Hubert's Heart Valve Journal

When I was about 35, my local doc heard a murmur when listening to my heart. Going for an echocardiogram showed I had a bicuspid aortic valve (BAV). They said to monitor it, but since I had absolutely no signs and was strong as a horse, I didn't give it much thought. I went about my work as a dairy cow veterinarian (very physically demanding) only focused on helping my farmers' cows, not focused on me much at all. Now its 12 years later and for the last couple years i have been feeling achey and tired a lot more. Wanting to get into shape, I went to a local doc for a physical exam since I knew I had the BAV and didn't want to start exercising and just keel over. First thing they always do is take a blood pressure: 120/40. I thought, "Great, nice and low". They said, "No, that is too low". Then they immediately did an EKG and found a possible LVH (Left ventricular hypertrophy) and two days later I am running a stress test and had a new echo done. I passed the stress test well (got up to 13 minutes) but the valve murmur was moderate to severe. Then they did a Trans Esophageal Echo (TEE) to see the dynamics of the aortic regurgitation (back flow) more specifically. It was an eccentric murmur, which is more difficult to predict. They put me on amlodipine (Norvasc?), to lower the difference between the 120/40 (which is 80 - also called the pulse pressure), which gives me a bounding pulse (wide difference between resting phase and working phase of the blood pressure). In a nut shell, I was told i am a classic, textbook case of Bicuspid Aortic Valve insufficiency: it catches up with you in the 4th to 5th decade, a bounding pulse, along with PVCs (premature ventricular contractions) which feel like the heart is almost doing a summersault occasionally, but especially after eating, for whatever reason. The amlodipine was increased to maximum within 3 months as my heart would be pounding while I would be at rest simply reading a book. They did another echo 5 months after the first and the regurgitation (backflow which causes the murmur) is more significiant and not too easily followed since it is worsening. Initailly they said I would need a surgery in 3-5 years but with the second echo 5 months later, they say surgery next spring. So now I am surgeon shopping (well, only between two potential hospitals) after reading Adam's book. Last week I had a CTA (Cardio Thoracic Arteriogram) done to check the coronary arteries, which is a new alternative to the standard cardiac catherization. Coronary arteries are all clear (fortunately) but the root of the aorta is about 44 mm, which is enlarged. People with BAV also tend to have enlarged aorta, which is truly a problem as it can lead to aneurysm and possibly dissection (keel over, permanently). Anyway, i have near complete confidence in aortic heart valve surgery, mainly because my dad had it done in 1975. He also had BAV but also stenotic valve leaflets (my are quite flexible still) and an aortic coarctation, which was surgically corrected in 1950(!). Addionally, my mom had her aortic valve replaced in 1991 and her two sisters also had stenotic aortic valves which have all been replaced. So it runs in my family - but now I am "it". In actuality, I am more worried about the recuperation than the actual surgery, as I have seen the surgeries go well in my family. Perhaps more worrisome is the possibility of hospital acquired infection. I'm a veterinarian and perhaps know too much. But as trained medical professional I can tell you that emergency medicine and major surgical procedures are the crowning achievements of modern medicine. My game plan for the next few months is to get in as good shape as possible, lose 10+ pounds (I'm 210 at 6'0") and exercise with a rowing machine (I love it!). Hopefully I'll bounce back better.

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When I was about 35, my local doc heard a murmur when listening to my heart. Going for an echocardiogram showed I had a bicuspid aortic valve (BAV). They said to monitor it, but since I had absolutely no signs and was strong as a horse, I didn't give it much thought. I went about my work as a dairy cow veterinarian (very physically demanding) only focused on helping my farmers' cows, not focused on me much at all.

Now its 12 years later and for the last couple years i have been feeling achey and tired a lot more. Wanting to get into shape, I went to a local doc for a physical exam since I knew I had the BAV and didn't want to start exercising and just keel over. First thing they always do is take a blood pressure: 120/40. I thought, "Great, nice and low". They said, "No, that is too low". Then they immediately did an EKG and found a possible LVH (Left ventricular hypertrophy) and two days later I am running a stress test and had a new echo done. I passed the stress test well (got up to 13 minutes) but the valve murmur was moderate to severe. Then they did a Trans Esophageal Echo (TEE) to see the dynamics of the aortic regurgitation (back flow) more specifically. It was an eccentric murmur, which is more difficult to predict. They put me on amlodipine (Norvasc?), to lower the difference between the 120/40 (which is 80 - also called the pulse pressure), which gives me a bounding pulse (wide difference between resting phase and working phase of the blood pressure). In a nut shell, I was told i am a classic, textbook case of Bicuspid Aortic Valve insufficiency: it catches up with you in the 4th to 5th decade, a bounding pulse, along with PVCs (premature ventricular contractions) which feel like the heart is almost doing a summersault occasionally, but especially after eating, for whatever reason. The amlodipine was increased to maximum within 3 months as my heart would be pounding while I would be at rest simply reading a book. They did another echo 5 months after the first and the regurgitation (backflow which causes the murmur) is more significiant and not too easily followed since it is worsening. Initailly they said I would need a surgery in 3-5 years but with the second echo 5 months later, they say surgery next spring. So now I am surgeon shopping (well, only between two potential hospitals) after reading Adam's book. Last week I had a CTA (Cardio Thoracic Arteriogram) done to check the coronary arteries, which is a new alternative to the standard cardiac catherization. Coronary arteries are all clear (fortunately) but the root of the aorta is about 44 mm, which is enlarged. People with BAV also tend to have enlarged aorta, which is truly a problem as it can lead to aneurysm and possibly dissection (keel over, permanently).

Anyway, i have near complete confidence in aortic heart valve surgery, mainly because my dad had it done in 1975. He also had BAV but also stenotic valve leaflets (my are quite flexible still) and an aortic coarctation, which was surgically corrected in 1950(!). Addionally, my mom had her aortic valve replaced in 1991 and her two sisters also had stenotic aortic valves which have all been replaced. So it runs in my family - but now I am "it".

In actuality, I am more worried about the recuperation than the actual surgery, as I have seen the surgeries go well in my family. Perhaps more worrisome is the possibility of hospital acquired infection. I'm a veterinarian and perhaps know too much. But as trained medical professional I can tell you that emergency medicine and major surgical procedures are the crowning achievements of modern medicine.

My game plan for the next few months is to get in as good shape as possible, lose 10+ pounds (I'm 210 at 6'0") and exercise with a rowing machine (I love it!). Hopefully I'll bounce back better.