What is the life expectancy of a 75 yr. old male, with enlarged heart and narrowing of aortic valve?

[14kathy]

My father is 75 years old, and has just been told that he has an enlarged heart and narrowing of the aortic valve.  He also has chirrosis of the liver. His blood platelets are critically low. He has been losing blood and needed a transfusion three weeks ago because his count was 7.9.  He has gone from 220 lbs., down to 130.  He is jaundice, has shortness of breath, lightheadedness, some degree of confusion/forgetfulness.  I know that all of this combined is not good.  Several dr. appt.s are coming up in the next two weeks.  My question is what is the approximate life expectancy and in your opinion, would he even be a candidate for ANY type of treatment?  Also, would it even be worth putting him through any treatments? Its not that I want to lose my father,...it's just I want him to have the best quality of life for whatever time he has left.

[kenkeith]

Very sorry for your father's medical condition, and I know the strain family members go through with a family member in ill heath and successful treatment is not available.  Take care, and thanks for your response.

[14kathy]

Today's results of last weeks scan show liver cancer, stomach cancer, pancreatic cancer and basically cancer all over.  Thank you for your help.

[kenkeith]

Yes, an irregular surface (lumpy) of the liver is an indiction of cancer.  The liver is at high risk for cancer as the blood is filtered through the liver. You may want to withhold any health opinion until all the medical reports have been evaluated by your father's doctor. I don't believe there is much that can be done medically with all those issues other than help him not to have any pain, etc. I hope the reports are favorable.  Take care.

[14kathy]

One of the physicians my dad has seen, said that the ct scan of his liver showed it was "lumpy and bumpy."  Is this an indication that the chirrhosis could now be liver cancer?  The dr. told us that in advanced cases this is what happens, however, he was told he is not a candidate for a liver biopsy because he has almost no platelets left...his last reading was like 37.  There just seems to be so much wrong...and no definite answers. Dad underwent another ct scan yesterday of liver, kidneys and bladder, with unknown results at this time.  All this, in addition to now newly discovered heart issues with the enlarged heart and narrowing aorta, makes me believe that if he is low on blood to start with, I do not see how ANYTHING could be working right.  He has half the blood he should, his aorta is narrowing and can't pump the blood properly, and his liver can't process the blood properly, and the platelets are all but gone.  How can any of his organs not be affected by this?  I'm sorry to repetitive, but I'm just trying to grasp this and understand it somewhat.  Thank you.

[kenkeith]

The scarring with cirrhosis is irreversible and most treatment procedures are more focused on managing symptoms and complications. Yes, the liver can repair itself, but with cirrhosus each time it tries there is scar tissue. And almost always when a dx is made the condition is advanced.

The scar tissue makes it difficult for blood to freely flow through the liver and the obstruction causes increased pressure within the portal vein making it difficult for effective blood  flow  through the liver. This causes an increase of pressure within the portal vein, which causes blood to be redirected to smaller veins near the liver. When this happens the "smaller veins may become overwhelmed by the pressure and can burst, causing serious bleeding. Building pressure in the veins of your esophagus is called esophageal varices. In the stomach this is called gastric varices". The significant loss of weight is an a very good indication of advanced cirrhosis.  A bypass of the liver is to take some of the pressure off the portal vessel and prevent serious bleeding, etc..

[ed34]

I'm sorry to hear about your cousins problems :(
Isn't the Liver a re-generating organ, where 75% can be lost? I remember watching something last year where a patient had a huge chunk removed, was given a HUGE variety of medication to try and compensate for the loss, and the Liver grew back quite healthy and functioning. I presume this was a different problem and assume chirrosis is a whole different ball game?

[kenkeith]

The lack of blood/oxygen to the liver is not the underlying liver problem and to increase the flow of blood to the liver would not be effective treatment.  Aorta insufficiency can be the cause of shortness of breath, etc. due a low cardiac output and chirrosis of the liver would be concomitant to the low cardiac output (if present?).  Also, chirrosis of the liver would be impervious to an increase in blood flow as chirrosis indicates scar tissue and complications thereof. This scarring is irreversible and prevents healthy tissue from forming on the liver and the inability for the liver to repair itself.

Without getting into the etiology of liver disease, treatment is to bypass or tunnel through  
the liver and connect the vessel that carries blood from the digestive system to the liver and to a vessel from the liver back to the heart.  A stent is then placed in this tunnel to keep the pathway open would be the remedial procedure.  With this disease syndrome there is a reduction of normal liver tissue, and the scar tissue obstructs the flow of blood, and also interferes with the liver function. Although often associated with drinking alcohol, there can be other causes.  My cousin did not drink, and was overcome quite rapidly with liver disease.  There are various stages, and depending on the stage would indicate the end point for liver disorder as well as the general health taken into consideration.  My cousin was very healthy up to the last few months...no effective treatment other than liver transplant.

[ed34]

Do you think the major problem here is the narrowed aortic valve, causing the dilated cardiomyopathy and not getting enough blood to the major organs such as Liver? Even a VLAD wouldn't help in this situation (I assume) due to the narrowed exit of the left ventricle?

[kenkeith]

You ask the question that many people ask about an aging family member who has challenging medical problems....how long can one live, and is the risk of treatment outweighed by the possible complication of pain vs. benefit?

The decision should be made by a doctor who has the experience, health history, wishes of family members, etc. regarding your father. A cousin was recently diagnosed with chirrosis of the liver.  There was a bypass of the liver, and he didn't live but a few months subsequent. Just prior he appeared very healthy and in his 80's when he and his wife enjoyed a motorcycle trip from Phoenix to Alaska...his wife took the plane back though. :)  

Personally, if I were in that medical condition as your father, I would want to be made as comfortable as possible and let nature take its course. I have never talked to anyone that would want to just survive for the sake of being alive, but that is a decision each of us will have to make.

Thanks for the question.  Take care and don't feel guilty with any decision you, your family and doctor may make.