Valve Choice

[PRRK4s]

I am scheduled to see a surgeon for a pre-op meeting. I tried to read all I could on the net. I am trying to absorb all I can. I have a leaking mitral valve as all the tests (stress, echo cath and finally the TEE) shows the damage. Last time at the cardiologist he tells me I need surgery. I asked if a repair or replacement. He told me they wouldn't know until they open me up. But I read that they can get a clue by looking closely at the test results. I plan on asking the surgeon that question. I am 45 and am wondering at that age, do I have a choice of what type valve if replacement is needed. What would be your recommendation at this age? I am sure there are certain factors to deciding. If it where your choice? What type and Why?  Is there leaps and bounds on the horizon of valve technolgy that will effect the decission? Thanks,

[PRRK4s]

I had the meeting with the surgeon several days ago and we set a date. For me it is a 50/50 chance at a repair according to what all the tests has shown the surgeon. He descibed what the leaflets looked like and if I am to hazard a guess, I think a replacement will be the final outcome. Hope I am wrong though. I really didnt get a choice of the type valve if needed. St Jude Mechanical. But he said he will first try the repair then check for leakage. A trace leak may be acceptable but any greater, he will replace. I also found out the left ventricle is somewhat enlarged to 4.8+CM. Normal is 3.5CM. Aortic and Pulminary valves are good, Tricuspid has a trace leak. So all that seems to be good. I was able to see the report and he explained all those technical terms. Seems to be a routine valve repair/replacement deal. Just wish it was over and 6 months past already....

[4timer]

hello, first time I have commented on the forum. I was on researching about PVC's and came across the question on valve choices.
I have had 4 open heart surgeries myself. 3 for valve replacement/repair and the 4th to repair an aortic aneurysm. First at age 36. I am now 48. Otherwise very healthy. Extremely patient wife and kids who have seen me through all this. The one surgery I had for mitral valve repair failed and they had to replace the valve with another surgery 7 days later.(had a world renowned cardiac surgeon in Toronto do the surgery but it just didn't work out.) I have St. Jude mechanical valves in both aortic and mitral position. My first surgery involved a Ross Procedure where my pulmonic valve was used to replace my aortic valve and a human donor valve replaced the pulmonic valve. Lasted 5 years and then was replaced with St. Judes at same time my mitral valve was replaced.

Because I had a history of atrial fibrillation I was destined to be on coumadin therapy anyway so I was recommended to have mechanical valves as they last longer than tissue valves. In hindsight I think I would have gone with tissue. I was told the ticking would eventually be quieter (or I just wouldn't notice it as much) I am not sure I have found this to be true. You never have quiet in your life again. I used to wear earplugs when I would travel and stay in hotels but now it drives me crazy as I just hear the internal ticking etc. I suppose having two of them is worse than one in terms of noise. Because of all the scar tissue from multiple surgeries and slight hypertrophy of my left ventricle I live with constant PVC's. I believe the mechanical valves make me more aware of every skipped beat.

One thing I can say is that the heart is an incredibly durable machine!

Hope this helps.

[NurseKagome]

Hi there, I was reading a post you wrote today on another topic (it has reached posting limit)and you said that you find exercise helps decrease your resting hr as well as decreases the length of your svt attacks? I am wondering how did you start the exercising? was it hard at first? did you get pvcs or skipped beats during it when you started or even now? I used to love exercising and now I feel afraid to...I went to the gym last week and I did about 40 mins of cardio at a hr of 160bpm and none of the hr gagets could take my pulse rate so I took it myself and noticed that every 5-10 beats I had a pause, one I felt on my pulse but not as a skipping sensatoin in my chest?? weird huh? considering I usually always feel them. And well, when I exercise I get skipped beat sensations and afterwards sometimes really bad for a half hour or so. I dunno, I wanna just run up and down the street now outta frustration!! I woke up the last two nights with nightmares of my heart beating funny and on waking it was! I had a dream once before also that my heart started goign into svt in...woke up in it. Isn't that the weirdest?? Also, my heart at times just is all over the pplace...like not beating in a regular rhythm and speed changes from fast to slow and fast again and etc with SKIPPED ONES TOO! it is the worst...I had one of those again this morning. Well PLEASE COMMENT I'd love to hear anything or from anyone who can relate or has some info they would like to share with me! Hope to hear from you all soon and HAPPY HOLIDAYS!!!


NurseKagome

[Cleveland Clinic]

PRRK4s,

Thanks for the post.  The choice of repairing or replacing the mitral valve is relies on several factors such as which portion of the valve is effected and what is the underlying cause of leaking (endocarditis, prolapse, etc...). Almost if not more important is the technical expertise of the surgeon. In general, a surgeon should be able to tell you the chances of him/her replacing or repairing the valve based on your echocardiographic images. If not, then he/she should be able to tell you his/her overall percentage of repair versus replacement in all comers. If you are having difficuly getting these numbers, a second opinion might help alleviate your worries.

good luck