mitral valve repair

[TSM]

I have read from past posts regarding the timing of mitral valve repair surgery that 'sooner is better' and its best to have it done before symptoms develop. I have severe MR, MVP, my left ventricle and left atrium are mildly enlarged due to a very large myxoma(4x7cm) removed from my left atrium last year. My docs assume that's what caused the problems though they have never come across a case exactly like this before. I am asymptomatic. My cardio and surgeon say that a MV repair is "inevitable." I feel they are urging me to have it done pretty soon though there is no "big rush." It is really hard for me to consider having another open-heart surgery especially when I feel so'normal'.My questions to you are: 1.Does severe MR always gets worse- it never gets better, right? 2.Is severe MR by itself is reason enough to have surgery? 3.Are eccentric jets are almost always underestimated in severity? 4. How long do you think it would take for me to progess to the point of irreversable damage? It's only been 8 months since the last surgery and I've already got these problems. 5. Is a MV repair going to last the rest of my life(I'm 37)? What's the percentage of a redo or problems down the road? Thank you for answering my questions.
Terry

[Cleveland Clinic, MD]

Dear Terry,
The timing of MV repair is more art than science but you are right that the leaning is towards sooner rather than later.  The question then becomes how soon is soon?  This will depend on the 'big picture' and the comfort of the patient and the surgeon.  I've tried to answer you specific questions as best I can.
Q: Does severe MR always gets worse- it never gets better, right?
A: It's true that in general MR does not get better but may get worse.

Q: Is severe MR by itself is reason enough to have surgery?
A: Yes.

Q:Are eccentric jets are almost always underestimated in severity?
A: No not always.  A TEE (transesophageal echo) is often useful in helping to determine severity of eccentric jets.

Q: How long do you think it would take for me to progess to the point of irreversable damage?
A: ??? It would depend on the severity of the regurgitation, how 'healthy' your heart is and the cause of the regurgitation.

Q: Is a MV repair going to last the rest of my life(I'm 37)? What's the percentage of a redo or problems down the road?
A: Good questions without good answers.  The hope is that it would last the rest of your life but there is a possibility that it won't and you may need a new valve.  The percentage of redo or problems would vary from surgeon to surgeon.  Dr. Cosgrove here at the Cleveland Clinic has one of the lowest complication and redo rates in the country and I would have my mitral valve repaired here if I had to have it done.

[Shannon to Peter]

For what it's worth: I've had mitral repair a little over a year ago, along with repair of an undiagnosed ASD.  My docs felt sooner was better because I had shown some fairly rapid degeneration over a six month period, and they believed that even though my only symptom was periodic tachycardia, I should have the surgery before my heart chambers were irretrievably enlarged.  

I had a cardiac cath the day before and a few hours after the cath, my cardiologist (not the surgeon) came and said, "well maybe we should wait; it doesn't look as bad as on echo."  I just couldn't deal with putting it off (and there I was already in the hospital) so I made the decision to go ahead with the surgery.

As it turned out, I made the right decision (probably just through luck...) because they got into my heart and found an ASD which required repair as well.  

Now, 15 months later, my heart is functioning perfectly, everthing is back to normal sizes and I have only "trace" regurg. So even though it was a hard decision (who wants to have their chest cut open, especially if like you, they've had it done already), I'm glad it's over with.

On the topic of "how long will a repair last?" my surgeon said that it is a case-by-case thing but that I personally had less than a 10% chance of ever needing another surgery.  I think that's pretty good odds.

Anyway, just wanted to tell you my story and I hope it helps you in the difficult process of making a decision.

best regards,

shannon

[bill]

I have been diagnosed with MVP with regurgitation and as a result of a recent echocardiogram have been told the regurgitation has increased and they are recommending surgical valve repair. I read your questions with great interest, but hate to admit that I don't know what "MR" is. What is "MR"?

[Shannon to Peter]

MR is mitral regurgitation.  Not everyone with MVP has MR so it's an important thing.  In fact, when my funky valve was first noticed, I had "trace" regurg, which ultimately turned into severe.  

hope that helps.

shannon

[Stan H.]

