Can 3+ MV severity correct itself?

[pleaseme]

I would like to know if a patient that has a 3+ reguritation of the left ventricle would ever be able to strengthen the valve without drugs or physican intervention? How important is it to have this monitored?

[Annie1953]

Thank you all so much for your concern and information. And Jack, my God, thanks for all the time you took getting all that info together for us, we will be going over every bit of it. Pleaseme saw her primary care physican and he is not at all happy with the results she has gotten from this cardiologist---safe to say she will never see him again. The primary care physicain says he has no idea what kind of shape her heart is in going by this guys reports---which are all over the place. The last report the cardiologist sent to the PCP said her heart is rated a ONE!!  WTF??  Anyway, Pleaseme's PCP agrees wholeheartedly that CC is the way to go and is making the arrangements. Jack, our thoughts will be with you in the coming days, you have the best doctors in the world and you will be a new man in no time at all!!!  You may be alone in that bed Jack, but all of us, Momto, Maggie, Pleaseme and I are all there with you in spirit, our thoughts and our prayers.

[Momto3]

My friend had bypass surgery about 4-5 years ago.  

I keep wondering if and when the time ever comes when I need valve surgery, will I head back up to Cleveland?  I'm thinking if there is a chance at repair, I'm sticking with CC.  Not sure if it would need replacement.  I have a cardio in NC, but still travel to Cleveland at least twice a year to see my EP.

Have a safe and enjoyable flight to Cleveland.  Are you staying with friends/family?  It is so beautiful this time of year!  Great temps, beautiful skies and gorgeous colors!  Stay positive, travel safely and be well.  We'll be rooting for you!!

connie

[Jack54]

I was afraid to ask what type of surgery your friend had, but was glad to hear that you think he is great.....Ok, what type of surgery was it?

Yes time is passing quickly. My mind is too busy so far to be scared. I just dread the airports and all. Plus I will be going by myself which I think is better.

Thanks again Connie,

Jack

[Jack54]

You are so welcome for the bit of reading. You are such a kind and cheerful lady :) I hope that you have a great weekend. Yes it has cooled off in Dixie a bit and I am enjoying it.

Bama plays Arkansas this Saturday. Is that tomorrow? Ha ha ha.
Well, ROLL TIDE, ROLL :)

Jack

[Momto3]

Over the year, I've referred to the ACC guidelines a lot!  It's interesting to note how they have changed rearding the timing on valve surgery.  My doctors always refer to the "window of opportunity" when it comes to repair of the valve.  I love the flowchart they include!!  Thanks for all that research for us valvers : )

Dr. Sabik operated on a very good friend of mine....I think he's a great surgeon : )  I hope everything goes well up at the CC.  Hey, when you're there, be sure to check out that great bakery place (even if it's just for a morsel of the good stuff...lol) that is inside the Clinic.  Wishing you the best outcome!

Connie

[maggiemag]

Wow, it sounds like you need another cardiologist!  BUT, in defense of his/her question of *why are you here?*,  this is a routine thing doctors are trained to do.  It is called the *chief complaint* of the patient, in other words, why they are at the doctor's office.  They are trained to put that at the top of their notes, usually just as CC: and then the chief complaint is listed.  It does NOT mean that they don't know why you  came in, they just want to know what the PATIENT thinks is the reason they are being seen!  (I hope this is making sense!)  Just FYI. :-)

[Jack54]

Good morning :) I feel like Rumpelstiltskin. I have slept for 24 hours it seems, but I have been on the job about an hour and a half.

There is, or use to be lots of disagreement as to when to repair or replace a mitral valve or any other. It seems to be a consensus now among the mainstream of cardiologist. It really is kind of complicated when you get into the "perfect' candidate for repair or replacement but I located the "Timing and indication of mitral valvular surgery based on American College Cardiology/American Heart Association (ACC/AHA) 2006 practice guidelines for the management of patients with valvular heart disease."

I have a link to this below that I hope you can open. I have copied some important information from the PDF document, but there is a "decision based flow diagram" that I wanted you to see.

I next went to the Cleveland Clinic web site to locate a valve expert, Tomislav Mihaljevic. I had already watched his web cast and checked his credentials.      http://www.clevelandclinic.org/heartcenter/podcast/?firstCat=3&secondCat=639

His boss man, the head of the CC cardiovascular unit, thinks very highly of him. (Dr. Sabik is on the page also, he is my  surgeon)

Well, you have never said, I don't believe, what is the cause of your MVR. Is it mitral valve prolapse (leaflets bend backwards), or MV stenosis? In the end it will not mean much to you, but it could determine whether your MV is replaced or repaired. I guess it does mean something to you after all.
There are 4 classes of heart failure due to cardiac malfunction per the New York Heart Association Functional Classification.
NYHA Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities.
Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class III: marked limitation of any activity; the patient is comfortable only at rest.
Class IV: any physical activity brings on discomfort and symptoms occur at rest.

