When to know rather or not a mitral valve needs replcaing

[pms_barbie]

Hello and thanks for taking my question.  I asked my local cardiologist when they would know my mitrl vavle needed  replacing.  The four things he said were heart enlargement naturally.  If I went into atrial fib.  Swelling of the ankles and feet and congestion in the lungs.  My question is isnt it already past the point of replacement if the hearts enlarged and your into atrial fib?  I mean shouldnt  sever reg be enough to warrnt a replacement or repair?    There seems to be some controversy over why I have mvp one drs says plain old mitral vavle prolapse another says rhuematic fever at some point in time.  I know no one wants to hear about pvcs but I already suffer from them and I sure dont want another rhythm problem on top of them.  I am curios as to the criteria for a repair versus a replacement.  My local cardio said if I could find a good surgeon its possible they could repair mine.  I have mvp and thickening of bothe the leaflets.  Any help would be greatly appreciated.

[Cleveland Clinic]

barbie,

Your cardiologist is pretty much right on target.  To determine the best time to repair a valve, we compare life expectancy after valve repair in different scenarios.  From multiple studies, we know that people can tolerate even large degrees of regurgitation as long as those conditions your cardiologist mentioned are not present for very long.  In some people, repair or replacement is never needed.  This is why you have followup echocardiograms. There are some cases where severe regurgitation is present that we just go ahead and fix the valve.  

The criteria for repair and replacement really depend on the mechanism of the regurgitation and the experience of the surgeon performing the operation.  For that reason, its best to try to seek out a very experienced surgeon when it comes to that point.

It is impossible to say specifics of when your repair should be without reviewing the data.  It would probably ease your concerns if you were to obtain a second opinion of your valvular disease and he timing of surgery.

[Momto3]

Here is a link for the ACC's guidelines for patients with valvular disease. It may help clarify your doctor's position.

http://www.acc.org/clinical/guidelines/valvular/dirIndex.htm


connie

[pms_barbie]

Thanks very much for the link its greatly appreciated.

[DottyCece]

Hi,

If your valve can be repaired and it is the professional opinion of your cardiologist that it is time, then do it.  Having a valve replacement instead of repair carries with it life long coumadin which is no fun.  PVCs are common in this scenario..I sure had them most of my life and believe me it is nothing to contend with in comparison to rapid uncontrolled atrial fib and heart failure stuff.  Until you have all of that, it is difficult to comprehend the gravity of it and the life altering experiences of having to contend with all of that.  Atrial fib is very common with mitral valve regurg etc.  

By the way, if you are moving forward with the repair, make sure you go to someone who has an expertise in repair and has done many of them such as Cleveland Clinics.  This is extremely important...believe me, I been there!!!

[hankstar]

Hi,

   I have been diagnosed with a redundancy of the mitral leaflets from 1983, last echo 2001 showed the same redundancy of the mitral leaflets without frank mitral valve prolapse and no leakage at all, yet I just read that a redundancy of the mitral leaflets put ones at high risk for sudden death, needless to say this has left me scratching my head and somewhat worried. I know I can't ask a question for the next 6 months and I would have to place an overseas call to my cardiologist to get this one question answered, I am wondering if anyone could chime in on this , maybe even the CCF doctors.

Thanks to anyone that can help!

Regards,
  Hank.

[uptowngirl]

Hi. I also have redundancy of the mitral valve (anterior leaflet only I believe).  Diagnosed in 1996, also have moderate prolapse and mild leakage, which has changed very  little, I am glad to say.  When I asked the cardio about the risk of sudden death he said I only had a 1-2% higher risk than the general population, unless I was involved in competitive sports then the risk would go up to 5%.  That was his take on it, with my situation. Your situation may be different of course.  I also take two meds.  Do you take any meds?
Are you involved in competitive sports?
Hope that helps.
Uptown

[hankstar]

Hi, Thanks for responding, I take atenolol 100mg daily in divided doses, 25mg 4 times daily and cozaar 50mg daily , also apirin 325mg daily and diazepam 5mg twice daily. I have a connective tissue disease(ankylosing spondylitis) for which I take the diazepam and aspirin , the other two atenolol and cozaar are for palpitation and B/P control.

