About 13 months after my mitral valve repair surgery (1/28/10), I had a recurrence of pericarditis/pericardial effusion symptoms--chest pressure and discomfort and shortness of breath. After all the tests (chest x-ray, EKG, echocardiogram, Chest CT), the doctors discovered I now have moderate+ aortic regurgitation/insufficiency and thickening and/or calcification of my tricuspid valve. My surgery report from just over a year ago said: "the arotic valve was normal" and "no other abnormalities were noted." My last previous echo in March 2010 also showed none of these issues. I had a consultation appointment with my heart surgeon, Dr. Kevin Accola. This much degenerative change in just a year is surprising. No explanations why. The plan going forward is "watchful waiting." I will have echocardiograms about every 3 months to monitor for interval change. As long as the AI (aortic insufficiency) remains relatively consistent, we will continue the same. If/when the AI worsens, I'll be back to Dr. Accola for a second open heart surgery. I had no idea I had heart issues of any kind until October 2009.
UPDATE FROM THE OTHER SIDE OF SURGERY & RECOVERY:
I had a mitral valve repair surgery by Dr. Kevin Accola at Florida Hospital Orlando on 1/28/10. The surgery went very well. However, due to some blood clotting factors I had, unknown to me before surgery, I suffered a cardio-embolic stroke two days later on 1/30/10. A miraculous interventional neuro procedure dissolved two clots in my brain. I suffer no damage from the stroke. Praise God. I am now a coumadin lifer. My recovery had it's ups and downs, including some issues with pericardial effusion. It's all covered in detail in the journals. I was back to work fully in five weeks.
ORIGINAL "MY STORY" BEFORE SURGERY:
UPDATE: SURGERY DATE January 28, 2010
My name is Duane Hunt, and I’m a 50-year-old Pastor from Winter Haven, Florida. My wife Peggy and I have been married for 32 years and have 5 grown children and 8 grandchildren.
I am a very active and reasonably fit person, have intermittently jogged throughout my adulthood, but in the past 11 or so years have very much concentrated on health, fitness, and diet. I try to lift weights at Gold’s Gym a couple times a week and run 2-3 times weekly. These goals have tapered some over the past few months. When I do run, it’s usually about 7 miles. At age 40, I day hiked to the summit of Mount Whitney in California with 3 of my teen kids, a 22-mile roundtrip hike with about an 8,000’ elevation gain then loss. I’ve hiked to the top of Half Dome twice in the past decade, plus the summit of Clouds Rest in Yosemite. About a year and a half ago, one son and I hiked to the bottom of the Grand Canyon to Phantom Ranch and back up in one day (pretty grueling stuff).
Every 6 months I have an appointment with my family physician, who is a good personal friend and a member of my church family, to monitor my health, check labs, and monitor my cholesterol, which has been high but has been reduced with statins. He has listened to my heart many times. At my annual routine physical on October 21, a day after a new granddaughter was born and 4 days before a son’s wedding, my doctor listened to my heart with different attention and body language than I had afore noticed. He detected a significant heart murmur. That had never before been noted by any physician. He asked about symptoms—chest pains? Palpitations ( I didn’t even know what that meant)? Shortness of breath? Nothing I had noticed.
Last March I had to have an EKG performed in my home as part of the application process for a new life insurance policy. No problem was detected, and I was approved for the policy with an A+ health rating. There is some family history of heart disease (maternal grandmother, 2nd cousins), but nothing of a heart valve nature.
After detecting the murmur, my doctor sent me for a chest x-ray and an EKG the same day in the clinic. An echocardiogram was scheduled for October 27. The echo revealed a severe mitral valve prolapse with moderate to severe mitral regurgitation. I was floored. I don’t recall ever even hearing these words before then. At that point I began to do my research, including www.heart-valve-surgery.com and www.heart-valve-surgery.com/heart-surgery-blog, youTube, Mayo Clinic, Cleveland Clinic, Web MD, etc. You know. Wait a minute…open heart surgery (?)…is in MY future??! This couldn’t be me. It had to be someone else, right? I have my Echo report, but I’m not sure what all the numbers mean.
For the uninitiated among my friends and family: The heart has four valves, which serve as gates and seals to keep the blood flowing in the right direction as the heart pumps, and to prevent backflow in the wrong direction. The mitral valve is between the left atrium and the left ventricle. Freshly oxygenated blood flows from the lungs into the left atrium, through the mitral value and into the left ventricle. From there it is pumped through the aortic value out to flow throughout the body. A mitral valve prolapse (MVP) means that the value is leaky and does not seal properly. It is not an uncommon condition and is not necessarily anything to be concerned with unless mitral regurgitation becomes significant. When that is the case, as with me, it is normally progressively degenerative and, without surgery, leads to congestive heart failure. The backflow overload causes the heart to work harder and harder, enlarging and weakening it over time, and eventually leading to failure. Ideally surgery is performed before the heart itself is significantly damaged. Repairing the valve is greatly preferred to replacing the valve. This is open heart surgery and has traditionally been with the sternotomy. In recent years, less invasive surgical techniques have been developed.
On November 11, I had my first appointment with a cardiologist (I have a cardiologist?!), beginning with another EKG. He reiterated what my research had revealed. My left atrium is a bit enlarged; my left ventricle is not enlarged but the EKG showed increased voltage. I then had an exercise stress echocardiogram test (the same day), and the cardiologist said it was “perfect” as we consulted afterward. He seemed surprised that I was asymptomatic. In retrospect, I have experienced some heart palpitations and fatigue, but heart issues never even crossed my mind. Now that I know, I don’t want to create the symptoms via anxiety, if you know what I mean.
My cardiologist felt that the prolapse does not currently warrant surgery but that surgery was not IF but WHEN and would be likely within “a couple years.” He recommended watchful waiting for now, with another echocardiogram in 6 months to see if the condition progresses. Exercise is okay. No restrictions noted. He told me to contact him immediately if I started developing shortness of breath especially.
With all of my research, I decided a second opinion would be in order. Though there are very good hospitals and physicians nearby, I also decided, when the time comes, I want to go to a high quality, high volume heart surgery center with much expertise and experience with heart valve repair surgery. In my area, this points to Florida Hospital in Orlando (50 miles away). I also personally very much appreciate their faith based approach to health care. Thanks to this web site treasury, Adam’s book, and other research, I decided that Dr. Kevin Accola, Cardiovascular Surgeons, Orlando is my surgeon of choice. Of course, I am very much hoping and praying for a mitral valve repair (rather than replacement) using minimally invasive surgical techniques. I have an appointment with Dr. Accola on December 21, taking all my labs and reports with me, and I am very anxious to learn his assessment. Regardless of the timing of the surgery, at least I will already be established with and known by him.
As many of you know, a diagnosis like this is very overwhelming. I so appreciate all the contributions made by Adam, this web site and blog. Thank you. For me right now…only the beginnings. Unless God chooses to heal me first, I am heading for surgery sooner or later; I just don’t know at this time if it will be sooner or later. Thank you for your prayers.