“Any Questions For The World’s Leading Heart Valve Specialists?” Asks Adam

I am 61 and have asymptomatic mitral valve regurgitation. Eighteen years ago I had my aortic valve replaced ( rheumatic fever hx). I learned last week that the mitral valve regurgitation has progressed from the moderate-severe to the severe range. They are now suggesting that I have surgery within 6 months. I feel great;I do either either weight, spinning or body pump classes daily. During the day I will admit that I sometimes feel a little tired but I try to increase my activity when I have that feeling. That normally does the trick. Now that surgery has been mentioned I’m relieved. I also am noticing that I might be tired a little more than I admitted. Have I been in denial of my symptoms?

What are the indications for anticoagulation therapy following mitral valve repair surgery?

My husband had open heart surgery almost 10 months ago and he is still having upper chest pain when trying to get out of bed or straining his chest. Is this normal? Are there exercises that would be helpful.

Thank you

Adam, Most everything I read on the internet deals with a singular leaking valve. At age 64, I was recently diagnosed with 3 valves leaking – aortic insufficiency, grade 2+, triscupid regurgitation, grade 2+, and a mitral valve regurgitation , grade 3+. I have shortness of breath and am very lite headed at times. I am waiting for my cardiologist consultation. What are the chances that someone has 3 valves leaking but still has a healthy heart? Should I be overly concerned?

Thank you for considering this question. Janelle Kimball

Hello, I ihad spiking blood pressure all summer. I have experienced palpitations, shortness of breath, chest pain, nausea with this.I also have fluttering in my heart.(I do have sleep apnea, and this helped some shortness of breath, however not all).My echo reads as follows “This study was quite difficult from a technical standpoint secondary to patient obesitywith the apical and subcostal views ben particulary difficult to obtain. Standard m-mode chamber dimensions and wall thicnesses are within normal range. The aortic valve is trileaflet and functions normally. The mitral valve leafletss are midly thickened without evidence for systolic prolapse.The tricuspid and pulmonic valve appear structurally normal.Left ventricular regional wall motion is normal with LVEF calcualted at 75% Right venticular systolic function also appears normal. There is no evidence for intracrdiac masses or thrombus and no valvualr vegetations are seen within the technical limitations of this study. No significant pericardial abnormalities are identified. Doppler interrogatin reveals the presence of mild mitral insufficiency and mild tricuspid insufficiency with estimated pulmonary artery systolic pressure jsut above the normal range at 32mm Hg. What do you think?

Hi everone! My brother is a 25 year old male who has had 2 open heart surgerys so far. His last operation was the Ross procedure 10 years ago. Now the Ross has failed and he has to have surgery again. What are his options? A mechanical valve and warfain is not a very attractive option?

I would like to speak with someone who has had robotic mitral valve repair and/or Cox cryo maze for afib. I have extreme anxiety still almost 5 months post surgery. Docs say my surgeries went fine and I am fixed. Just want to know if anyone else experienced this.

Just over 2 years ago I had a serious accident (50′ fall) that resulted in heart damage due to blunt force trauma. I now have a Grade 4 diastolic murmur and aortic regurgitation. My echocardiogram from April 2011 stated:

1. Good quality echocardiographic study
2. Normal left ventricular size and systolic function
3. Moderately severe to severe aortic regurgitation with a regurgitant jet hugging the interventricular
septum.
4. The regurgitation appears to be mainly through the right coronary cusp.
5. There has been little change in the patient’s left ventricular end-diastolic dimension area and we have 3
readings now over one year of 62 mm, 55 mm and 58 mm. These differences are within the statistical
variability of the methodology.

Thanks to my stability in compensatory mode and my asymptomatic status (e.g., 13 mile hikes with 4000′ elevation gain, playing hockey, etc.) I am now getting annual echocardiograms.

I have several questions:

1. Is there any chance my heart can permanently compensate or is aortic valve replacement inevitable?

2. Previous echo reports: March 2010 “no aortic stenosis, concern for possibility of partially flail aortic leaflet”; Oct 2010 “thickening of aortic leaflets”; Apr 2011 “mild calcification”. Is the calcification likely due to healing of the damaged leaflets?

3.Are damaged leaflets more likely repairable (rather than requiring valve replacement)? Or would the long interim between injury and surgery (if necessary) negate possibility of repair?

4. Do I now have stenosis AND regurgitation?

5. Given my very active, healthy lifestyle, is there any chance that I wouldn’t notice a gradual onset of symptoms, or will I KNOW when the time for surgery is here?

6. I’ve seen the precipitous drop in survival curves once heart enlargement goes above a threshold or the patient becomes symptomatic. If symptoms of congestive heart failure become apparent, how quickly do I need to travel to see my cardiologist (hours/days/weeks/months)?

