Surgeon Q&A Video: “Is It Common To Have A Murmur After Heart Valve Surgery?” Asks KerriganPosted by Adam Pick on October 1st, 2012
I recently received a great question from Kerrigan about heart murmurs after heart valve surgery. In his email, Kerrigan writes, “Hi Adam – I had aortic valve replacement with a porcine valve three years ago. Since the valve replacement, I’ve had a detectible murmur that has not changed since the first, post-op baseline echocardiogram. Is it common to have a murmur after heart valve surgery?”
To answer Kerrigan’s question, I met with Dr. Luis Castro, MD, the Medical Director of Sequoia Heart Institute. During his career, Dr. Castro has performed over 3,000 heart valve procedures. You can see the highlights of our discussion in this video. For the patients in our community who are hearing impaired, I have provided a transcript below.
I hope this video helped Kerrigan (and perhaps you) learn a little more about heart murmurs after valve surgery.
Thanks to Kerrigan for his question and a special thanks to Dr. Castro for sharing his clinical experience with our patient and caregiver community.
Keep on tickin!
P.S. Here is the transcript from my discussion with Dr. Luis Castro:
Adam: Hi everybody, it’s Adam from HeartValveSurgery.com. I’m very happy to be here with Dr. Luis Castro from Sequoia Heart Institute, in Redwood City, California. We were just having a conversation about valve surgery. But, before we discuss the patient question… Can you tell me, Dr. Castro, a little about your background here? You’re the medical director as I understand it.
Dr. Luis Castro: Absolutely
Adam: And about your history with valve therapy?
Doctor Castro: I’ve been here for 14 years now, almost 15 years. It’s a pleasure to have you here today Adam. Our valve practice here has evolved over many years. There’s been many iterations, there’s lots of great people that have been here before me. This little hospital here in Redwood City, does 80% valves, for the most part. We do our aortic valves through tiny little incisions; we call it small incision surgery. Most people think of it as minimally invasive. But we know that it adds tremendous value. Mitral valve operations are done through small incisions. Aortic valve operations can be done that way too. And we get a whole host of operations that are more complicated. This is our third case of the day today; patient had an operation 4 years ago, had a bypass operation that has failed. And now she needs re-operation surgery and she may need a mitral valve repair as well, on top of that. The first two operations of the day today were a mitral valve repair in a young man and we did an aortic valve replacement, both through mini incisions in an older woman.
Adam: That’s great, how are the patients doing?
Luis Castro, MD: They are doing beautifully, they are doing all fine. Obviously we know that the operation is one small part of the total care of the patient. Really needs a team, this is about a team. You can have great operating room staff and have great skill in the operating room, but the ICU is so critical and beyond the ICU the care that they get in the step down unit is critical. And then the post-operative care is as important as well, the recovery. Because we know this is a process.
Adam: Speaking of teams, we’ve got a great team of patients out there and they often right in with questions. And one of the questions that I got recently was from Kerrigan. He wrote in to me that he had aortic valve replacement three years ago and his first echo, what you call the base line echo, showed a heart murmur after valve surgery. As patients we here “murmur after surgery” we get a little nervous. Is this common for patients to have a little heart murmur after valve surgery?
Doctor Castro: A murmur is very common. A murmur is just a little sign that there may be a little bit of turbulence or abnormal flow through a valve. That is the first signal that you need an echocardiogram. The echocardiogram needs to explain what that murmur might be. In patients who’ve had valves, the valve prosthesis, if you will, meaning either mechanical heart valve, or pig, or bovine or cow is an abnormal tissue that is suspended within a stent, within a frame. That in itself produces a sound that we interpret is a murmur. The most important thing about that patient is that he does need follow up because a murmur is just a murmur, the images on the echocardiogram determining whether or not that murmur is pathologic, meaning the valve is getting narrowed or is leaking are more important. So I am sure that valve is fine.
Adam: And so for Kerrigan, your recommendation for him though would be to keep having annual echocardiograms.
Dr. Luis Castro, MD: Annual echocardiograms, enjoy life, a murmur is quite normal. I may have a benign murmur. But the images on the echocardiogram determine exactly what is causing that noise and we know just by having a valve creates murmurs.
Adam: Well on behalf of all of the patients out there, and all the patient testimonials that you get from your patients, I know how much your work means to them, so I wanted to thank you for your ongoing commitment to the space, your dedication, your pursuit of healthy hearts. We really appreciate it.
Dr. Castro: Well thank you Adam.