I want to know why this redundancy of the mitral valve is s marker for increased risks, espeecially when I have been told that I don't meet the criteria for a diagnosis of mitral valve prolapse and erson with mild MVP are usually given no restriction , I am told that my risk are about the same as general population, yet while reading these latest findings are I am a bit anxious!

  I have never participated in competitive sports due to abnormal response in heartrate( not really that abnormal, but I was very symptomatic even with a normal increase in heartrate and only sinus tachycardia) to exercise, but I do moderate exercise, all test indicate that I have a structural normal heart, exercise stress(BRUCE)  also have shown that I have excellent exercise tlerance , can you believe that!! Walking upstairs , lifting anything heavy , bending suddenly has aggravated most of my symptoms. I know this can be associated with an SVT called AVNRT, sometime I wonder if i have it, almost could bet I do.

  I worked side by side with some good doctors and nurses( I worked in the medical profession myself , I'll just leave it at that without elaborating), I have looked at my echo and ECG tracings myself and should know better as they all appear fine, but I'll let you in on a little secret , or maybe a BIG one, persons who work in the medical profession especially doctors and nurses make the worse patients, they can help others, but are not much at helping themselves, no disrespect intended to them, but I know this for sure! As they say sometimes IGNORANCE IS BLISS.

Take care and thanks for responding, just curious do you have a prolonged QTc with your mild mitral valve proplapse, that is the only thing i could think of that would put you at such a risk or some degree of hypertrophy.

Best wishes,
     Hank.

[dafan]

Hi Mom to three..im so sad to hear of your problems... I guess it makes mine not bad at all... However.. and i hate to post on pvc's I just went to the emergency room yesterday morning with a terrible bout of them. I started having them in February only in the evening. They had almost vanished... maybe 10 to 20 a day... Until my wife had gall bladder surgery. i was really stressed out that morning and i had a flurry of them for an hour. that was a week ago. And now they are with me constantly, to the tune of about 2 to 6 a minute. I am feeling what i think are couplets,very often. But they didnt show on the ekg that they took. My pcp put me on atenolol but yesterday but it hasnt done a thing to suppress them. I had an echo, holter in March and my cardio said my heart was normal. Did your ebb and wane like that? Im kind of concerned now and im going to go get a second opinion. thank you so much.

[Barbarella]

I understand your concern.  I've been having PVC's off and on for the last 40 yrs. Ten yrs ago I had PVC's so bad it was like every other beat for a very long time, especially after a meal. I was afraid to eat.  Meds only helped a little.  After being checked out by a doctor and a Cardiologist (numerous tests), plus numerous tests while in the ER my Cardiologist told me not to worry and to "ignore" them.  Yeah, easier said than done. The Cardiologist told me that stress, fatigue, and not enough sleep will bring out the PVC's also to much caffeine, alcohol and cigarettes. I found out that when I'm stressed and I don't have enough sleep they will come out at its worst.  What helps me the best, more than tranquelizers or beta blockers which I cannot take due to my pulse dropping to 34 bpm, the best for me is to take one or two Tylenol PM at night, you can buy "Simply Sleep" which is the same without the Tylenol.  I sleep the whole night after a stessful event, and I am free of PVC's the next day.  The Tylenol PM are not habit forming btw.

[Barbarella]

Hi Barbie,

Did you ever have a "TEE" (Transesophageal Echocardigram)test done?  The reason I'm asking is because I had an echocardiogram done last January and it showed "severe mitral insufficiency". Of course I freaked out and couldn't wait till the day of the TEE test.  This TEE test showed the total opposite which is "MILD Mitral Regurgitation".  The Cardiologist said I don't even need a follow up, that lots of people have this.  Of course I asked him why the echo showed "severe" and the TEE test showed "mild" and he said sometimes if a person has severe anxiety during the test (which I had) the way this person is breathing  can screw up the echo result and he listed other reasons which I don't remember.  He said that is why he ordered the TEE test because an echo was NOT the final test if it shows severe mitral insufficiency.

