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Heart Disease (Expert Forum)
VALVE REPLACEMENT SEPTUM RESHAPING
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.
VALVE REPLACEMENT SEPTUM RESHAPING
by TSC__0, Nov 16, 1998 12:00AM
I have had IHSS for many years. Seven years ago I was referred to the NIH to become part of a study after several severe bouts with afib. At that time a pacemaker was inserted and an oblation performed. This has worked well until recently when my condition has become noticeably worse. I has an esophageal echo which detected vegetation on the valves. After four weeks of IV administered antibiotics the echo was repeated and the vegetation remained. Both the cardiologist and the infectious disease doctor suspected endocarditis but the cultures were not positive. Do any of your Drs. have an idea as to what it could be? The doctors are now considering valve replacement and septum reshaping. My symptoms are very pronounced. Difficulty breathing, unable to ascend steps, inability to lift and carry heavy objects and lightheadedness when I bend over. Thank you.
Doctor's Answer
by CCF Cardio MD - MTR, Nov 16, 1998 12:00AM
_
Dear TSC, thank you for your question.
First, I'll address the possibility of endocarditis with the vegetation noticed on one of your valves. Endocarditis can occur with negative blood cultures either from a low inoculum of organisms that was not enough to turn the cultures positive or from an atypical organism that doesn't grow on typical culture media. Four weeks of IV antibiotics should have cured an infection, but a vegetation often remains because it's composed of more than bacteria (fibrin, scar tissue, thrombus, etc.). The other possibility is that you had a non-bacterial vegetation. Unless the vegetation is affecting your mitral valve by causing mitral regurgitation, it's probably not related to your symptoms.
Second, I agree that you need evaluation for septal reshaping (septal myomectomy) and mitral valve replacement given the severity and progression of your symptoms. During this procedure, a portion of the thickened septum is excised and the mitral valve is replaced with a mechanical valve to "open-up" more space in the left ventricular outflow tract to alleviate the outflow gradient. Dr. Harry Lever here at the Cleveland Clinic is an international expert on IHSS and he would be happy to see you if you would like to have an evaluation here. Dr. Lever can be reached at 216-444-6970. Additionally, our surgeons are very experienced with the myomectomy procedure.
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.
Dear TSC, thank you for your question.
First, I'll address the possibility of endocarditis with the vegetation noticed on one of your valves. Endocarditis can occur with negative blood cultures either from a low inoculum of organisms that was not enough to turn the cultures positive or from an atypical organism that doesn't grow on typical culture media. Four weeks of IV antibiotics should have cured an infection, but a vegetation often remains because it's composed of more than bacteria (fibrin, scar tissue, thrombus, etc.). The other possibility is that you had a non-bacterial vegetation. Unless the vegetation is affecting your mitral valve by causing mitral regurgitation, it's probably not related to your symptoms.
Second, I agree that you need evaluation for septal reshaping (septal myomectomy) and mitral valve replacement given the severity and progression of your symptoms. During this procedure, a portion of the thickened septum is excised and the mitral valve is replaced with a mechanical valve to "open-up" more space in the left ventricular outflow tract to alleviate the outflow gradient. Dr. Harry Lever here at the Cleveland Clinic is an international expert on IHSS and he would be happy to see you if you would like to have an evaluation here. Dr. Lever can be reached at 216-444-6970. Additionally, our surgeons are very experienced with the myomectomy procedure.
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.