Thanks! Now that I’m on a once-a-year check up, it’s a lot to have in the back of your mind without regular feedback that all is OK.

Hello again, Adam, and thank you!

From what I’ve read, it seems that at this time some of the newer (i.e. less invasive)valve surgical techniques are recommended for those who are not candidates for the traditional open-heart surgery (perhaps too ill or with other complicating factors??). Why wouldn’t these newer techniques be better for ALL valve surgical patients rather than subjecting anyone to the more traditional, highly more invasive approaches? If the newer approaches are proving successful, I don’t understand why anything else is still being used. (I’m sure there’s a fascinating explanation!)

Many thanks,
Dorothy

Hi Adam. I am a 38 year old Paramedic/Firefighter in California with moderately sever Aortic Insufficiency due to two cusps being fused. I’m very involved in my own care and very knowledgeable about what is going on with it. I get quarterly check-ups and semi-annual echos. My last echo (June 2011) shows me still well compensating with an end diastolic volume just barely outside normal (around 60mm) and a normal ejection fraction. I do have a little mitral regurg because my aortic jet pushes back against my mitral valve.
That being said, I am asymptomatic and very active. I do have some transient ectopy, usually atrial, that comes and goes (when it’s around it is usually a lot – around 3000 pac/day). I exercise at least 6 days each week, including everything except heavy isometric exercises.

The question I have is this:

Is there any reason, related to my condition, that I should not train for and compete in a marathon? My cardiologist felt that there was no positive specific contraindication other than the process is generally hard on the body. I figure this is a great chance to get a knowledgeable second opinion.

Someday I’ll have to get my valve replaced, but hopefully I’m still a ways out.

Your book is great! I found it very informative and enlightening. Being in the medical field helps me stay in the know too, thankfully.

I’m a 69 y/o male.I had a mechanical aorta valve and 1 bypass in sept of 2010.
The surgeon relayed the difficulty endure puttting the valve in because of calcifaction ( the surgery took 5 1/2 hrs). 3 weeks later I had a setback because of the valve leaking.
It was decided to treat with meds.
My cardilogist,after a recent ECHO,thinks the valve needs repaired.The ECHO indicated moderate to severe leaking.I am leary because of the initial difficulty with calcifaction.
It’s my belief that any surgeon will be faced with the calcifaction issue and results will be no different.
do you have any thoughts?
thank you,
John Bird
Bradenton, Fl.

Hello

I just have my angiogram done last week and everything was fine until the Cardiogist found an extra artery and is working properly sending blood to my heart is this good? I have a hole in my heart plus Tricuspid is leaking..

please respond ..

thanks

Hi Adam,

Thanks very much for this oppurtunity.I am 31 years old recetly diagnosed with a Bicuspid aortic valve.I have severe aortic regurgitaion but I am asymtomatic.My LV systolic and diastolic demensions are normal and my EF is 62%.I know that some day I will need to have my aortic valve replaced or repaired.

Wanted to ask you if there will be a point in the near future when bicuspid valves could be replaced over a catheter without an open heart surgery?

Hi
My name is Sherry i am 40 years old and my doctor tells me i have a leaking heart valve.And its not a big deal but needs to be kept looking after.But i can’t stand the hurting in my chest and the dizzing feeling and blurred vision so will this ever go away.

I am heart patient by birth. MRV has been done 2 xtimes. There was hole at my birth. but at the age of 14, it was covered and Aortic valve failed. Open heart surgery done. it was again done in 2007. Now i m feeling pain which i did not feel in my whole before 2006. Dr say that stichthes in the internal chest opened and valve is leaking. no treatment is possible.