[dafan]

Hi there Barb.. thank you for the response.. no i had a regular echo, but it had good imaging according to the report??

[dafan]

Thanks for the advice on the Tylenol pm. The funny thing with mine is when i excercise they go away. Just like now, I had them all morning and i went to the gym at lunch.. ran a mile and lifted weights and im still pvc free! I wonder... my pulse rate is naturally low mid 40's to 50's at rest. Could it be that they tend to occur more at rest with that? Also im not sure if the really calming effect of the xanax might bring them on?? just a guess. Even tho at one time i thought the xanax helped.

[Erik36]

Redundant mitral leaflets are consistant with Mitral Valve prolapse itself, yet you have no leakage. I have never heard of This redundancy causing an increased risk of sudden death. That must mean that it could cause sustained Ventricular Tachycardia. I have never heard of a connection between the two. The only thing I have heard is that MVP can cause Atrial Arrhythmias. The Beta Blocker you take would reduce whatever risk you do have of Arrhythmias. I'm sure what you read is something that is controversial. I doubt there is any strong connection between Redundant Mitral Leaflets and sudden death. They say that Paxil can cause prolonged QT Interval. But most Cardiologists would deny this. Paxil has never caused me this phenomenon, yet I suffer from PVC's PAC's and A-Fib. It's been several months since I've asked a question. If you don't get any feedback from the forum doctor I will ask this question because I want an answer to this question too since I have a close relative who has the same redundancy.

Erik

[hankstar]

  Thanks,I really wish you could post the question. I read it on several different abstracts lately. I left(medically retired because of AS) the health services over a year and a half ago and seldom have any contact with persons that work there now, also my regular cardiologist is overseas, though not far away.

  Believe it or not after working at a hospital for over 18 years, I even hate going there even to get my medication now. I still tend to think this is referring to mitral malve prolapse with leakage and not to just a redundancy of the mitral leaflets without frank mitral valve prolapse. I really don't  see the mechanism for such an malignant arrhythmia to be triggered, unless the thickened leaflets tend to irriate the ventricles and thus trigger the arrhythmia, who knows maybe I got my wires crossed on this one.

Thanks.

[Momto3]

Dafan,

Not sure your post shound have been directed at me.  I have MVP and 2-3+ regurgitation of the mitral valve, but am not a candidate for surgery.  I've had the mvp/mr for over 20 years, including through 3 pregnancies - no problem so far.  I have some thickening of the leaflets, but all in all, I am doing OK. Doctors watch closely for any changes.

I HAD pvcs for over 20 years. Holters indicated 24% of my beats were ectopic (ventricular, no atrial), thousands of couplets, too many bigeminal cycles to bother counting, and some nsvt. They didn't really scare me, probably because I had had them for so long, it was kinda "normal for me. Getting used to a regular rhythm was actually weird.  But for the cardiomyopathy, I'd still be "living with them." I was fortunate in that I'd had them for all of my adult life, so I was not afraid of them.  Now, the leaky valve- that's a different story.  I'm hoping that if and when the time comes for surgery, a repair is possible.  

If I remember correctly, Tenormin is the generic RX for atenolol. If that's right, it didn't work for me. Took one dose and was taken off because of a systemic reaction.  However, many others on this board have had great relief with atenolol.  My symptoms were better controlled with Inderal.  I took it on/off for years to combat the frequent pvcs, but in 1998 when I was convinced the pvcs were not going to hurt me, I weaned myself off of it (with doctor's approval) for good.  

When I later developed a cardiomyopathy, I had 2 alternatives: antiarrthymics or ablation(s). Tried the RX for several months, and finally opted to try ablation(s). Fortunately I have a team of great doctors and the procedures were very successful. My heartbeat is rhythmic and the CM has resolved.  

Yes, they definitely waxed and waned (for whatever reason).

Hope you are feeling better!

