Aortic Valve Replacement

[Lee1]

In December 1995 I had an emergency valve replacement surgery, due to a bicuspid valve and subsequent advanced calcification, not only of the aortic, but mitral valves and septum.  I was told the opening of the aortic valve measured .3 cm, and that I was very lucky to be alive.  I now have a St. Jude's valve, and am being monitored for my coumadin level every two weeks.  I was also told that the valve would probably last a lifetime.  If this is true, why does my cardiologist want to see me every six months?  I understand why my tendency to bleed causes a concern, and why I must take penicillin prior to dental work or surgery, but I still wonder what could possible go wrong with the valve itself, if it is infallible?

[Response to Lee]

I know how you feel, Lee.  I have valve surgery in my future for
mod. to severe aortic insufficiency.  The surgeon I talked with said that probably a mechanical valve would be my best choice when the time came, because of my age (49).  

It seems any medical procedure that would have been not that
complicated at one time, now revolves around my bad heart valve, and that scares me.

And not all of my doctors agree on what procedures I should or should not be on antibiotocs for, and my gynecologist makes me feel that if I'm on
antiobiotics too often, they could be ineffective should the
case arise that I really need them.  

Then, after the valve is replaced, I will still have to be concerned about antiobiotics and infection, but also bleeding from coumidin.  Then, I worry
about getting older and maybe down the road acquiring diabetes, since it runs in my family, or cancer and need treatments, or other major surgery, all which could affect my heart adversely.

I don't know, perhaps I dwell on these things too much, but sometimes I get real depressed.  I wonder how many years I have ahead of me and what complications I may encounter.  I dread having surgery, and I'm also afraid that after the surgery, maybe I will still have problems.

I'm sorry to sound so down, but I'm going through one of my down times.  I'm also having a few other medical problems, and all of this hitting at one time is starting to get to me.

Thanks for listening.

[Lee]

Thanks for your answer.  It just seemed like the surgery went well, the prognosis was excellent, and my recovery was amazing.  Then the cardiology team insists on close follow-up for the rest of my life, and when I needed emergency surgery, it was a big deal because of the coumadin intake, without time to lower the dosage before the surgery.  A urinary tract infection required a week in the hospital because I lost a lot of blood and it was feared I would go into shock.  I didn't realize that even oral surgery would be dangerous.  But if I hadn't had the heart valve replacement, I would have surely died, so maybe the alternative isn't so bad, even though I didn't expect it.

[Gary]

RE: Penicillin prophylaxis: Bacteremia. It can cause endocarditis, bad news. It affects all heart valves, whether prosthetic or not, and most easily enters the blood stream from skin that is cut, particularly from the bacteria legion in the mouth. It's a precaution, and anyone with vulnerable heart valves has been taking it for many years. I've been taking it before dental work and surgery for over 40 years and the  'protocol' established after lengthy research is 2000 mg, an hour before dental work.

[CCF CARDIO MD - DLB]

I would not categorize any medical device as infallible. I think your cardiologist is wise to look in on you periodically. Mechanical valves can cause all sorts of problems, such as breakdown of blood cells or infection.