surgery

[Joanne]

I had a mitral valve repair (leaflet) when I was five years old (1974).  I have had regular EKGs and echos through the years and and have had increased regurgitation.  Over the last two months my symtoms have increased to the point where regular activity is troublesome.  I have had short of breath at rest which increases greatly with activity, increased palpatations, dizziness, coolness and tingling in my toes.  I have been relitively active to this point, including walking 4 days a week.  My recent echo shows 4+ reguritation, with an enlarged atrium, mild stenosis, and increased pulmonary hypertension.  My left ventricle is normal, but there is bicuspid and tricuspid insufficiency.  I am scheduled for a TEE next week, but I have been told by my cardiologist that surgery will be in my near future.  It has been suggested to me several times that a valve replacement may be necessary.  This is an option that I would rather not consider if possible.  I have researched many of the cardiac surgeons in my area, Buffalo, and have been unable to find a surgeon who specializes in valve repair or replacement.  Because of my age, 31, I would rather have a repair if possible.  I have read many articles about different types of valve repair done by the Cleveland Clinic that are not performed in my area.  I am curious to know the process of being referred to your hospital even if my cardiologist believes someone in my area can do the surgery.  I would also like your opionon on activity level I should be maintaining with the information I have provided.
Thank You

[Todd W]

You may consider going to Toronto (The Toronto Hospital) - Dr. Tirone David is world known for valve repair and replacement.  My HMO in Michigan paid for my surgery with him - (Aortic Valve and aneurysm repair - the David Procedure).  I can not say enough good things about him as a surgeon.

[dkader]

Dear Joanne,

I had MVP repair exactly one year ago yesterday at the Cleveland Clinic with Dr. Cosgrove as my surgeon.  I just wanted to give my highest recommendation that you come here and have your surgery if at all possible.  I do know that if there is anyway to repair your valve, these are the guys to do it.  From what I hear Dr. Cosgrove is not operating as much - I have heard good reports of a Dr. Sabik.  I'm sure they are all fine surgeons.  I just wanted to put my two cents in.  Best of luck to you - don't settle for less than the best - it's your heart.

[CCF CARDIO MD - DLB]

These are all important questions you have raised. The valve needs to be fixed - no question about that. If a repair can be done instead of a replacement, no question that would be better. So, the real question is whether the valve is suitable for repair. If the degree of stenosis is at all significant, repair is unlikely to be successful. The TEE will help sort that out. If you are considering a repair here at the Cleveland Clinic, it may be better to also get the TEE here, so that the test does not need to be repeated. You can make an appointment here (1-800-CCF-CARE) on your own, without your cardiologist's assistance. You would need to make an appointment with one of the adult cardiologists who specialize in valves (there are several of them, all excellent). They would evaluate you and, if appropriate, refer you to one of our surgeons.