Valve Replacement?

[midd245]

I have a VSD since birth.  In 2001 I had an echo that showed right ventricle midly dialated and aortic valve calcified but opens well, trace regurg on all other valves.  In 2002 I had a TEE that showed the Tricuspid valve at mild regur +1.  What kind of progression am I looking at.  Will the ventricle and Tricuspid valve continue to worsen?  Is there anything I need to be doing?  Right now the cardio doctor has me coming back in 6 months but he has a pretty weird attitude "What the worst thing that can happen we'll just replace the valve".  Is there any further testing that I need to be looking at?  I am overweight and am trying to get my weight down.  I am on Niaspam for high chlosteral and my liver enzymes are slightly elevated.  I am also taking celebrex for joint pain.  I have "spells" were I get real dizzy and then fatigued for the rest of the day, sometimes when I am just setting at a desk or watching TV.  My blood pressure runs pretty normal.  It seems that I get short of breath pretty easy also. I might mention that I am 37.  Any words of wisdom would be appreciated.  Thanks for your help.

[CCF-M.D.-KE]

VSD

You are currently experiencing shortness of breath associated with your VSD and worsening valve function.
Approximately 75-80% of VSDs close spontaneously by late childhood. Of those that persist their restrictive nature protects the patient from pulmonary vascular injury. Life expectancy is thought to be essentially normal for patients with small defects that persist into adulthood.

Given that your right ventricle is mildly dilated you may be experiencing an increase in your right heart pressure(pulmonary hypertension), which will likely worsen. In patients  who have not developed irreversible pulmonary hypertension (Eisenmenger's syndrome) surgical closure should be addressed. I am not sure whether or not your pulmonary hypertension is reversible, but from what you describe it seems as if it maybe mild. Therefore you may be a candidate for VSD closure. But, once the pulmonary hypertension becomes irreversible the prognosis is grim and VSD closure is not an option.

I would recommend discussing  closure of  your VSD with your cardiologist. Maybe even consider a second opinion from a different cardiologist. You should seek an opion soon given that your disease may be worsening.


Thanks for your question,


CCF-MD-KE

[debra21784]

I had a valve repair at age 44 for severe regurgitation and resulting heart failure.I t was not an easy decision but one I made with the help of a good cardiac suregon at a world renowned academic medical center.I do not regret the decision as it changed my quality of life from poor to good.See a good cardiac surgeon you can trust.They don't recommend this surgery lightly If it is necessary they will tell you.Don't wait till it's too late.It is a quality of life issue.Good luck

[midd245]

What kind of valve replacement and where did you have it done?  What kind of trouble were you having prior to the replacement?

[Avel]

I would like to encourage you to go directly to an excellent cardiac surgeon as soon as possible. My husband had/has congenital heart issues. He was slightly blue at birth, but did fine as an infant and child, which makes me suspect that any opening closed on its own, as KE mentioned happens in a majority of cases. However, he also was born with an abnormal aortic valve and defective aortic tissue which have resulted in two surgeries in his adult life. Cardiac surgery continues to progress - his surgeries were 11 years apart - and what can be done today is very impressive. What you do not want to happen is to wait until you have some irreversible condition. In general, seeking out a major heart center is very important, and you need to find a surgeon knowledgable with congenital heart conditions in adults. I also want to point you to a book written by cardiac surgeons for their patients - "State of the Heart" by Larry Stephenson, MD. It is available online at www.sts.org/doc/6394 There are chapters on heart conditions from childhood, valves, etc. that will be of interest to you. You will also find information written by currently practicing heart surgeons from the major heart centers. Best wishes in finding the help you need. Please feel free to contact me at ***@****

[gregcharestonhealthclub]

I am seeking information on Aortic valve issues. I found out through my routine physical that I have severe aortic regurgitation and the valve can not be repaired. My mother and her brother both died at 48 and 52 of heart failure. I suppect that they may have had the same problem. At 42, I feel great and still think this is a nightmare. Tests in April show that I only have slight enlargement of my left ventricle. I am scheduled for more tests in September and need to know what I am getting into. I am very fit running 3 miles per day. I have no symptons which have surprised my doctors at Barnes in St. Louis. I met someone in Florida last week whose dad died when his aortic valve burst at 52. Worrying about this drives me crazy.

[NBCT]

You may find some information at ValveReplacement.com, Good Luck.

[debra21784]

My valve surgery was done at Johns Hopkins in Balto with Dr.Duke Cameron, it was a mitral valve.He saved my life.Don't regret it for a moment.Better to have it done as elective rather than emergent.I waited a little too long as it resulted in heart failure.Good luck.Find someone you can trust,who will answer your questions and has a high success rate with valve replecements.

[Avel]

Hi Greg,
I would like to encourage you to look at Chapter 10 in "State of the Heart" that I mentioned to Midd245. Pages 158 - 160 discuss the aortic valve. This book also has sections that explain the different tests that are done, and in the back of the book is a glossary of terms that is very helpful. The CCF heart center web page at www.clevelandclinic.org/heartcenter also has very helpful information on valve disease.
Especially given your family history on your mother's side, it is very important that the underlying cause of your aortic valve regurgitation be understood. You want to know whether or not you were born with this valve condition, which has not been detected until now. (Even if there is no family history, one can be born with valve problems.) The bicuspid valve is a malformation of the valve with which one may be born. Both the book and the website I mentioned explain this. If your valve is bicuspid, you want to discuss your aorta, particularly the ascending part, with your doctors also. The aortic tissue should also be suspected of abnormalities in cases of bicuspid valves. My husband had two surgeries, because the relationship between his aortic valve and the defective aortic tissue was not recognized at that time.  Now the aorta can proactively be replaced, even if it is not yet dilated, at the same time as the bicuspid valve, protecting the patient from life threatening problems with the aorta later.
It is also possible that your aortic valve was damaged sometime after you were born, perhaps by an infection. And when surgery is recommended, the decision also needs to be made, with your surgeon, regarding what type of valve will be used as the replacement. Be sure the surgeon goes over the pros and cons with you. It is important to have as much information as possible, and ask lots of questions as you work with your doctors. Best wishes to you.

[MacyMaid]

Whta does VSD stand for?  

I recently had a Dobutermine stress echo and read the results on the paper.  It stated 'reason for stopping test "LVOT Obstruction"

Questioning a doc at the Texas Heart Institute, he said no ischemia was seem and the LVOT Obstruction means it is a normal wording for this test.  

I want to believe him but something tells me that something is wrong as I am short of breath have some chest discomfort and it seems to be getting worse.

Being a female, I do not want to make a fool out of myself.  Maybe you good people can help explain about a LVOT obstruction and if this wording is normal for Dobutermine Stress Echos and does not mean anything serious.

I am also looking for a good female cardiologist and if anyone knows of one in the Houston area, I would be grateful.

Thanks/

[midd245]

VSD stands for Ventricular Septal Defect.  A hole in the septum between the left and right ventricle.

[D Love]

I was told that I had a leak in all 4 of my valves and that the right side of my heart is not function well. My cardilogist to me that I need a heart cath done. I am only 30 years old. My blood pressure is normal 120/80, I have 2 spells of shortness of breath. I feel fine. I wanted to know if any one else had this problem.