Heart Valves

[PJmomrunner]

Thank you for this wonderful service you provide.

What is the expected longevity of the different types of prosthetic heart valves?  What are the factors to be considered when choosing a valve?  How much patient input is appropriate in making the determination as to which valve to use?

[keylolo]

hello,
I have been diagnosed with mitral valve stenosis, I have had a valvuloplasty done last october. The previous symptoms of lightheadedness, sob and tiredness have returned. I recently had a stress test that was able to tell if my heart, lungs or being deconditioned is the problem. Well to make a long story short, the heart compensated for the excersise for 3 minutes after the 3 minutes it was explained that even though I continued to excercise for 3 additional minutes my heart didn't step up to the pace I was going. It reached it peak and it stopped. I am to under go a echo stress test next week. This is all so foreign to me what does it mean? and what type of questions should I ask?

[Konopka1955]

Hi,  I think your question has many scenarios and the good doctor will give you plenty to think about..  There is also another site www.valvereplacement.com that has many patients with various types of valves and they might have some input as well from the patient point of view.  I have a mechanical mitral valve - I was wishing to get a mitral valve "repair" - but once they got inside - they said my valve was to far diseased from rheumatic fever and if they did do a repair chances are they would have to go back in - in another year - as the repair wouldn't last me very long.  But that was MY valve.  Which I should tell you was quite damaged..  I never knew I even had rheumatic fever till after my surgery.  My mom said I almost died from pneumonia when I was a baby - but I guess it turned out to be more than pneumonia.  Luckily I survived the rheumatic fever.  :-)  

I think there is alot of patient 'input' in deciding what type of valve you would "like" to go with and I guess that can depend on which type of valve your talking about..  that may have a bearing on your decision and input plus if you have heart disease and the condition of your overall health.  I also think the medical center you choose for surgery may vary on various valve types and expertise.  Usually the larger medical centers offer better outcomes and better technology.  I went to a fantastic medical center and I'm very happy with the decision my surgeon took.  

I should say if you need the mechanical valve - you do need to take coumadin the rest of your life and that takes awhile to adjust to as well. Its not horrible or anything - I mean my toes haven't turned green or anything and I don't squeek like a mouse.  But the drug can be effected from any over the counter drugs like Tylenol or Motrin or other various OTC drugs you take and I believe coumadin is one of the top 10 drugs to take as far as interaction with other drugs..  I could be wrong !!   Plus, if you ever need surgery - they need to make sure your INR is within certain guidelines or you can hemorage..  SO your INR needs to be monitored regularly when taking coumadin.  For instance, my dentist won't even clean my teeth without my INR reading and that has to come from my PCP and in paper form signed by my doctor and 3 days before my cleaning.  I've heard that some mechanical valves can last a lifetime - depending on your age.  So you see there is so much to consider and perhaps you need to give more information in order to get a more overall picture and everyone is different.  

I live a very normal life with my St. Jude mitral valve - I work full time - I exercise and I take my INR levels at home with my own monitor kit.  I do have high maintenance but nothing that can't be taken care of if taken the time.  I do hear the valve click, click, click some nights..  I've gotten more use to the sound - some will play a radio at night so they can't hear theirs.  I've gotten use to hearing it - its when I don't hear it that I worry.  There are thousands of people with mechanical valves and you could never tell by looking at them.  I probably look like the most healthy person at work and yet I have lots of devices that keep my heart beating....  Technology is fantastic today and people are living very long normal lives. I fully expect to be able to see and hold my first grandchild.. I would dearly love to get two or three of them...  of course my daughter said I have to wait 10 years !!!   But I can do it..  and I should say I do manage to get a medal or two each year for running in my road races.  So you see I'm doing very well and I know many others with mechanical valves that are doing just as well.  Attitude is everything and of course some great doctors make a huge difference..  

Good Luck
Best Wishes
Marilyn (runner)

[CCF-M.D.-MJM]

Hi pj,

This is a complicated answer to type but I will do my best.

Mechanical valve

pros:

--increased likelihood of needing a single operation and the valve lasting your lifetime


cons:
--life long coumadin and the associated risk of bleeding.  This can be a significant risk over 20 years time.
--coumadin cannot be taken with early pregnancy (conception through 12 weeks).  Then you have to decide whether to go back on coumadin until delivery or us IV / subQ (skin injections) of heparin for the remainder of your pregnancy
--if the valve thrombosis from inadequate anticoagulation (you must be compliant with coumadin), increased risk of stroke or other serious potentially life threatening problems

Bioprosthetic

Pros:

--no life long anticoagulation unless there is another reason
--compatible with pregnancy, although the valve will have a decreased lifespan because of pregnancy and the hemodynamic stresses during pregnancy
--If you are older and there is a good chance a bioprosthetic valve will out live you, this is a better option.  Your risk of bleeding increases as you grow older

Cons