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Two Open Heart Surgerys; Third before Pregnancy?
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Two Open Heart Surgerys; Third before Pregnancy?

Hello!  I am 27 years old. I was born with an endocardio cushion defect resulting in three holes in the walls of my chambers.  When I was 3, I had my first open heart surgery to correct the defect.  It left a cleft which left me with a heart murmer.  Two and half years ago, I was told I needed to have my second open heart surgery because my mitral valve was leaking moderate-severly and my triscuspid valve was leaking mild-moderately. (They said this was because of the cleft from my previous heart sugery).  At the time, I was very short of breath and feeling palpitations.  I ended up having the heart surgery where they repaired the mitral value and put a cuff on the tricuspid; the surgery itself resulted in a pacemaker (not a defibrillator).  Recently I was pregnant (I ended up miscarrying), and had an echo done that showed my heart leaking moderately.  They said it was not as bad as it was in 2010; however, it is still a concern.  Due to me being pregnant at the time, we scheduled another echo and follow up the same day, as we could not schedule a TEE or anything more invasion.  My husband is scared to try to conceive again because he is worried that the pregnancy will hurt my heart more.  I am respecting his wishes and waiting to hear back from my cardiologist.

My main questions:  I am seeing many posts of people saying their heart is leaking worse than mine was, and many of the advice is to not have surgery.  Did I get wrong information?  Should I have not had open heart surgery in 2010?

Being pregnant increases your blood volume; even though I was very early at the time of the echo (8 weeks), would my heart have been leaking more due to the increased blood volume?

If they recommend surgery again:  is it best to hold off on trying to become pregnant until after I have recovered from the surgery?  Should I listen to them? Can pregnancy affect the health of my heart at the state it is in right now?

Thank you.
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Without having the ability to review your entire chart/history it is impossible to tell you whether open heart surgery in 2010 was the right or wrong thing for you.  You are correct in that we often grade how severe a leaky valve is with a scale and generally speaking reserve surgery for valves that are leaking severely and/or causing major problems (i.e. atrial fibrillation, elevated blood pressure in the lungs, decreased heart function, congestive heart failure etc.).  In your case I am unsure which of these was present at the time of your surgery.

With regards to your current situation, it is not uncommon for the increased blood plasma volume to accentuate the degree of mitral regurgitation present on the echocardiogram.  

Mitral regurgitation is one of the more better tolerated valvular lesions with respect to pregnancy as symptoms can be managed with close follow up with a cardiologist.  

Before planning another pregnancy with your husband I would recommend a thorough cardiovascular evaluation by a cardiologist and also planning with an obstetrician.  
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