My 17 year old son has to have heart valve replacement surgery

[annbrownma]

My 17 year old son, who has always been very active in sports, especially football and basketball was injured two months ago when a pellet went through his chest and eventually ended up lodged in the neck area behind his right ear.  Doctors say where it is lodged, it will never move and should not pose any problems at all.  He spent three days in the hospital with a collapsed lung and a week out of school. Doctors were amazed that the pellet traveled as it did and they couldn't figure out how that happened.  Almost three weeks later, my son was back on the basketball court playing and doing very well.  His doctor out of curiosity ordered a heart ultra sound and found that he had a hole in his heart caused by the pellet. He had a TEE this week and it was determined that he will have to have a heart valve replacement surgery.  They are leaning towards a Mechanical Valve because it is suppose to be lifelong...but he will be on blood thinners and he won't be able to play football.  I have done some research on on the Mechanical and also the Bioprosthetic Heart Valve Replacement...I realize the Bioprosthetic Valve may have to be replaced after ten or fifteen years but it appears he may not need to be on blood thinners with this valve.  My question would be for a 17 year old boy what would most doctors recommend and if we did choose the bioprosthetic valve would he be able to return to sports, especially football?  Also where can I find out more detailed information about both procedures so we can educate ourselves before we meet with the surgeon.  

[ed34]

I agree with your cardiologist. IF the valve is beyond repair without any doubt, which is obviously the best first choice of procedure, then a prosthetic valve would be a better choice. Think of the risks involved with surgery, let alone the fear. If I was your Son, I would live happier without the thought of being opened up again in 10 years time. Why go through the possible risks twice when it can be done once? I do realise that the success rate of such surgery is very high and 5 years post op is around 88% success, but I wouldn't want to push my luck. Infection is one of the biggest killers from major surgery, and this is something that catches all the professionals unaware.

[skydnsr]

I meant to say, "what kind of shape the valve is in"  -- you know, meaning how much of the valve is left to be repaired.  No way to edit comments, once they are posted.

[skydnsr]

First of all, I'm so sorry that your son and your family are having to go through this situation.  My next thought is that I would want, in your position, to know more detail about the precise path of the pellet and the exact structures that were damaged.  If it is the case that the pellet actually hit the cusp of a heart valve, my first thought would be to try for a valve repair and not a replacement.  This may not even be an option, but I would want to be satisfied in my own mind that it was not.  You didn't mention which valve it was, but mitral valve repairs are pretty common, depending on what kind of shape the valve is on.  Aortic valve repairs aren't common, but they're done at a few of the premier regional and national heart centers.  If it's the tricuspid or pulmonary valve, I've personally never heard of those being repaired.

If your son does have to have a heart valve replaced, there are pros and cons to both mechanical valves and bioprosthetic valves.  You know the main issues:  the mech valve will probably last a lifetime, but it requires his being on blood-thinners.  The bioprosthetic valve will require eventual replacement, but it doesn't require a life-long regimen of blood thinning medication.  

There are a couple of points that you may not be aware of, though.  One is that the bioprosthetic valves, tend not to last as long in young people as they do in middle-aged or older people.  I would not count on one lasting for ten or 15 years in a 17 year-old.  Oftentimes, they will last five years or less, in a person that young.  There's just no telling how long the valve will last, and your son might be one of the ones in whom it lasts ten years or more, but you really don't know until you've lived with it all the way through.  This is a point to discuss with your son's surgeon.

It might still be worth it to your son to go the bioprosthetic route, just to have the chance to play sports in college, but that is a personal decision.  As to whether he would, in fact, be allowed to play contact sports with a bioprosthetic valve in place, I am pretty certain that there would be a waiting period of at least about a year, to make sure that the sternum was fully healed.  After that, I'm thinking it would probably depend on the policy of the institution for which your son wanted to play.  If they say no, then he won't be playing, and I don't believe there is any universal rule about it.  I believe each school and conference probably sets its own rules.  

I have heard of one or two players in the NBA who have come back from  valve surgery and played again, but I have not heard of any college or professional football players who have come back from any kind of open-heart surgery to play football again.  Even with a bioprosthetic valve and no need for blood-thinners, valve replacement surgery causes a major injury to the center of the chest.  There is a scar, there are wire sutures that are usually left in place just underneath the skin, and the thought of being hit hard, repeatedly, on that spot is not a happy one for most people.  I rarely think about my scar, but I would think about it if I were going to get hit there.  

The other thing of which you may not be aware is that being on Coumadin is not the totally horrible thing that it is cracked up to be.  There is life after Coumadin.  Contact sports would be ruled out, yes, due to the possibility of head injury.  The brain is more likely to bleed from a concussion while on Coumadin, and there's no quick or easy way to stop bleeding within the skull.  Therefore, sports with a high risk of concussion are out.  Other than that, there are not too many limitations.  In fact, I really can't think of anything you can't do on Coumadin, other than sports that impose a high risk of concussion.  

A lot of people are very active on Coumadin.  They travel, they play 99% of all sports, and they (believe it or not) eat what they want to.  Okay, there is one other thing that's not okay to do on coumadin, and that's binge drinking. You can take a drink of alcohol now and then, but it's risky to repeatedly get crazy drunk.  That is another thing that can be an issue for college students.  If your son wants to be able to experiment with alcohol in the way that many college-age men and women do, maybe that's another reason to consider the bioprosthetic valve.  But, again, the trade-off is that the next open-heart surgery might not be that many years off.  

It used to be that elderly people got bioprosthetic valves, and young or middle-aged people got mechanical valves, period.  Nowadays, surgeons tend to be more flexible, because the bioprosthetic valves are better than they used to be.  I would not be surprised if your son's surgeon is willing to leave the choice of valve type up to him.