Mitral Valve Surgery

[Frank]

Thank you for this site. I know it is a great help to others as it is to me faced with a heart condition. I'm a 49 year old male and last June at my annual physical my family MD refered me to a cardiologist to have my mitral valve prolapse evaluated.  In 1983 my mother had valve surgery with a pigs valve and then again in 1993 with a mechanical valve.  In 1984 I had an echo and the regurgitation was determined to be minor.

In July of this year when I had the echo the cardiologist said "you will need surgery to correct this problem". I asked when but he wasn't certain. I then on my own arranged to meet with the surgen that operated on my mother both times. Last week he agreed that I needed surgery and that he was 90% sure that he could repair the valve rather than replace it. He said that the degree of reguritation was between moderate and severe and that my ventricul and atriam had minor dialation. He wasn't sure but said that it appeared that one of my cords may have ruptured.  

I immediatly arranged a surgery date but then changed my mind and called back the doctor.  My question to him pretained to the fact that everything is being based on one echo. At the time of the echo I had a few days previoulsy been playing basketball,  had just had an upsetting phone call minutes before the echo and the cardiologist had commented that my BP was rather high 180/80.  I normally am in the 140/70 range.  Also the cardiologist since prescribed me Monopril 10MG.  

From what I've been reading surgery is usually recommmended at the severe stage.  Is it possible that now that I've discontinued playing basketball and am taking the Monopril that surgery may be forestalled or become not necessary?  The surgen doesn't think so but encouraged me to get another echo if that would make me feal more compfortable. I know you cannot diagnose individual cases but what is your general opinon of this type of situation.  I am quite anxious and the any input from you will be much appreciated.  Sorry for the long email, I just wanted to state all the pertainent facts.
Frank

[TSM]

If you do not find any answers here-try   www.valvereplacement.com. They have a great forum of perpole
that have had all kinds of experiences with all types of valve replacement surgeries. You could probably bet on finding someone to answer your questions. Sincerely, TSM

[Deesef]

Emma,
I hope things work out for you.  I had my second echo done today and should know the results in a few days.  I,m interested in how you're case turns out.  There really are a lot of good people on this forum that seek to help each other out.  Although it looks as though I'll eventually need the surgery I'm still hoping I won't.  If I do, I hope to support others in this situation when I can.  My email address is ***@****.

[emma]

Hi Frank,

In some ways we are in the same boat.  During the same storm...  I am 47 and am quite active. I have been told by one doctor that I have severe mitral valve prolapse and significant dilation - atrial and ventricular - this based on an echocardiogram in his office.  I then had a cardiac catheterization and the doctor who performed it told me that my prolapse was moderate, that I didn't need surgery - and not to bother having a TEE.  He said a comparison of pressures (between my left atrium and left ventricle I think) also indicated that my problem was not severe.  The first doctor continued to disagree with the first - even after the two had talked and reviewed my cath film together - and recommended I have a TEE. I decided to go ahead and have the TEE - with the hope it would clear up confusion.  I had it today, and all I know at this point is that I have a sore  throat.  I respect both doctors a lot, and they both are very experienced and well regarded - and in the same practice.  Good luck to you.

[Jim]

I am 71 years old with idiopathic cardiomyopathy, ejection fraction around 30%. My mitral valve and tricuspid valve are described from echos as severe or moderate to severe, and there is moderate aortic stenosis. Two doctors have told me that I would be at high risk for open heart surgery due to the weakened heart output. Has anyone had any experiences with the so-called "keyhole" procedure for repair or replacement of the valves, or using a catheter through the groin to aid the aortic stenosis? It is my understanding that the mortality rate for these procedures is much lower than open heart surgery, but I don't know how effective they are or if they are done with any regularity, if they are approved or experimental, etc. Thanks for any advice.

[Shannon to Peter]

Frank, ditto on Denise's comment.  I had mitral repair 18 months ago (along with repair of an undiagnosed septal hole).  I'd be happy to tell you more about what to expect, what I know, etc. Denise and I became friends through this forum! I suspect you'll make a few new ones, too.