I think you are between a II and III, from what you and you nice SIL said.
I also think that you should have the valve repaired or replaced at the Cleveland Clinic if they think it is necessary. Doctors with heart problems go to the CC.

Here is the url for the web site for women with heart disease. You do know that the timing for surgery/repair is involved with preventing enlargement of your left ventricle which can cause heart failure. You need to make sure that YOU get the actual readings from each of the echocardiograms/TEEs that are performed. The left ventricle end diastolic volume  (LVEDV) is a very important dimension, second only to your left ventricular volume.  http://www.clevelandclinic.org/heartcenter/pub/women/conditions_valve.htm

I also read a short story about the following. The title is all you need to understand although I would speak to my doctor about any corticosteroids in my future:
"Rapid appearance of severe mitral regurgitation under high-dosage corticosteroid therapy"


Excerpt from the American College of Cardiology

D. Mitral Regurgitation

Factors influencing the timing of surgery for MR include
symptoms, LV EF, LV end-systolic dimension, atrial fibrillation,
and pulmonary hypertension (Figure 7). In most situations,
MV repair is the operation of choice for those patients with
suitable MV anatomy.

Operation is indicated for most patients with severe MR and any
symptoms. Operation is also indicated in asymptomatic patients
who demonstrate mild to moderate LV dysfunction (EF 0.30 to
0.60 and end-systolic dimension 40 to 55 mm). The patient with
severe LV dysfunction (EF less than 0.30 and/or end-systolic
dimension greater than 55 mm) poses a higher risk but may
undergo surgery if chordal preservation is likely.

There is controversy regarding the timing of surgery in the
asymptomatic patient with severe MR and normal LV function.
If MV repair can be performed with a high degree of success
and the operative risk is low, it is reasonable to proceed with
surgery to prevent irreversible LV dysfunction from occurring.
However, this “early” operation should only be performed at
centers in which there is a high likelihood of successful MV
repair because of their demonstrated expertise in this area.

http://www.acc.org/qualityandscience/clinical/guidelines/valvular/Valvularpocketguide.pdf

[Momto3]

OMYGOSH!  As I'm reading your stories, I'm sitting here fuming!  First, and foremost, find a compassionate cardiologist.  It will make all the difference in the world....I was in a very similar situation a few years back and thought for sure it was time for MV repair/replacement.  My cardiologist, an EP, referred me to the Cleveland Clinic (Michael Lauer, MD) b/c my echo revealed a moderately severely leaking mitral valve.  I was scared outta my mind!  My doctor, who is at another large Cleveland based hospital said she would prefer me to go the CC because they are the BEST at repairing valves.  Sooo, I see Dr. Lauer, who reviewed my echo tape and am referred for a TEE.  Dr. Lauer did not think my valve was leakly severely, but wanted to err on the side of caution.  

Had the TEE and NO surgery was indicated!  I was very, very happy to hear that. There is some variance in reading and interpreting echocardiograms and b/c I have an "eccentric jet" the severity of the leak could be slightly over-rated.  

Since that time, I've had two ablations for chronic pvcs and have been taking lisinopril for optimal BP control.  My BP was not too high, but my doctor wanted it near perfect (better for the valve).  More recent echos and stress echos indicate the valve is no worse, and possibly a little better. Like Jack said, BP control is very important.  The regurgitation is stabe, somewhere between 2 and 3+.  The doctor feels that since the current echos are very similar to the one I had just before the TEE, then at best case, there is no change.  And, perhaps, some improvement.  

The really important thing about the leaky valve is the window of opportunity to have a repair (optimal) as opposed to a replacement should things change quickly.  That's the why doctors watch for any changes in the heart's function (EF) as well as any remodeling, increases in regurgitation and/or symptoms.

Try not to worry.  I agree with getting into the CC for an evaluation.  It is very possible you are not a surgical candidate, but wouldn't it be great to hear it from the CC?  The way you have been treated is unacceptable....I've been to quite a few cardiologists and there are some very, very good (and kind) doctors out there.  Don't shortchange yourself...go to the best!