Barbarella,

I had a similar experience with a routine echo in 2000. Echo suggested "at least moderately severe" regurg. I was sent for a TEE for clarification.  Result was mild to mod regurg.  My dr. said that b/c of hemodynamic changes and individual interpretations, regular echos are subject to a range of interpretation. I just ran into the same thing last month.  The interpreting physician said "severe," but when my test result was compared to others from 2000 - 2003, nothing had changed. Therefore, the TEE performed in 2000 (considered the "gold standard" for assessing valvular disease) was used to clarify the objectivity in interpretation. Glad I had that done : )  

Glad to hear of your good report!!

Connie

[hankstar]

Hi,

   That is exactly how my PVCs occur they wax and wane ,sometimes with years in between episodes, then "bang" several a minute for weeks to months, but they tend to occur more frequently at a higher heart rate, maybe this is why beta blockers such as atenolol is effective in suppressing them in my case.

  I almost hate to say this , but your PVCs are probably what is known as vagally mediated PVCs, occuring at a slower heartrate due to your conditioning and high vagal tone, of course that is no reason to stop exercising as the last of exercise has an adverse on your overall cardiovascular health whereas, the PVCs in your case doesn't.

  Do you find yourself feeling fainty in crowded or heated room or even sometimes in a warm shower?

  Take care, my guess would be you have nothing to fear.

Best wishes.

[hankstar]

That should read the lack of exercise , not the last of exercise.

[dafan]

Thanks Hankster. Well ive only been taking the Atenolol for 1 day so i dont guess it has had time to produce any side effects. Youre probably right, im not sure that the drug will work for me. I know it sure had me dragging this morning. Thank you so much for your input here. The support and encouragement and sharing of experiences makes this place wonderful.

[dafan]

Hank, Just one more question. When they send you the report of your echo in the mail it isnt very specific. Mine just stated no effusion, Mitral and tricuspid valve normal, Ef of approximately 60% and ventricle size normal. I requested a followup appointment and was going to ask about the actual values but he stated very emphatically that there was nothing at all wrong with my heart. If you had some subtle things going on would the actual report state that even tho the card they send you says ...normal??

[NBCT]

Just some info. on Tylenol PM. It does work well and is non-habit forming....but the sleep aid in it is Benadryl which can cause a feeling of anxiousness and tachycardia in some individuals. My heart would race after taking just one and I have MVP with freguent PAC's and PVC's.

[hankstar]

Your echo would be termed essentially normal, having a normal sized ventricle and no trace or trivial regurgitation of the mitral or tricuspid valve, which even if you did have a trace, that in itself is considered a normal finding as 20-30% of the population would show this on echo, with a normal ejection fraction of 60%, which in some institutions normal ranges from 50-70% and 55-75% in others. On the whole there is nothing of clinical significance on your echo. It is completely normal.

Please note this is my understanding only of the information you provided , your doctor could advise with much more reassurance. I have medical background , but I am not certified MD., always trust your doctor, if not that is what second or even third opinions are for.

[hankstar]

NBCT is absolutely correct,(It contains diphenhydramine(Benadryl) the actual sleep aid in Tylenolol PM. PLease note persons with a prolonged QTc interval should avoid Benadryl(diphenhyramine) it can cause dangerous arrhythmias in persons with this condition and should be avoided. For other person it is generally safe, but can aggravate palpitations in person prone to them.

[Barbarella]

Thanks hankstar for telling me about the Tylenol PM.  I don't take it very often only if I had a really stressful event.

Mom to 3,

I know what you mean about "glad you got that test behind you".  But I was glad they had this test otherwise I'd believe that I had "severe mitral insufficiency".  Anything that has to do with heart and BP freaks me out.

[uptowngirl]

Hi.  Thanks for the info.  You have a wealth of information.  I guess I am glad I'm not in the health profession, but in the teaching field.  Although sometimes I research things to death!

I have only had 2 abnormal ECG's  in my life, but neither had to do with the prolonged QT interval that you mentioned, so the answer would be no.  Although I'm not quite sure what the prolonged QT situation is all about.

I also take atenelol, (and cardizem).  They have been friendly drugs for me, very few side effects.
All the best,
Uptown