitral valve replacement posted by Billie on November 09, 1998 at 21:02:04:






my 31 year old son has mitral valve prolapse from damage which occurred in a 1985 car wreck ( a fairly rare occurrence, we were told). At the time of his wreck, he had only minimal regurgitation and no surgery was done. Now he has severe regurgitation and mitral valve replacement is necessary. He is having a heart cath this Friday ( Nov 13) at St. Joseph Hospital in Lexington, Ky. Dr. Dennis Kelley is his cardiologist. We don't know yet who will be doing the surgery. I hope a response to some of my questions will help allay my fears.
1. I have heard many good things about Cleveland Clinic, especially in the area of mitral valve replacement.  What criteria should we use in our decision as to WHERE to have the surgery done?  We, of course want the very best surgeon, but if this surgery is a fairly common one and one often performed at other hospitals such as St. Joe, it would be closer to home and more convenient to have it done there.
2. I understand that a titanium valve will be used.  What success rate have you experienced with this procedure? How long should it last him, assuming there are no complications?
3. Is there a minimally invasive surgery for this process or must the chest cavity be cut open?
4.  My son is a construction worker and must climb, lift extremely heavy equipment, and endure extreme hot and cold temperatures.  Will he be able to return to this type of work or should he be thinking about job retraining for work which is indoors?
5. How long can he expect to be off work?
6. How long will he be hospitalized ( again assuming no complications)?
7. His heart is enlarged. There is thickening of the heart walls.  Will the heart return to a normal size after the surgery?
8. If you believe the surgery may be performed just as successfully at St. Joe, who or what should we be looking for in a surgeon?
9.  I think I am asking the impossible here, but are you willing or able to recommend a surgeon in Lexington?
Thank you so much for your help.  Billie
Dear Billie
1. Tough question. If the valve definitely needs to be replaced, this could probably be handled by an experienced cardiothoracic surgeon in your community. The real question is whether it can be repaired - this type of surgery does require special expertise. We do a lot of mitral valve repairs here.
2. Mechanical valves usually last for decades.
3. There are minimally invasive approaches to mitral valve surgery (we also do a lot of these). The chest must still be cut, however. Only a surgeon with expertise in minimally invasive approaches should try it.
4. He should be able to return to work after he recovers.
5. At least six weeks.
6. Four to ten days.
7. There should be some degree of return to normalcy over time.
8. It is a personal decision whether to have surgery close to home (which is definitely a big plus) or to have the surgery at a large referral hospital by the most renowned surgeons. IF you go to your community hospital, inquire whether the surgeon has any experience in mitral valve repairs or minimally invasive approaches.
9. I do not personally know any of the surgeons at your hospital.
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.