Heart Valve Replacement

[manjut]

Hello,

We are devasted as our sister is diagnosed with Severe Mitral Regurgitation and Flail PML. There were no symptoms but the doctor advised to do echo cardiographic screening as they heard murmuring sound from her heart. After considering couple of cardiac specialists, they both have suggested two complete different options for valve replacement. One of them suggested to go with open heart Mechanical valve replacement surgery as the doctor has been doing it for many years and the valve has 20-30 years lifetime. Another specialist suggested to go with Non-invasive Bio valve replacement as my sister has also got nerurofibroma and blood thinning required for mechanical valve replacement may have side effects on her neurofibroma. But the life for bio valve seems to be around 10-15 years.

We are very confused and deeply worried which option to take? My sister is in a horrible state as she is devasted and in more concern about her future and family. I have also mentioned below the report and attached the scans we received from echo screening:

Flail PML
PML (Chordae rupture)
Severe Mitral Regurgitation
Other valves Normal
LA is mildly dilated, Other Chambers Normal LA:4.3cms
Pericardium Normal
Normal LV function Systolic (LVEF:63%)LV:5.3/2.8cms
No Regional wall motion abnormality
Trivial TR(TR of 3.0m/s;RVSP 41mmHg) Mild PAH

Can you please help us with your highly valuable advise on this please?

Many many thanks, Manju.

[Linnyw50]

I had the Mechanical Mitral Valve surgery.  I am glad I did, it has improved all my symptoms.  However it took 2 years to feel better after the surgery.

[ed34]

Hi, I can't think of any other questions. Please let us know the conclusion in the meeting :)

[manjut]

Also, I forgot to mention that my mom is diabetic and it seems heriditary as there is a family history with some of them in our previous generations had also suffered from diabetes. I thought it is better to mention this here, just in case if it is important.

Many thanks again,
Manju.

[manjut]

Many thanks to both Ger57 and ed34 for your advise. The surgeon who suggested us to go with Non-invasive bio valve replacement surgery due to her neurofibroma has asked us to meet him tomorrow in order to explain why he is suggessting a bio-valve. From both of your point of view, is there anything in particular do you like me to ask him apart from ed34's advise on angioplasty option?

[Ger57]

Hi Ed,
very impressive development!

It is still a tissue valve though, so with limited lifespan. They talk about it being "retrievable".
I am not sure but i think they mean retrievable during the procedure.

If they mean it is retrievable (and replaceable) after 10-15 years, then the disadvantage of the limited lifespan becomes a much less important issue.

[ed34]

Actually Mitral valves have been replaced in many countries, but in trials with great success. This year Minneapolis hospital did a trial on a patient with great success. http://www.dicardiology.com/article/minneapolis-heart-institute-foundation-conducts-first-us-implant-tmvr-device

If neurofibroma is a great concern, then this will make the patient viable for such a treatment I would have thought.

[Ger57]

Hi Manju,

If the valve has to be replaced and not repaired, I think the only option is open heart surgery. They can nowadays replace the aortic valve via a catheter, but afaik it is not possible for the mitral valve (yet).


Your sister being 36 years,  I fully agree with Ed34 that the mechanical valve is probably the best option. I think 20-30 years lifetime of the mechanical valve is a very reserved estimate. Normally they easily outlive the patient.

Lifelong medication is of course not what you want at 36 but hey, how many people take lifelong pills for blood pressure or  cholesterol. It is not the end of the world.

[manjut]

Many thanks for your explanation and advise Ger57. Sorry that I forgot to mention my sister's age. She is 36 years old. Regarding valve repair instead of valve replacement, we have already consulted this with the specialists and they advised to go with valve replacement after analysing her report. I have also provided the links of the scan and detailed reports in my second comment if you require.

Thanks again, Manju.

[Ger57]

When intervention is required with mitral valve regurgitation, there is first the question whether the valve needs to be replaced or if it can be repaired.
If it can be repaired, that is almost always the best way to go.

If  the valve needs to be replaced then questions arise the type of valve (mechanical or tissue) with its pros and cons (lifetime, medications)

Then there is perhaps the option of open heart or via a minimally invasive procedure.
The last option is often considered for fragile patients that can hardly endure the open heart surgery. The success rate of this procedure is however lower than the open heart surgery.


You did not give the age of your sister. 10-15 years for a tissue valve is not "lifelong" for a younger person, where as the mechanical valve never wears out.
The lifelong anticlotting medication does not need to be such a big problem. (I just had 2x a full year without real problems).

[manjut]

Many thanks for your reply ed34. I will surely check with the surgeon about the option of using angioplasty. Regarding effects on neurofibroma, to be precise, he mentioned that using blood thinning may affect her neurofibroma or during the time of any treatment/surgery if required in the future for neurofibroma.

Thanks, Manju.

[ed34]

Hi. I have no idea why the specialist feels that anti clotting agents will interfere with neurofibroma, I have found no research which suggests this. I would go for a non-bio(mechanical) option because they last so much longer. Has the option of inserting the new valve using angioplasty been discussed? This is where the valve is passed along a catheter in an artery to the site and expanded into place. This means the chest isn't opened. Don't be worried, you have time to decide, it isn't a rush into theatre job.

[manjut]

The scans are available here:
https://onedrive.live.com/redir?resid=B929A16E2CD45858!1998&authkey=!AGGjrlt5XODoMps&v=3&ithint=photo%2cjpg
https://onedrive.live.com/redir?resid=B929A16E2CD45858!2000&authkey=!ACqcWmr1QisNIi0&v=3&ithint=photo%2cjpg
https://onedrive.live.com/redir?resid=B929A16E2CD45858!1999&authkey=!AL_7j7O0L0rZZzU&v=3&ithint=photo%2cjpg