Good luck!
Connie

[Annie1953]

OK---Busybody sister-in-law of "pleaseme" here. On 6/12/07 "pleaseme" had an echo done that was read as {Severe Mitral Regurgitation 3+}. On 8/17/07 she had another echo done that was read as {Mitral Regurgitation 2+}. Echo #2 was done after being on Cozaar for one month. Both echos were read by the same Dr. Now, this is what has us stumped, how does the severity of this condition  improve by one whole point, in only two months, with no medical intervention? Did the Dr. read the test wrong the first time----the second time----or what?? The Dr. says she has no heart damage. He wants her to come back in 6 months for another echo. In the meantime, "pleaseme" is walking around with all of the symptoms that led to her heart being tested in the first place. Her ankles swell on most days, she has a lingering cough, she is fatigued and her chest hurts when she does real strenuous activities. And this Dr. tells her she is "Doing Fine" and to come back for another echo in 6 months. Everything we have read on the web recommends repairing these valves BEFORE there is heart damage----so what is this Dr. waiting for?? As far as qualifying for the guidelines for mitral valve repair, "pleaseme" is certainly in the ballpark. This Dr. scares us. We think she should go to the Cleveland Clinic. You seem to be very knowledgeable about these things, Jack, and we would appreciate knowing what you think. We are still in shock over this diagnosis and we are getting no quidance from the doctors, that's for sure.  Thanks, Annie

[pleaseme]

I'm going to my primary physician tomorrow, I'm going to ask him to refer me to a doctor in the Cleveland Clinic. Well, here is as much, as I know, I had a echo on 6/12/07, due to what I thought was complications from just getting over bad case of COPD. for about 4 months,  O.K. I'm 50 years old and a little over weight. This was the first time that I have ever been sick more than a day. I work with 1100 lb horses daily and can outwork just about any 20 year old man.
On 6/28, my primary doctor choked up as he was telling me that I had a leaky heart. I did not press the issue and asked him to give me a copy of the report. Went home and looked up the 3+ severity meaning. Shifting gears, I decided to go to the same cardiologist that read the report figuring that he would be familar with my case. On 7/10 was my first visit, I took a second person along with help me to listen for information and to help me review what options I had. The doctor would not discuss anything with either of us and suggested that I go to Cleveland Clinic. He listened, did not ask any questions except what are you here for? MY THOUGHTS--- DAH! your the Doc, that revealed the numbers. Not losing my temper. we went out to the waiting room where his nurse said wait a minute he has some things for you. Things, WELL they were in the form scripts, and lab work needed.
I played this game and passed with flying colors except my bad ldl was 191. On 8/7/07 he did a stress test, echo. He prescribed Lipitor for the LDL Levelat this time, When I asked what was this drug, His commit was " So that you do not have a heart attack.----- O.K.---- I once again left the office with no more information. On 9/6/07, I had a appointment with him hopefully to get to the bottom of his findings. The first report my mitral valve was a significant 3+, Bp 155/88, Mild global hypokinesia in the LV, EF reduced to 54%. Second report EF 54%, BP 158/88, 3 minutes into the stress test B/P 164/92. heart rate 144,  He told me I was O.K. for now, Come back for another echo on 2/5/08 and review the findings on 3/27/08.. I wonder if I'll be around or checking the root system on my daisy patch.

[Jack54]

Now you know that such a thing would put the valve docs/surgeons out of business (the info you asked for). I will study for you today and get back with you.

I'll bet that Momto3 has been down all of those roads to avoid surgery.

You just cannot wreck your left ventricle, aka the Big Bopper :)

Your BP is WAY TOO HIGH! When do you see this doctor next?

Jack

[pleaseme]

My doctor has been sitting on this information for 3 months. He has me on cozaar to lower my blood pressure but today it's 155/98. LOVELY!
HAVE YOU EVER HEARD OR READ that a regurge rate can be lowered without surgery and corrected on medications?

[Momto3]

Hi and welcome!

I have had mitral regurgitation for at least 30 years.  I've always had checkups to watch for any changes.  In 2000, my ejection fraction dropped and the doctors thought I might need surgery. My regurg. was graded 2 - 3+, but fortunately, the EF did not drop because of the valve.  So, I did not need surgery.  I do, however, have semi-annual checkups to keep an eye on things.  Does the patient have regular echos to watch for any changes?

Hope it's a great day!

Connie

[Jack54]

Do you believe in miracles? More than likely this MV regurge rate (scale is 0-4, I think) has already remodeled the left ventricle and lowered the LVEF. The patient is also at an extreme risk for stroke, pulmonary embolism(s) and elevated pulmonary venous pressure, which can cause pulmonary edema (fluid on the lungs).

Many blessings to this patient,

Jack