mitral valve replacement - post-surgical arrhythmias

Posted By  CCF Cardio MD-SGM on January 25, 1998 at 22:52:58:

In Reply to: mitral valve replacement - post-surgical arrhythmias posted by Kathryn Mann on January 25, 1998 at 15:49:58:

: My cousin, who is in her late 40's, has had an emergency mitral valve replacement for mitral stenosis caused by rheumatic fever.  She is 9 days post-surgery and has persistent arrhythmias (prob. atrial fibrillation), including the most recent episode (yesterday) which required defibrillation.  She also is having problems with electrolytic imbalances.  She is expecting to be discharged to home today.  She complains of extreme fatigue and is convinced she will not survive.  Are her concerns - and ours - legitimate?  Is this an unusual effect of value replacement?  Thank you for any advice you can provide.

[CCF Cardio MD-SGM]

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Dear Ms. Mann,
You may be surprised to know that fully 50 percent of patients who undergo valve replacement surgery experience atrial fibrillation in the post-operative period.  This risk is likely higher in patients with mitral stenosis, especially with a pre-operative history of atrial fibrillation, due to scarring of sometimes very enlarged atria (upper heart chambers).  First, I would reassure your cousin that news of her impending discharge is highly encouraging, leading me to believe that despite the problem with arrhythmia, her doctors must consider her overall condition quite good.   The longer term treatment of post-operative atrial fibrillation includes medicines that slow the heart rate such as beta-blockers, calcium channel blockers, or digoxin.  Recurrent episodes of arrhythmia are treated with anticoagulation (blood thinning) as well as therapy with medicines known as antiarrhythmic drugs.  
Especially with a history of pre-operative atrial fibrillation, don't be surprised in this problem recurs.  Again... good therapies are readily available.  Best of luck with the recovery.
Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.