Congenital aortic v. disease and replacement

[Kyvet]

Concern is regarding 58yr. 125lbs. father with congenital aortic valve dz., otherwise healthy. Meds.-Lanoxin, Coumadin, lipitor. 1st valve replacement in '91 leaked immediately after SX due to Ca build-up, also 50% blocked c.a. was not repaired. 2nd replacement 5-03(Medtronic-HAll). At this time also had the c.a. repaired(was still 50% blocked)w/Saphenous v. and aortic aneur. repaired. Why repair c.a. at that time, will not using chest wall v. cause faster graft failure? Surgeon seemed surprised to find old valve 50% torn at circumference even with all diagnostics that had been performed and did not seem to think Ca build-up would be a problem. Now current valve leaks and stress test is scheduled fo r6 mos. Is it likely that Ca will cause new valve to fail? Is there not a better method for deteriming how bad valve is torn loose other than intra-op? I cnnot find much about this in research othe than possible percut. method in future. How can he help prevent further leaking, maybe keep HR below cetain level. How does surgical site breakdown mos. to yrs. post-op? ANy info or reference articles would be greatly appreciated, just do not know what life expectancy to expect for my father. His cardiologist seems confident that this valve will last 15 yrs. like he was told prior to SX? What do you think, will his C.A. graft last this long. Is there ususally recurring problems with aneurysm repairs. Thanks for this wonderful website and your time and expertise.

[CCF-M.D.-MJM]

Hi Kyvet,



Sorry for my delay, I was out of town for the weekend.  You ask some very difficult questions.  I am not sure that there are answers to all these questions.





Why repair c.a. at that time, will not using chest wall v. cause faster graft failure?



The vein is probably a vien from the graft, not the chest wall.  About 50-60% of vein grafts are open at 10 years.



Is it likely that Ca will cause new valve to fail?



It is difficult to tell what caused the last valve to take on calcium and predict whether this one will also.  



Is there not a better method for deteriming how bad valve is torn loose other than intra-op?



The other method is transthoracic and transesophogeal echo.  Most valvular pathology can be determined from these studies.



How can he help prevent further leaking, maybe keep HR below cetain level.



Valve degeneration is combination of factors like the stress imparted on the valve (heart rate, blood pressure), surgical technique, and the valve used.





How does surgical site breakdown mos. to yrs. post-op?



The surgical site usually does not breakdown.  The valve itself can break down over time secndary to the factors mentioned above.





Is there ususally recurring problems with aneurysm repairs.



Not usually, but they do need to be followed over time.



I hope this helps.  There are not good answers to many of these questions though.