Adam, I sent an email directly to your email address last evening, but am concerned that you may not read the same in time for the seminar. I genuinely want to find out if an exception for doing transcatheter aortic replacement can be made under the circumstances with my back complications. I will try to attach what I wrote last evening, and apologize for quite so much writing. Please ask if I could be considered a candidate, of course with my consent and understanding of the risk, to correct my heart issue(s) during these clinical trials with transcatheter valve replacement. I realize I am close to the point that I will need to do something sooner than later. Thanks so much!
Email of last evening below:
Adam, I had written in previously on your blog when reading about Sara, Jim and Chris’ scheduled surgeries. On that note, I hope they have all had successful surgeries and are well on their way to speedy and healthy recoveries. I will look forward to reading about their surgery success stories.
As mentioned then, I have been meaning to write you for any advice/suggestions you may have, and then saw you are attending the Valve Seminar in Chicago, scheduled for 10/13-10/15. How very exciting! Now, for my concerns/question(s) – I just turned 60 years old in September. Approximately 4-5 years ago I was informed I was born with a bicuspid aortic valve, which at that time was heavily calcified, but still only in moderate to severe category. Approximately 2 years ago, it was classified as severe aortic stenosis. My cardiologist and I had always discussed holding off on any surgery (fairly asymptomatic) as I did not wish to have a mechanical valve and be on meds the rest of my life (I am a vegetarian and prefer to stay away from prescriptions), and using an animal valve would not suffice in endurance, given my age, without having to be replaced down the road. My concern, and without making it too confusing, is that I had an 8 hour back surgery 2 years prior to my heart condition being diagnosed. The only concern at the time I had a Dynesys spinal stabilization system from my L-4, L-5 thru S-1 (in place of a fusion and rods) put in was I had been told since my 30’s that I had a very loud click and murmur which was thought due to mitral valve prolapse. My issue in the past 2 years is that my spinal stenosis, disc bulging etc. above the stabilization needs major surgery as well. My doctors basically never reached a conclusion on even just doing what I’ll call a temporary fix, or short operation to rectify my back problem which also effects my legs and feet. The only definite stand was that I could not undergo any standard or lengthy anesthesia due to the heart condition. Guess what I am trying to deal with is how do I justify the current methods with open heart surgery to have a dual valve replacement as you did, knowing my back and legs are in constant pain and also need another major operation. I also am never sure I could really go through open heart surgery as the explanation of the heart being mechanically kept alive while being repaired is something I find hard to accept. Bottom line, in reading in the past about the Edwards Sapien and then your recent blog on the transcatheter device that passed CE approval in Germany, I would like very much to be considered as a candidate for transcatheter surgery. My Dynesys spinal stabilization had just come out of clinical trial when I had my surgery, and actually the FDA as of a year ago, again flatly refused to approve this system. I had, and still have great faith in its overall success. I am basically in good health, stay active, hold a job, swim etc. but am never really without pain. My argument for being considered for transcatheter valve surgery is that while neither my neurosurgeon nor cardiologist want to commit to working anything out to resolve my issues, it is a catch 22, as the saying goes. My aortic stenosis is severe and my L-3 in my back is totally shot, so both play against each other in endurance and pain levels at times. I would love to entertain and be seriously considered (even though not elderly or in otherwise poor health) for the transcatheter aortic valve surgery, even as part of a preliminary clinical trial, so that I could face and believe I would be able to withstand another major back surgery as well, and then be able to really function on all levels. With the brain seemingly focusing on the back issues and pain and making it through the day, I struggle at this point to keep weight on. While always average to somewhat slender, am now only slightly over 100 pounds at 5’4 1/2″, and obviously am concerned that my low weight is indicative of all the strain my heart is enduring when coupled with my back issues. While trying to be oblivious to my health issues, I know I am struggling a bit at this point to keep up a “normal” lifestyle.
I would be most appreciative of any advice or suggestions regarding being a candidate for transcatheter surgery due to my particular situation and back complications. Just as I had great faith in my neurosurgeon and the Dynesys system, I would like the opportunity and introduction to a cardiologist where we would share belief in each others respective performance as surgeon and patient and the exciting new technology(s) available. Thanking you in advance for any information you are able to obtain from these highly qualified surgeons at the Valve Seminar. You, your book and your website are a wealth of information to those of us diagnosed with heart conditions. Adam, again, thank you so much for your sharing and dedication. Adrienne

I am suffering from Rheumatic Heart Disease, and My Age is 30 Years.
I have gone though various article related to said disease, but not able to understand the actionable (Valve replacement is necessary or not?)

Request you to please guide me….

I am 58 years old. I had an bovine aortic valve replacement 6 years ago and now it has a mild leak. What causes this to happen? Where is it leaking? What is the reccomended surgery if needed?

I m suffering from beat missing problem from 9 years . Nd i was done eps 2 months ago nd my problem is not solved please suggest me any treatment .

Hi Adam,
My husband, age 55, is having surgery for a Aorta Valve replacement. He had a Ross Procedure 13 years ago and now it needs replacing. We are dealing with the decision on what kind to use. It may be likely that he will need, yet, another surgery in the future with any valve other than a mechanical. He doesn’t want to take comadin and I can’t bear the thought of him needing another surgery. The surgeon went over all the choices of equine valve being an option. Would you offer some advice, as we are running out of time and need to make a decision by the week of the Oct. 24th. Equine is so new….I am hesitant to go that route. Thank you for your help!

Am I the only person who had a palmontic valve repair at age two and at age 54 experience narrowing of the palmontic valve? 30% as of the last angioplasty

My father is 85 years old and diabetic who, 2 weeks ago, underwent a heart valve replacement. The surgery went well but he is going downhill in terms of his recovery since he left the hospital. He was always a healthy, active alert adult. Now, he has stopped eating, won’t/can’t exercise, stopped dressing himself, won’t talk – it’s like he has become a vegetable. Is this typical of a recovery? What is a typical recovery like for a man of his age? How should I handle this?

