aortic heart valve replacement

[Sheley-Read]

Posted By  CCF CARDIO MD sc on March 09, 1998 at 09:40:12:

In Reply to: aortic heart valve replacement posted by Shelley Read on February 28, 1998 at 18:52:31:

: I am a 29 year old female, who is going to require heart valve replacement surgery within
  the next six to twelve months due to having rheumatic fever as a child.  I've been told that
  because of my age I will be getting the mechanical valve, but there is a possiblity that they
  might only have to do a repair. My questions are can you have more than one valve replacement?
  What are the side effects of having to take coumadin for the rest of my life?  What is the quality
  of life tha I will enjoy, will I be  able to normal things again like skiing, running etc.?
  What will I have to watch for, infections, palpatations etc.?
  If you could answer these questions for me, I'm sure it will help ease the fear of what I'm facing.
  Sincerely,
  Shelley

[CCF Cardio MD sc]

_
Dear Ms Read
Your questions are very appropriate and I will do my best to alleviate your concerns. There are a number of options for repair/replacement of the aortic valve. The choice  depends on a number of factors which include the patient’s age, prior surgery, associated disease in other heart valves, and compliance of the patient to take medication post surgery. The options include a mechanical valve of which there are many, a bioprosthetic valve, cadaveric valves. There is also a procedure called the Ross procedure which is technically more difficult than a simple replacement and it entails transposing your own pulmonary valve into the aortic position and replacing the pulmonary valve with a bioprosthetic valve as these kinds of valves in this position are less likely to degenerate. I agree that every attempt should be made to repair your valve. With regards to one of your questions,  prosthetic valves may be replaced a number of times. This obviously entails tougher surgical technique with every subsequent replacement and should be reserved for surgeons who are well versed in this procedure.
With regards to the anticoagulation issue, there are many patients who have been on coumadin/warfarin for many years and who are able to live a relatively normal life. The effects of coumadin is to decrease the clotting tendency of blood. If taken correctly this will significantly decrease the incidence of any clotting on a prosthetic valve. The drawback with coumadin/warfarin is that no two people metabolize in the same way and as a result the right dose has to be find for each individual patient. This is done by means of a blood test which measures the clotting tendency of the blood and adjusting the dose of coumadin to the range that is safe. This might entail blood draws every few days while you are starting on the drug but these blood draws may become as infrequent as every 4-6 weeks once a stable dose has been found. Obviously as the effect of coumadin is to thin the blood the complications seen with its use are ones of bleeding. These bleeds may be spontaneous if the dose given is to much, hence the frequent blood tests while the right dose is found or else they may complicate trauma or injury. It is for this reason that most contact sports are obviously not recommended. Your activities should involve ones that do not put you at a risk for trauma as there may be increased bleeding as a result of the coumadin if it occurs.
I would also like to stress, that coumadin has is also associated with congenital abnormalities in the fetus if taken during pregnancy. Since you are still young and of child bearing age you must make sure that any pregnancy is well planned so that you may be taken off your coumadin before this happens and switched to a drug called heparin which has to be given by the subcutaneous route just like insulin for the duration of the pregnancy.
After the procedure your cardiologist and surgeon will also explain that you will need to take one or two doses of antibiotics before some surgical procedure to prevent the valve from becoming infected.
I hope you find this information useful, and I am sure that with a few minor adjustments you will find that you are able to lead a normal life. I would like to stress the importance of having your surgery done in a center where they do a large volume, and where the surgeons have a good track record in repair and the  alternative procedures I have alluded to. Since these centers are relatively busy you should start looking early so that  a tentative date for your surgery may be given.
If you have any further questions or would like to see one of our cardiologists with a expertise on valvular disease here at The Cleveland Clinic please feel free to call 1-800-CCF-CARE to set this up.
Information in this forum is intended for general purposes only. Specific diagnosis and treatment should be reserved for physicians directly involved in patient care.