Jan just sent me an interesting email about pleural effusions and heart valve surgery.

In her note, Jan writes, “Dear Adam, I am the caregiver of my 59-year old brother who had aortic valve replacement (with a bovine valve) at Vanderbilt University Hospital on July 13, 2009.  The valve itself has done okay but he has been in-and-out of the hospital twice since surgery. Fluid continues to collect between his chest wall and right lung. The fluid has been drained twice. Is this common? Thanks, Jan”

It sounds to me like Jan’s brother is experiencing a post-operative complication known as a pleural effusion.

According to The Cleveland Clinic, a pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing.

The common symptoms of pleural effusions after heart valve surgery are:

• Chest pain
• Dry, nonproductive cough
• Dyspnea (shortness of breath, or difficult, labored breathing)
• Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)

Specific to Jan’s question, “Are pleural effusions common after heart valve surgery?”, there are about 100,000 total cases diagnosed in the United States each year, according to the National Cancer Institute.

During my research, I learned that pleural effusions are somewhat common after cardiac surgery. Net Wellness suggests, “Post-operative pleural effusions are common in patients who undergo cardiac surgery. Most of these effusions develop as a consequence of the surgical procedure itself and follow a generally benign course.”

Specific to the use of drains to clear the pleural effusions… Karen Kutoloski, Director of the Cardiac Rehabilitation and Assistant Professor at MetroHealth Medical Center, suggests that while pleural effusions can be relatively common, post-operative chest tube drainage is rarely required. Accoring to Kutoloski, most pleural effusions are small and asymptomatic.

I hope this helps answer Jan’s question about fluid in the lungs after heart valve replacement and heart valve repair procedures. Unfortunately, it sounds like Jan’s brother falls into a relatively small category of patients that required fluid drainage after heart valve surgery.

Keep on tickin!

P.S. Did you experience pleural effusions? If so, please click here to leave a comment. (Or, scroll below to read 15+ patient comments.)

Elizabeth Taylor just announced that her heart valve repair was successful, adding that “it is like having a brand new ticker.”

The message on her Twitter page comes two days after she announced she was having heart surgery at an undisclosed hospital to repair a leaky heart valve. In a short message, the Oscar-winner thanked fans.

Elizabeth Taylor – Recovering From Heart Valve Surgery

“Dear Friends, My heart procedure went off perfectly,” she posted on Twitter. “Thank you for your prayers and good wishes. Know they all helped.” The 77-year-old did not go into further detail about her heart condition or the medical procedure.

Elizabeth Taylor suffered from mitral valve regurgitation. A new minimally invasive procedure, known as the MitraClip, was used to repair her leaky valve without any physical trauma to her sternum. This unique device, which was recently acquired by Abbott Laboratories from Evalve, Inc., does not require open heart surgery or the use of a heart-lung machine. Click this link to learn more about the MitraClip for mitral valve repair surgery.

While the MitraClip does have a CE mark in Europe, the technology is not approved by the FDA in the United States. However, the device is currently in clinical trials and may become FDA approved within the next few years. The MitraClip belongs to a new class of minimally invasive procedures that use a catheter-based approach to replace and repair heart valves.

Keep on tickin’ Elizabeth!

Here’s a joke I just received from John. It’s called, “Norma Findley, Ready For Discharge”:

A sweet grandmother telephoned St. Joseph’s Hospital.

And she timidly asked, “Is it possible to speak to someone who can tell me how a patient is doing?”

The operator responded, “I’ll be glad to help, dear. What’s the patient’s name and room number?”

The grandmother in her weak tremulous voice said, “Norma Findley, Room 302.”

The operator replied, “Let me place you on hold while I check with her nurse.”

After a few minutes the operator returned to the phone. “Oh, good news. Her nurse has told me that Norma is doing very well. Her blood pressure is fine. Her blood work just came back as normal. And her physician, Dr. Cohen, has scheduled her to be discharged today.”

The grandmother said, “Thank you. That’s wonderful. I was so worried! God bless you!!! God bless you for the good news!!!”

The operator replied, “You’re more than welcome. Is Norma your daughter?

The grandmother said, “No, I’m Norma Findley in Room 302. But no one tells me anything!”

Although this joke did get me to giggle. There is some truth to Norma’s fictitious story. Remember, keep asking questions throughout your pre- and post-operative experience. You have a patient right to know as much as possible.

Keep on tickin!

I just received an excellent question from Julie about trace heart valve leakage after surgery.

Julie writes to me, “Hi Adam – My husband, who had mitral valve prolapse surgery on October 31, 2008, went for the annual check-up with his cardiologist. In review of the echocardiogram results, we were told that there was slight leakage in the mitral valve. The cardiologist told us that it was okay. But, when I asked him if the valve could require surgery again, he said that was possible. Do many patients experience heart valve leakage after surgery. Thanks, Julie and Jon!”

I can directly relate to the concern and worry that Julie carries regarding the trace regurgitation in Jon’s mitral valve.

So you know, Dr. Rosin, my cardiologist, told me that I had trace leakage in my aortic valve one year after my Ross Procedure. That news was very, very, very tough to digest.

Why?

Well… As patients, we want the post-operative valve to function perfectly. We want to hear that everything will be okay for the rest of our lives. We want to hear that we are “fixed”.

However, as Dr. Rosin shared the echo results with me, he noted, “Adam, I can see your concern. But, please know this is trace leakage. I would not even go so far as to say it’s mild leakage.”

I started to feel better considering all that I knew about the different classifications of aortic regurgitation.

Dr. Rosin continued, “Just so you know, most people have some form of leakage in their valves. Aortic, tricuspid, pulmonary and mitral leaflets do not always seal perfectly. In my opinion, you are just like everyone else. You are fixed. This is nothing to be concerned about. There is just a little leakage around one of the sutures. This does occur. Everything else in your echo looks great!”

Then, Dr. Rosin looked up at me with a convincing smile and ended our appointment by saying, “Now.. Get out of here! Go have some fun!”

So… Is my situation the exact same as Julie’s husband, Jon? The answer to that question is a simple no. All patient cases should be considered unique. However, my gut tells me that if Jon’s echo is only showing trace leakage this is not much to worry about right now.

Could Jon’s valve deteriorate? Yes.

Could my valve calcify? Yes.

Could the Earth stop spinning tomorrow? Yes.

However, current echocardiogram results and celestial data suggests that those things will not happen in the near future.

Remember, heart valve surgery is a medical miracle. Enjoy your “second chance” at life. We are not cats. We do not get nine lives. So, please make the most of this opportunity. As I have learned time-and-time again, worry is a useless attribute.

Keep on tickin!

P.S. Did you have leakage after your heart valve surgery? If so, please leave a comment by clicking here.

Considering my fascination with medical technology, I recently came across an interesting video about the use of stem cells to create heart valve replacements for the treatment of valvular disorders including aortic stenosis and mitral regurgitation. That said, I thought you might find this video very interesting:

In the past, I have written several stories about stem cell use for heart valve development. Here is one story which chronicles Dr. Magdi Yacoub’s ongoing research about heart valve replacements generated by stem cells.

Keep on tickin!