Klara's Guestbook

Ana Brusso  Agree with Richard. I’m sure you are very busy being a physician, mother and wife. Write when you can. 

Klara Čičić  Hi Svetlomir, yes I am. Some days I forget 🙈 but I try not to...baby aspirin after mitral valve repair in a younger person without risk factor is still unsolved problem, some experts are pro, some are contra and I guess the decision in the end is individual :) Take care! 

Svetlomir Ivanov  Yes, I knew that, but what is the exat logic - if, the purpose is blood thiining, sintrom is much more efective. By the way, do you have artificial chords to ancor your MV leaflets, or you surgery was just resection of the extra tissue ?

Klara Čičić  This is from UpToDate, one of the best international medical guidelines: "Limited evidence is available to guide antithrombotic therapy following surgical valve repair. Studies of patients who have undergone surgical valve repair indicate a significant risk of thromboembolism. Annuloplasty ring-associated thrombus and thromboembolism have been reported, even in patients receiving short-term anticoagulation. However, the optimum regimen to reduce the risk of thrombotic complications of valve repair has not been established.
Observational studies of patients with surgical mitral valve repair have not established a significant benefit from routine postoperative warfarin therapy compared with aspirin therapy, but the findings are inconclusive given study limitations."  I have artificial chords and a ring, no resection was made. As you can see, the brightest of minds haven't reached a consensus yet. Go with your gut and your doctor's advice :)

Svetlomir Ivanov  So do I, I have chords and ring, no resection. But exactly in this site dr.Gedrish said that after 3 months the ring is overgrown with tissue and no longer exposed to the blood. Same about the chords. I see the issue is cotraversial. May be we should ask mr.Adam Pick to interview the surgeons ? 

Klara Čičić  You can ask mr. Pick to interview them, but I don't think that we will get any different answer :)  warfarin is mandatory only the first three months after the repair. After that it is up to your cardiologist who makes the decision - warfarin,baby aspirin or nothing at all  based on known scientific evidence, on your individual history and risks.... 

Svetlomir Ivanov  Today was my 6-month control check after the operation. Aspirin was prescribed instead of sintrom for half year, but maybe permanent. But in America this is not like that, americans think that only 3-4 month after the surgery is enough

Klara Čičić  Andrew!!!!! :))) Long time no hear!!! I am doing fine, preparing for my final exam to become full GP specialist after 4 years of residency and 6 years of college! I think it is enough:))) 10 more days ....it's a huge test and huge stress. I miss my kids but study all the time.... Heart is hopefully dealing with this stress, time will show.... sometimes heavy breathing....I assume it's just anxiety from this exam. How are you, your job, your beautiful girl and wife? How are you mentally? Heart? Tell me all! 

Andrew Dial  Klara that is amazing! Wow, you have been putting your heart and soul into that, haven’t you!? You are an inspiration!! So what is your main goal in the end with your career? Heavy breathing… I’d assume that’s probably from anxiety as well. 

Things are well on my end, busy busy, as always haha. I’m building boats again, but for a different company. I’m on my feet for 10 hours a day in the cold, so I’m really putting my body thru some stuff, but I’m dealing pretty well. I have had some depression/anxiety going on, so I am on a low dose anti depressant. We will see how that goes in the coming weeks. But I am excited for better weather in the spring and then eventually summer, when we will be doing lots of camping and fishing!! Girls are good, Aubrey is in 1st grade and loving it, wifey is working her butt off as always. 

so glad to hear from you fellow heart Warrior :) 

Klara Čičić  This sounds good Andrew, I am glad you are doing the low dose antidepressants. I take anxiolytic every now and then, I am no longer trying to be "a hero", life is too short and I want to take care of my heart better so I help myself any way I can instead of suffering needlessly. Two days ago I took the final residency exam and it was brilliant, I am finally done with formal education (6 years of medical school, then 4 years of GP residency ) and now I am officially family medicine specialist (like dr. Mike haha, I guess you know who he is) on Monday I start working in my GP office... I am looking forward to that, although it isn't an easy job, it has many challenges.... Take care of your heart and be careful with it. It is harder to do that when you are young like us, I think.... And I want that hoodie, Andy! :)))

Klara Čičić  That is so valuable to hear, I always like to hear older (is that also forbidden word now?) and wiser than myself and I take notes. Trying to learn and do my best as a parent.... I have more confidence now so it is easier in that sense, but luck does play a role and by now, luck has been by our side. Your grandkids are lucky to have such a sharp and funny grandad. That is invaluable. 

