SEVERE TRICUSPID REGURGITATION

[Link_pad]

Hi,

I had Endocarditis abotu 5 years ago which was treated medically for 3 Months. I recovered but there was mild damage to my Tricuspid valve.

Now i had an echo done 3 years ago that showed further deteriation to Severe TR but at the time i was showing no symptoms and because of my young age (26) we all agreed it wasn't worthwhile to get valve replacement.

Now i had an echo done in January showed Severe TR and mild RV dilation is this anything to worry about. The reason i ask this is I think i'm beginning to show symptoms like :-

* A dull achey pain in my upper abdomen/lower chest area that lasts for hours but doesn't get worst on exertion or make me breathless (liver/heart ??)

* Pulses in my neck occasionlly like fluttering in my neck and legs.

* Constant tiredness lack of energy and dizziness when i stand upright.

* Wierd sensations of palpations/abnormal heart rythm episodes (rare) but i been told all my ECG's have been fine.

Is this anything to worry about or is there any medication that could help me out ?

Thanks Patrick Lee

[Mom2four85]

that's why I wanted to clarify it and make sure what had caused yours; some people just assume things without asking questions and judge others at the drop of a hat

I had group B streptococci during a pregnancy which turned septic and my son died and they thought I was going to die also - I'm wondering if that could have been what started all my problems - I've gone through tons of treatment also and off & on now develop severe infections where they give me meds in the super drug category (can't remember what it's called)

I don't think I have to worry with mine though all are just mild at this point.  Good luck and a speedy recovery.

[Link_pad]

Hi,

I didn't get the Endocarditis from drug use ive never been a drug addict !!

I got the impression the replacement operation is too risky to warrant doing by itself as the mortality rates are exceedingly high from what i have seen, unless i am missing something ?

Staphylococcus aureus i am pretty sure was the type of bacteria involved i had a 3 months course of loads of different anti-biotics until it eventually cured.

And as for how long it runs before needing replacement, i am a bit concerned as they always say that heart dilation is worst on the operating table than what shows up in an echo. And if the heart dilates or starts showing dysfunction it could be too late even if they did replace the valve ....

[Mom2four85]

something you said I'm curious about - Tricuspid valve endocarditis - when I looked this up I find different types & causes, which drug use is one of them, but I would appreciate any info you have on other causes -

I'm particularly interested in this: "Virulent organisms, such as Staphylococcus aureus and group B streptococci, are typically the causative agents of this type of endocarditis"

how does the drug related endocarditis differ from a causative agent such as Group B Strep, are they basically the same thing and run the same course?  could it take more than 10 years for the valve to need repair/replacement?

[lvhguy]

Well this should teach you from using IV drugs!

Tricuspid valve endocarditis is 99% caused by injecting unclean drugs into the blood system.

Most surgeons will not fix the valve when it occurs as I mentioned in previous posts. Simply take it out b/c most IV drug users are noncompliant with the postsurgical requirements.

If you are clean and sober, then get it fixed, it will prevent eventual right sided heart failure which is what happens to people with no tricuspid valve. Which means you get swollen ankles and jugular venous distenstion.
None of which is life threatening.

The left part of the heart pumps blood to the whole body, the right heart pumps blue blood about six inches to the lungs and would get there without it eventually.
Tricuspid valve is optional if you are still using, if you are clean and can follow the treatment then get it done

[Link_pad]

Hi,

Yes they have done a liver function test alongside an abdominal ultra sound i had a month ago which showed a normal sized liver with no scarring which i was suprised about.

As for exercise i do the odd light job but as you say nothing to extreme, i saw a cardiologist who said as it is the right side of my heart it is well tolerated and exercise won't have much effect on it and should help within reason.

My heart consultant Surgeon reckoned I had months until Right sided heart failure back last November ! And I had heart failure before  (5 YRS Ago) with my Endocarditis so i know how bad it is.

The bigger picture is as it is isolated Severe TR from treated Endocarditis and there is nothing else wrong with my heart to warrant operating at this time (previous valve disease etc...) and i am not really showing any serious symptoms they deem it not worth it at this point in time until i start showing any deteriation.

