“Is Heart Valve Leakage Common After Valve Repair Surgery?” Asks Valerie
By Adam Pick on May 22, 2012
Valerie sent me an interesting question about leaky valves after heart valve repair surgery.
Her email reads, “Hi Adam – I had my mitral valve and tricuspid valve repaired in October 2011. I recently had an echocardiogram done. The echo showed that both valves are leaking (mildly). I went to my cardiologist and the surgeon to discuss this. They both told me there was “nothing to worry about”. I am worried! I cannot seem to get a straight answer. Is this common to have leakage after a repair with an annuloplasty ring? I would appreciate any information you have on this situation of a mild leak after a repair. Thank you, Valerie”
Leaking Mitral Valve Diagram
As I’ve received this question twice in the last week, I wanted to provide Valerie (and you) an expert response, so I contacted Dr. Patrick McCarthy, the Chief of Cardiothoracic Surgery at Northwestern Memorial Hospital in Chicago, Illinois. During his thirty-year career, Dr. McCarthy has performed over 10,000 cardiac procedures of which more than 4,000 included valvular treatment.
In response to Valerie’s question, Dr. McCarthy first addressed the commonality of regurgitation after valve repair surgery:
It’s not uncommon to have a mild leak after valve repair. In fact, it’s not uncommon to find this in people without major heart disease. The mild leak means that a few drops of blood go backwards through the valve when the heart contracts. Echocardiograms are very sensitive at detecting this reversed flow. It’s unlikely that the amount of blood is enough to create a heart murmur (the abnormal sound made when blood flows through a leaky, or through a stenotic, heart valve).
Then, Dr. McCarthy discussed the potential causes of the leak:
The most common cause of a mild leak after repair is that the leaflets do not line up just right. When the leaflets hit together during valve closure, a small amount of blood may leak. If the repair was performed for ischemic mitral regurgitation (from a weak heart after a heart attack), then mild, or even moderate or more regurgitation, may be seen although repair in that condition has been improving in the past several years. Mild leak is less common when the repair was performed for degenerative or myxomatous prolapse.
In his closing remark, Dr. McCarthy discussed the potential next steps given this situation:
Even though common, the physician will usually suggest a repeat follow-up echocardiogram in 6-12 months to make sure that there is not progression. In most patients it remains stable.
Thanks to Valerie for her question and a special thanks to Dr. McCarthy for sharing his clinical experience and research specific to heart valve leakage after surgery.
- To learn more about Doctor Patrick McCarthy, cardiac surgeon, please click here.
Keep on tickin!