Hi Adam, I had a mitral valve repair just under two years ago. The heart is doing great, absolutely no problems. I do have a problem with my sternum. It never healed properly. My surgeon says that this is the first non union of the sternum he has seen in over a thousand surgeries. Thankfully, he has scheduled a new surgery to fix it. Can anyone explain why this would have happened? My initial closure was with wires and this is still his preferred method for the upcoming surgery.

Thx, Bill

hi
i underwent double valvereplacement mitral and aortic in 2007 due to rheumatic fever when i was 12 year old.
now i am 36 year old i am planning for my marriage is there any risk in pregnancy and delievery.help me
thanks

Hi Adam. I had mitral valve repair in August 2010. They said everything went well , but here I sit everyday with more palpations then I did before surgery. I just got out of the hospital again for arterial fibrillation for the second time. I never had this before surgery… Why did it start 6months after surgery and now. I was rushed in the hospital 10/26/11 after boarding an airplane. My heart rate went from normal to 195. At the end of my flight they had an ambulance waiting. After being admitted 4 hours later my heart converted back. The first tome I had to have a cardioversion. My question is why is this happening after surgery and now they are thinking I need an ablation.

what is “vegatation” growing on a porcine aortic valve. 6 years post op?

Will people with mechanical valves be able to get their real valves regrown in the future.

I need an aorta valve replacement surgury. I need to find a hospital in Southern WI including the Milwaukee Area that can give me the best chance of a successful outcome. Also I am interested doing it the most non-invasive way with the newest best technology. Would you be kind enough to tell me my best options for hospitals that fit that criteria I could investgate? Mabe the top three?

My essentially asymptomatic 87 y.o. father (quite active, healthy – other than HTN, significant curving of spine -? osteoarthritis?))is found to have a completely failed valve (not sure which one) – it has been suggested that he will need open heart surgery at some point – he is leaning toward having it done while he is still relatively healthy – as he is asymptomatic (he is still actively taking care of calves on a farm!!) what would be the major risks of NOT having surgery?? Is stroke a big risk with or without surgery? Tahnk-you

To David Luther:
1. St. Luke’s
2. St. Luke’s
3. St. Luke’s

I had Dr. Daniel O-Hair who is great. robotically assisted is your best option if you can!

I had aortic valve replacement in nov, 11. I have been doing OK but did not really care for the surgeon… My question is: If I should need any other heart surgery could I go to a different surgeon or would I have to go back to the same one.. I know it’s my right to choose but would a different surgeon take me now?

Thanks…

Hello Drs.
It’s been two years since my aortic root and aortic valve replacement.
the constant thumping(regular beat) is ongoing and pounding at night(regular beat) especially when lying on the left side, is really annoying. I take pills at night to sleep, prescribed by the cardiologist.
Any suggestions?
thank you
j.

As I read about mitral valve repair, it is recommended to go to a reference surgeon; especially for complex valve issues such as bi-leaflet prolapse. Is there a list of these reference surgeons and their locations? How does a person know if a surgeon is a reference surgeon or not?

Hi Adam

I was diagnosed with Rheumatic valvular heart disease when I was young, I have been attending all my regular check-up, however I would like to know how serious is my condition. From my recent health check-up my health report states;

Aortic Valve: minimally thickened with mild eccentric AR
Peak (mmHG):17
Mitral Valve: mildly thickened with slight prolapse of the AML and rigid PML and minor chordal rupture to AML, mildly thickened subvalvular apparatus with significant eccentric MR. I would like to know what does this mean in terms of my condition. I am now 23 years old and the thought of having surgery now scares me, is my condition base on this report so sever that i have to consider surgery or can I pospone it.

Thank you
Zandile

After cabg/avr two years ago I developed what was termed as a-fib. A few months ago I was examined by an EP and the thought it might be atrial flutter instead but would have to perform ablation to be sure and if it was not flutter then another ablation procedure at a later date for a-fib.

Hundreds of times I have “converted” my heart rate of about 100 by jerking my upper body. I discovered this by accident when hospitalized shortly after cabg/avr surgery with about 160 bpm. I fell asleep while being monitored and awoke with a “jerk”. Immediately, I was in sinus rythmm. The nurse said I converted myself. At that time I was on sotolol and was switched to antenolol but, for me, the rapid pulse is ALL about being overly tired, stressed or just plain ol worrying about something. Sometimes it comes on from exertion. I don’t think the antenolol helps at all. My dosage is 12.5mg morning and evening.

I have arotic regurgition mild.may be in some next few year i shall go for surgery.my problem is blood thinner. Can i go for bovine valve .is it safe if in futhur i go for reopration ..is any risk in second surgery.and what is success rate..