My consultant says he has known people up to 10 years without needing surgery which i find hard to believe !

Regards

[ed34]

Well there is exercise and exercise. By that I mean gentle and vigorous. You have mild dilation of the right ventricle and don't want to make this worse by over exercising. This could lead to heart failure. I have a feeling your upper abdominal/lower chest pain may be your liver, it could be swollen. Have they done Liver function tests?
I would limit your exercise to gentle walking and nothing more until a treatment plan has been decided upon. What has your cardiologist said? and what are the time scales?

[Link_pad]

Hi,

I am unsure what precautions i should take with my Severe TR as my cardiologists gives me the impression i should carry on exercising liek normal to keep my heart in good condition and the odd drink isn't that harmful. What do you think with Severe TR ?

[Link_pad]

Yeah you have heard of it too, i wasn't quite sure if this could be done for the tricuspid valve but you say it can be done as it is such a large valve. But i get fed up of being in pain all the time ....

I live literally right on the border of Wales to England so I am stuck on the god damned Wales Hospital care. I am seriously considering upping sticks and moving to England.

As you say the London heart hospital as far as i have seen is amazing I can only dream of being treated there thanks again ED !!

[ed34]

I would have thought the procedure is available on the NHS, if you can find a hospital which has the trained Cardiologists. It is basically installed the same way as a Stent, collapsed on the end of a catheter, it's sprung into place when the existing valve has been squashed into the heart out of the way by a balloon.

Do you live near London?  I would ask your GP to refer you to St. Mary's hospital in Paddington. It's all part of a training/research hospital and has the latest techniques available in the Country. It's actually part of Imperial college London and even uses the famous da vinci robot, the first used in the country for keyhole surgery.

[Link_pad]

I saw a cardiothorosic Surgeon Consultant (NHS) earlier in the year, The endocarditis isn't there anymore. Apparently the valve is beyond repair, they suggested a bio prosthetic valve due to not being on blood thinners and it apparently works better in the Tricuspid position.

The heart surgeon said he's known people for up too 10 years with Organic Severe TR then needing operation for Heart failure.

Ed What is this Percutaneous Intervention you mention ? I keep hearing of some method of putting an implanted bioprosthetic valve directly over the previous valve minimal invasive ? I am on the NHS here but if i knew of any good safe procedure i would go private.

Thanks for your help Ed34

[ed34]

It would appear your right ventricle has already started to dilate (enlarge) due to the leakage in your tricuspid valve. The problem is, you can take medication to assist the heart in some ways, but due to valves having no dedicated blood supply, medication has no effect on them directly. Even the immune system is useless.
As Kenkeith has stated, your right ventricle will continue to enlarge until it eventually fails.

So, has your cardiologist indicated if the valve can be repaired? This is the best option so long as the Endocarditis is under control. If not, you will obviously be looking at a valve replacement, probably mechanic at your young age.

You could discuss the advancements in percutaneous intervention for valve treatments. I read recently that there have been some new tools produced to repair valves this way, and many valves have been replaced using this method, very successfully. Recovery is much quicker.
I think the valve repair is still in trial stage, but perhaps there is a research hospital using this technique near you. I have read that 80-90% success rates are achieved with a great reduction in regurgitation.

[Link_pad]

Blood pressure seems normal, at times when im stressed at work or exercising it does vary a little sometimes low and sometimes higher. So i reckon my blood pressure is normal until i exert or get stressed and then it goes haywire !! (130/80)

[kenkeith]

You have listed the symptoms and signs and although usually absent, but with severe TR it can cause neck pulsations, a holosystolic murmur, and right ventricular–induced heart failure or atrial fibrillation.

What eventually may happen is that the right ventricle can/will continue to increase in size.  When that happens the right ventricle will not be able to pump effectively.  That will reduce the amount of blood to the lungs and this reduction will reduce the amount of blood the left ventricle to be pumped into circulation.  That will cause heart failue as the heart cannot meet the blood/oxygen demand.

[ed34]

How is your blood pressure holding up?