ventricular hypertrophy and pleural effusions

  I have hypertrophy of the left ventricle associated with mitral valve regurgitation. 4 years ago I had my mitral valve replaced with a St. Jude's valve.
  After the surgery I had recurrent pleural effusions that eventually required hospitalizations and pleurodesis on the left side (something I hope to never have to esperience
   again!). Now I have to be very careful about the amount of sodium in my diet, and if I go out to dinner at
  a restaurant I often feel the effects the next day. I feel shortness of breath doing things that
  didn't affect me before the extra intake of sodium and I have jugular vein distension. During one
  of these episode I had a chest X-ray and there was a mild pleural effusion on the right side.
  I guess my question is, is the source of the effusions the hypertrophy of my
  left ventricle? I never get any swelling in the ankles or feet, or anywhere else. Is there anything I can do besides take
  diuretics all the time?
  This is very frustrating for me because I do a lot of work (I'm a biologist)
  in other countries where I have essentially no control over how much sodium I get in my diet. At the
  same time, these countries are hot and the work is somewhat physically demanding, so I don't want to
  take diuretics all the time and get dehydrated. When I get the effusions, it also means that I have a lot of difficulty hiking uphill,
  or even going up the stairs.
  I basically want to understand what causes the effusions.
  Thank you!

[CCF Cardio MD - MTR]

_
Dear Ned, thank you for your question.  This is a difficult question to address because the cause of pleural effusions post-open heart surgery is usually multifactorial.  I'll presume that you did not have bleeding into the lungs immediately after surgery, because that would have been an emergency.  Left ventricular hypertrophy can cause pleural effusions (which may be a manifestation of congestive heart failure) if the LV is so thick that it cannot relax well enough during diastole to allow a normal amount of blood in.  If this is present, the term is called diastolic dysfunction.  Other manifestations of heart failure including peripheral edema and jugular venous distension are usually present when diastolic dysfunction is present. Another possibility is that your lymphatic channels inside the chest cavity were damaged during the surgery and that lymph fluid is chronically accumulating in your right thoracic cavity.  If this is the case, then pleurodeisis  on the right side should help.  Since you have such a complicated condition, I suggest that you speak with your physician or perhaps, see a pulmonologist, for specific advice and recommendations.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
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