{"id":7258,"date":"2012-01-27T14:00:29","date_gmt":"2012-01-27T19:00:29","guid":{"rendered":"http:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/?p=7258"},"modified":"2019-03-05T15:31:15","modified_gmt":"2019-03-05T20:31:15","slug":"asymptomatic-patients-richard-lee-md","status":"publish","type":"post","link":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2012\/01\/27\/asymptomatic-patients-richard-lee-md\/","title":{"rendered":"&#8220;Do Asymptomatic Patients Really Need Heart Valve Surgery?&#8221; with Dr. Richard Lee"},"content":{"rendered":"<p>Following our last post about watchful waiting for patients with moderate heart valve disease, I received several emails from asymptomatic patients. While each email was unique, most patients were curious to know if patients <span style=\"text-decoration: underline;\">without<\/span> symptoms should undergo heart valve repair and heart valve replacement procedures &#8212; for conditions including aortic stenosis and mitral regurgitation.<\/p>\n<p>Luckily, during my recent tour of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital in Chicago, I was fortunate to discuss this topic with Dr. Richard Lee, an associate professor of cardiac surgery. The video below contains the highlights of our discussion. (For the hearing impaired members of our community, I have provided a written transcript of this video below.)<\/p>\n<p>&nbsp; <\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/FvAcx48LwCU\" frameborder=\"0\" allowfullscreen><\/iframe><\/p>\n<p>&nbsp; <\/p>\n<p>Thanks to Dr. Richard Lee for taking the time to share his clinical expertise with our community. To learn more about Dr. Lee, please click <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Richard-Lee-Chicago-Illinois.php\">here<\/a>.<\/p>\n<p><!--more--><\/p>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n<p>P.S. Here is the transcript to my discussion with Dr. Lee:<\/p>\n<p>Adam: \u201cHi everybody, it\u2019s Adam, and we are answering your questions that were put up at HeartValveBlog.com.\u00a0 Today, I\u2019m thrilled to be at the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital in Chicago, Illinois.\u00a0 I\u2019m with Dr. Richard Lee, a cardiac surgeon here, and we\u2019ve got just a great question for Dr. Lee, and I hear it all the time.\u00a0\u00a0 And the question is: Adam, I feel great.\u00a0 I don\u2019t have any symptoms, but I\u2019m being told that I need to have heart valve surgery.\u00a0 Do I really need surgery if I\u2019m asymptomatic?\u201d<\/p>\n<p>Dr. Richard Lee: &#8220;Well the answer is, it depends.\u00a0 But, I\u2019d say the first thing you need to do is talk to your family members.\u00a0 So many times, we see this all the time, where there is a husband and he comes in and he says he doesn\u2019t have any problems, and his wife says wait a second, you get short of breath now much more than you did before.\u00a0 So I\u2019d start with really taking a thorough history and physical, and seeing if there are symptoms or not.\u00a0 But even if there are no symptoms, sometimes the answer is still yes.\u00a0 There are different conditions of the heart, as you know.\u00a0 There is four different valves, and the valves can either be tight or leaky, and there are really three conditions, of those valves, that probably merit consideration for operating on asymptomatic patients.<\/p>\n<ul>\n<li>The first one is <a href=\"https:\/\/www.heart-valve-surgery.com\/mitral-valve-regurgitation-symptoms-leaking.php\">mitral regurgitation<\/a>, that\u2019s a <a href=\"https:\/\/www.heart-valve-surgery.com\/leaking-heart-valve-symptoms.php\">leaky heart valve<\/a> on the left side of the heart.\u00a0 If you have a leaky in valve on the left side, mitral regurgitation, the answer is yes. \u00a0Even if you are asymptomatic, you should get a heart operation.\u00a0 And why is that?\u00a0 Well we know from many studies that if you don\u2019t fix that problem early on, you\u2019ll get worse and worse and worse and actually have, not only symptoms, but a lower survival.\u00a0 If you fix the problem before those other problems occur, and prevent those larger problems, you\u2019re survival is just the same as yours or mine.\u00a0 So, for mitral regurgitation, if you go to a center, with a very low operative mortality, and a very high repair rate, meaning keeping your own valve and just fixing it, then you definitely should get repaired for asymptomatic mitral regurgitation.<\/li>\n<li>For some of the other conditions, like aortic stenosis, we know if you have a tight out valve on the left side, more and more data are emerging suggesting that if you don\u2019t take care of that problem, even when you don\u2019t have symptoms, you will have symptoms. \u00a0You will go on to need an operation or it will cause you some harm.\u00a0 So, I think over time, we support that, if that valve is causing problems, we should at least watch it very closely and maybe down the road, even if they\u2019re asymptomatic, getting that taken care of.\u00a0 We also know if you have a tight valve, out valve, on the left side, at the time of regular cardiac surgery, it needs to be replaced. To learn more about aortic stenosis, <a href=\"https:\/\/www.heart-valve-surgery.com\/aortic-stenosis-valve-heart-narrowing.php\">click here<\/a>.<\/li>\n<li>And the last condition is tricuspid insufficiency.\u00a0 It\u2019s the in valve on the right side of the heart.\u00a0 Well, if you\u2019re asymptomatic, you shouldn\u2019t go to the operating room, just for that.\u00a0 But more data is suggestion that if you have a leaky in valve and you\u2019re going to heart surgery for another reason, you probably should get that fixed as well.\u00a0\u00a0 Because we know it probably doesn\u2019t go away when you correct the other problems, and we know that if you don\u2019t take care of it, at the time of surgery, it\u2019s much harder and patients do much worse. So those are really the three main conditions that patients should consider surgery for, if they don\u2019t have any symptoms.\u00a0 For all the rest of the valve problems, really probably very close monitoring with your cardiologist is a better route.\u201d<\/li>\n<\/ul>\n<p>Adam: \u201cGreat, well Dr. Lee thanks so much for answering our question and all of the great clinical work you are doing here at Northwestern.\u00a0 We really appreciate it.\u201d<\/p>\n<p>Dr. Lee: \u201cMy pleasure.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":25672,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[70],"tags":[],"class_list":["post-7258","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-before-surgery"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/7258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/comments?post=7258"}],"version-history":[{"count":0,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/7258\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/media\/25672"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/media?parent=7258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/categories?post=7258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/tags?post=7258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}