I guess I'll put in my two cents worth.  I had a mitral valve repair done by Dr. Cohn at Brigham & Women's in Boston 5/17/99.  My MR had been followed since late 1996 and held steady until 3/99.  When first diagnosed, I had 3+ regurg...it went to 4+ in March.  When I first saw my cardiologist, he recommended early surgical intervention because I was totally free of any symptoms or complications.  A local surgical team evaluated me and refused to do the surgery because they felt it was simply too early on their "surgical curve"... they discouraged me from having the surgery done.  About a year later I developed PVC's which got progressively worse...no problem according to the doctors, but it was something I never had before.  Between 12/98 and 3/99, although I was still asymptomatic, my left atrium and left ventricle nearly doubled in size.  It was at this point that surgery became a must.  Because of the enlarged atrium and history of PVC's, I was pre-disposed to a-fib, and suffered severe a-fib starting 3 days after surgery and continuing for over 3 weeks.  Because of the a-fib, I had to be put on a massive regimen of meds which made my recovery much more difficult than it should have been.  I believe that if I had taken my cardiologist's advice and had the surgery done early, I would have avoided the onset of PVC's and the horrible discomfort of post surgical a-fib and its meds.  Over a year later, I am fully recovered, the a-fib is just a bad memory, the PVC's are still with me but very mild now, and my chambers have returned to normal size.  The repair, which went very well, should last my whole life, but since repairs have only been done for the last 15 years or so, that's just an educated guess.  In any case, I for one, am now an advocate for early surgical intervention in cases of moderate to severe mitral regurgitation.

[Dan R]

Thanks for the all of the input.  This is a new experience for me, and I am just trying to "get a handle" on the "disese (disease)" and  its potential solutions.

I was diagnosed three years ago (36 years old) with MVP with MR (mild to moderate).  As of my last echo (6/00), it had progressed to moderate-severe, and my LV had enlarged so as to consider repair.  I am an otherwise healthy (run, work-out, 155#, 5-11, resting pulse low-mid 50's, non-smoker, vegatarian) male.

My questions are as follows:  (1) can the repair be done with "minimally invasive" techniques, or is it always open heart?  (2) what are the reletive in-hosipital recovery times for the options, (3) considering I will be travelling to get the repair done, what additional time is required to allow for travel, and (4) what sort of backlog are you looking at to get the procedure done.

Thanks for the help, in advance.  I have a TEE scheduled for this week , and am attempting to become educated, as it looks like a repair will be in my future.

[TSM]

Hi Dan,
This is the Terry that posted the original question. It sounds like we have alot of the same problems. If you are wanting one of the docs to answer you, they won't here. They won't answer a ? under someone else's post. A good time to try is about 900 AM. I believe minimally invasive surgery for a repair is open heart surgery. Your heart is stoppped vand you are on bypass. I really don't know why they call it "minimally invasive" because you still have a 4-6 in. scar in the middle of your chest vs a few inches longer. They still have to open your sternum. I've been told to ask about a right thoracotamy(sp) which is going thru the right side of the chest to repair the heart. I doubt they will do that though. When I had my first surgery to remove the tumor, I came home on day 4. I don't know what you mean about backlog(I'm in the USA, maybe Canada would have a backlog). I would expect to have it within a few weeks. How long would you be traveling? By car or plane? I think that ? depends on these things. Write back to let me know how things are going.
Terry

[Ela]

Terry, I believe Doctor Cosgrove is one of the best (if not the best) in the country.  It would be worth it to see him.  He repaired my aortic valve, after a local surgeon did some damage to it during mitral valve repair.  I would return to Cleveland if I had any further trouble.

[chris]

In response to timing of mitral repair.

I was 45 and in excelletn health when diagnosed with 4+ MR in 11/99 after a murmur was discovered in a physical. I had no symptoms that I was aware of. TEE 1/00 confirmed MVP. By 2/00 I had 2 brief episodes of Afib while jogging and soon had shortness of breath with much exertion. My cardiologist left the decision re:surgery to me. Had Heart cath in 4/00 which showed a very large Left atrium. This raises a huge risk of persistent afib. I had surgery 5/22 which included intraoperative ablation in the LA. (An 8 min procedure). I was able to get a repair and have had no persistent rhythm problems. Highly rec cardiac rehab. after any surgery. Heart chambers can change more rapidly than we think and you run the risk of afib with a large LA and left ventricle dysfunction if it gets too large even with a repair.

[Hank Eyring]

Terry,

We have a great support group going for valve replacement surgery patients.  We have a lot to offer in the way of person to person help for your trying situation.

Go to our website (www.valvereplacement.com) and make an entry in the guestbook and I will help you become a member.

You can learn from us and we can learn from you.

Thanks and hope to see you soon.

Hank Eyring
***@****

[Larry Dunn]

My mother in law has reciently had her second mv replacement.  The first went well 10 years ago.  The second not so well.  The heart could not be regulated and so a regulator was implanted.  Now six months later she is not improving. She has had chronic nausia and is still low on gaining weight.  The docs have tried every thing small town doctors know with no let up.  Has any one heard of this problem?  Any solutions.

[harsha]

My mother has MVP repare by narayana hrudayalaya in bangalore.
They told us that if they place mechanical valve blood thinner must be taken,
They said those tablets have more complications as it will lead to many other problems.

Doctor P.V Rao Said that atleast if we repaire my mother might live for another 10 years.
Doctor could not answer to my question what after 10 years?.

Please suggest me weather to go for mitral valve replacement or repire.
And can any one tell what are the chances of redo.

Thanks in advance.
Harsha