Take care and stay in touch.

Shannon

[Stan H]

As you can tell by now, many of us on this board have already been through the same situation you are currently experiencing.  It's a worrisome and trying period, but ultimately everything seems to work out okay.  Before anyone can say you're a candidate for surgery, more testing will be done and a "baseline" will have to be established.  A catheterization,  a TEE, and more echos are likely before any surgery could take place.  I had moderate to severe regurg with mild dilation for several years before I went in for surgical repair.  Only when the regurg and dilation increased was I scheduled for surgery.  A change in what may be a stable, long term condition is what they are looking for...when that change occurs, the waiting is over.  It's a condition you certainly would not have requested but, as bad as it may seem now, it IS repairable if it worsens.  The surgery is highly successful and has an incredibly high survival rate.  You'll be fine.

[Deesef]

Chris:
Thanks for your comments. Hope you're doing fine with the valve. I'm planning to visit with my family MD next week to see about the follow-up echo and will also inquire about a TEE.  Have you had the surgery? If so how was it.  My surgeon advised that there have been considerable advancements in the last few years with anesthesia.

[FROG]

Since I have not been able to post a question, I thought maybe someone would see this and answer it for me.  I can not get info. anywhere else.  Has anyone had experience or heard of  facial numbness that was related to the heart?  I have been to the neuro. had the MRI/MRA and everything was ok. Thanks for the info.

[cutefrog]

Since I have not been able to post a question, I thought maybe someone would see this and answer it for me.  I can not get info. anywhere else.  Has anyone had experience or heard of  facial numbness that was related to the heart?  I have been to the neuro. had the MRI/MRA and everything was ok. Thanks for the info.

[dkader]

Dear Frank,

I am a 48 year old female that had MVP repair June 1999 at the Cleveland Clinic.  If you have any questions that you think I can help with (in regards to the surgery - I'm not a doctor), I would be happy to do so.  I have tried to help others faced with the same thing I was faced with as others helped me so very much.  My email is ***@****.

Denise

[Chris S.]

Frank, I empathize with your situation. I had severe mitral regurg diagnosed last year after a new murmur was found in a physical. My cardiologist ordered a TEE (transesophageal echo) after the thoracic one. I would recommend you ask for this. It is an outpt procedure but requires some IV and sedation. The TEE images the mitral valve & LA in great detail and is better at detecting torn "chordae." If you have a flail leaflet (torn chords) you definitely want to proceed to the surgeon. Even without symptoms your risk of bad outcomes are high. There have been great strides in valve repair in the last 10 years and you defintiely want repair rahter than replacement. Check the Amer. Heart Assoc site for links about guidelines with valvular heart disease.

[Chris S.]

Frank, I empathize with your situation. I had severe mitral regurg diagnosed last year after a new murmur was found in a physical. My cardiologist ordered a TEE (transesophageal echo) after the thoracic one. I would recommend you ask for this. It is an outpt procedure but requires some IV and sedation. The TEE images the mitral valve & LA in great detail and is better at detecting torn "chordae." If you have a flail leaflet (torn chords) you definitely want to proceed to the surgeon. Even without symptoms your risk of bad outcomes are high. There have been great strides in valve repair in the last 10 years and you defintiely want repair rahter than replacement. Check the Amer. Heart Assoc site for links about guidelines with valvular heart disease.

[CCF CARDIO MD - DLB]

I do not think the basketball influenced the results of the echo. The elevated blood pressure could certainly have increased the degree of mitral regurgitation seen on the echo, and the monopril may decrease the amount of regurgitation seen. We generally only operate for severe regurg, though if a patient has related symptoms and/or the left ventricle appears dilated or is starting to become dysfunctional, we would also operate even if the regurg is only moderately severe. A second echo or a transesophageal echo may help clarify the situation.