st. jude valve stenotic

[eileneee]

thanks & merry christmas.  first a little history:
56 yr. old female, rheumatic fever as a child, resulting in valve disease.  went into a-fib & CHF age 48.  emergency mitral valve repair for stenosis.  tried numerous meds for a-fib, was cardioverted 8 times to no avail.  still in a-fib 7 yrs. later.
had 2nd open heart to replace severely leaking mitral valve (st.jude's)and tricuspid ring put on.  now less than 3 years post op, mitral valve leaking mildly and becoming stenotic.  echo shows calcification of posterior leaflet of mitral valve & decreased excursion.
mitral orifice of 1.8 with max gradient of 18 with mean of 6.l what does this mean?
mild tricuspid regurg with pulmonary artery systolic pressure of 40-45 mmHg
left atrium enlargement
moderately reduced left ventricular function
ejection fraction down to 45% from 55% less than 3 yrs. ago
left atrium enlargement, left ventricular function mildly reduced

question:  l. can artificial valve become stenotic & leaky?
           2.  please explain pummonary artery stystolic
               pressure.  are mine good, bad, indifferent
           3.  what is decreased excursion of mitral valve?
          
will i need 3rd open heart to replace valve again when it becomes severe?  prognosis for 3rd surgery?  any input is appreciated

thanks for your help.
eilene

[Tracee]

None at this time.

[CCF-M.D.-RCJ]

Eilene,

Thanks for the questions, and merry christmas to you as well.

(1) Yes, any heart valve can become both leaky (regurgitant) and stenotic.

(2) Your PA pressures are mildly to moderately elevated.  This is usually a sign that the left side of the heart is struggling to pump all of the blood forward out of the heart, thus some of the blood is going backwards.

(3) Decreased excursion of a valve leaflet means that it is not moving through its full range, which is usually from 0 to about 80 degrees for a St Jude valve.  This decreased motion can be caused by tissue ingrowth onto the valve, clot on the valve, improper seating of the valve, jets from other valves striking the leaflet, and other less common causes.

From what information you have provided (lowering of the EF from 55 to 45 after the surgery, increased PA pressures, enlargement of the LA, decreased excursion of the mitral valve leaflets), I think that you should have evaluation at an expert center regarding the future course.  The decision to undergo a third time redo valve surgery is to be made by an expert only.  Although I may be accused of bias in this regard, I would not have this evaluation done at any place other than the Cleveland Clinic or Mayo Clinic.  Further, I would only have the surgery done at the Cleveland Clinic.  The prognosis of the surgery would depend on your other medical history and particulars regarding the previous surgeries

If you wish to be seen here at CCF, I would recommend (not in any particular order) Drs Brian Griffin, Craig Asher, Mario Garcia, Richard Grimm, or Loretta Isada for your exaluation.

Hope that helps and Merry Christmas.