Richard Munson  You sound like a great parent. The trick is to be a parent, not a best buddy. You want your kids to respect you. We are going thru it right now with shadow. As our trainer says, he will always love us but respect is what separates the good ones from the bad. 

Klara Čičić  Wow that is a good one! I agree and am trying my best to achieve just that. It's not easy, but if you have self-respect to begin with, it isn't unachievable also! :) I love parenting, just not the sleepless nights. Those were a nightmare (well, I wish there was a chance for a nightmare, but no, there was zero sleep haha).  Now that everyone sleeps it is much more enjoyable. 

Klara Čičić  I took warfarin for 4 months. I stopped after cardiac rehab, after some tests like echo and 24h holster.... Just sharply stopped and continued only beta blocker and baby Aspirin.

Klara Čičić  I am fine thank you, feeling good, no major issues. I have echo in 2 months and am already a little bit anxious....

Svetlomir Ivanov  Do not worry,one person here (Travis Watson, you may see his profile) has moderate regurfitation after mitral valve repair for 12 y., but it stay stable.I knew that, because I am corresponding with him for these 12 y.
I do not know what kind of repair is yours: resection or implantion of chords to ancor to leaflets? But probably it will last very long time or forever. Why do you presume that the MR will for sure worsen? Now you have reapir to close the gaps in the valve, and MR is just a result of the fact, that it was not watertight seal. Of course, it is better to have no MR, but read this:

https://www.heart-valve-surgery.com/heart-surgery-blog/2012/02/08/mitral-regurgitaiton-progession-craig-smith/

Klara Čičić  Oh, your words are golden for me :))) I surely hope it will last as long as you say, but I just look at it rationally, a looked at data - data shows that more complex repairs after Barlow's disease have higher chance for failure, and last shorter than simplex repair, especially when done in a younger person, which is kind of logical cause it has to endure more...

Svetlomir Ivanov  If you stay outside when raining, you have a higher chance to be struck by tunderstorm :) You are not a chance, but individual, chanses are based on statistics. By the way what is you heart rate per minute? Was it higher after surgery and for how long? Did you take beta blocker and for how long time?

Svetlomir Ivanov  Could you say, also, how long time was necessary you heart beat to normalise? How many monts, and to tell me the nimbers, i.e. your heart beats per minite before and after surgery? Waht about the beta blocker, do you continue to take it, and why (if the heart rate is normal)?

Klara Čičić  I take beta blocker bisoprolol from highschool days 1,25mg daily. My heart rate was and still is around 80-85/min. Regarding size of heart chambers, my LA was back withing normal range in 6 months after the surgery, and was enlarged before the surgery. I can not tell you exact numbers at this moment.... How are you doing? Are you off diuretics finall? 

Svetlomir Ivanov  Hi Klara, I am doiing pretty well, I am able to climb even 9th floors, of cours last floors I have to breath more deeply. No problems with walking, but still not try to running and heavy lifting. My heart rate vary, about 70-80, but on the last echo before several days, it was 95, probably because of especting results...and doc prescribe a beta bloccker, 2,5 mg. bisoprolol, but maybe 1,25 mg will be enough. But the Sintrom (bllod thinner) doc did not stop, tell me to take for  onther 3 months. Diuretics I qiut by myself because my BP is 120/80 ene even less. Of course, on the check it was 130/80, but it was measured when I was standing almost, and of course again under pressure of waiting.

Klara Čičić  It went very well! :))) very happy. Hope my heart endures it all haha. I still have 2 parts of the exam to do.