Hard pounding in the chest after mechanical AVR

I think I had some of that with my On-X aortic valve installation. The mechanical engineer in me thinks some of the effect could be due to the fact that we both now have e a working valve which flows well and opens/shut correctly. Higher flow, so the heart is volumetrically flowing more and actuating differently. The other possible 'hydro'dynamic effect could be that these valves close rapidly, and the dynamic pressure wave in the aorta will be higher. I can imagine both of these effects causing different noises and motion.

After a short time, the clicking and thumping are absolute non-issues.

JWalters said:

I think I had some of that with my On-X aortic valve installation. The mechanical engineer in me thinks some of the effect could be due to the fact that we both now have e a working valve which flows well and opens/shut correctly. Higher flow, so the heart is volumetrically flowing more and actuating differently. The other possible 'hydro'dynamic effect could be that these valves close rapidly, and the dynamic pressure wave in the aorta will be higher. I can imagine both of these effects causing different noises and motion.

After a short time, the clicking and thumping are absolute non-issues.

Click to expand...

"Higher flow" - the valve doesn't cause higher flow - your heart pumps what your body needs - a new valve would cause lower velocity through the valve (whether from a stenotic valve or one that has significant leakage). The "valve close(s) rapidly" is correct, in about 30 ms. - this is what causes the click. The pressure on the aortic valve is lower than on a mitral valve.

JK

JWalters said:

I think I had some of that with my On-X aortic valve installation. The mechanical engineer in me thinks some of the effect could be due to the fact that we both now have e a working valve which flows well and opens/shut correctly. Higher flow, so the heart is volumetrically flowing more and actuating differently. The other possible 'hydro'dynamic effect could be that these valves close rapidly, and the dynamic pressure wave in the aorta will be higher. I can imagine both of these effects causing different noises and motion.

After a short time, the clicking and thumping are absolute non-issues.

Click to expand...

What’s your mean gradient J? I have exactly the same valve and size as you but my gradient is still a bit high at 22.

nobog said:

"Higher flow" - the valve doesn't cause higher flow - your heart pumps what your body needs - a new valve would cause lower velocity through the valve (whether from a stenotic valve or one that has significant leakage). The "valve close(s) rapidly" is correct, in about 30 ms. - this is what causes the click. The pressure on the aortic valve is lower than on a mitral valve.

JK

Click to expand...

That's a better way to say it

9mmHg is my Ao mean PG. EF is on the low side at 58%, and my Ao diameter is on the high side at 3.7cm. At least all this has been stable for 7 years now.

Windfinder said:

What’s your mean gradient J? I have exactly the same valve and size as you but my gradient is still a bit high at 22

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Windfinder said:

Good to know, seems like it’s kind of normal then. Btw, what’s your heart rate 8 weeks post op? I am 5 weeks post op now and it’s still so much higher even with a beta blocker. Resting heart rate is 75 and after eating it stays in the high 80’s for a good couple of hours or more.

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Sorry— I seemed to have missed this.

Current resting is 70-75 as I type this message. Any walking/activity bumps it to 80-90 and exercise still has it 100-125 depending on intensity.

Up until week 4-5 it was consistently 80-95 at rest even with my metoprolol. Recently it has slowed down a bit but is still above my pre-surgical resting of 60-65 and towards the end of my dose of metoprolol, does drift up 80’s or low 90’s.

I think it just takes time to remodel and heal and exposure to gradual cardiovascular exercise to fully come back down. It’s not pounding/racing like it was earlier in my recovery so I consider that a win, and continue to see trends of improvement!

Hey!

What’s your height and weight? And what size On-X AV do you have?

For the record, I’m over two years post op with a 23mm On-X and …

My resting heart rate is generally 10bpm more than before surgery. It has never returned to pre-surgery levels. That said, I don’t think that has been an issue for me.

I was not prepared for the huge thumping in my chest after surgery. I knew about the clicking and accepted that. But I wasn’t prepared for the thumping. I am happy to say that the thumping decreased as I healed. At this point, I don’t notice it much anymore. I do notice it when I exercise and also when I lay on my left side.

I asked about your height and weight, because I have always had this curiosity as to whether the much larger size of the On-X valve contributes to the thumping. For medium-ish individuals like myself (5’9”, 170lbs), the larger valve potentially takes up more room when considering the ratio of space available to valve external area, and could potentially conduct sound better to the rest of the body.

The difference in size between an On-X and a St. Jude valve is quite dramatic. If I could do it all over again I wouldn’t have bought into the hype of the On-X and would have gone with the tried and true St. Jude’s valve.

Timmay said:

The difference in size between an On-X and a St. Jude valve is quite dramatic. If I could do it all over again I wouldn’t have bought into the hype of the On-X and would have gone with the tried and true St. Jude’s valve.

Click to expand...

resepct dude, Witness!!

ncw3642 said:

Sorry— I seemed to have missed this.

Current resting is 70-75 as I type this message. Any walking/activity bumps it to 80-90 and exercise still has it 100-125 depending on intensity.

Up until week 4-5 it was consistently 80-95 at rest even with my metoprolol. Recently it has slowed down a bit but is still above my pre-surgical resting of 60-65 and towards the end of my dose of metoprolol, does drift up 80’s or low 90’s.

I think it just takes time to remodel and heal and exposure to gradual cardiovascular exercise to fully come back down. It’s not pounding/racing like it was earlier in my recovery so I consider that a win, and continue to see trends of improvement!

Click to expand...

Thanks a lot NCW, very useful information, gives me peace of mind as I feel what I’m going through is normal then.

Timmay said:

Hey!

What’s your height and weight? And what size On-X AV do you have?

For the record, I’m over two years post op with a 23mm On-X and …

My resting heart rate is generally 10bpm more than before surgery. It has never returned to pre-surgery levels. That said, I don’t think that has been an issue for me.

I was not prepared for the huge thumping in my chest after surgery. I knew about the clicking and accepted that. But I wasn’t prepared for the thumping. I am happy to say that the thumping decreased as I healed. At this point, I don’t notice it much anymore. I do notice it when I exercise and also when I lay on my left side.

I asked about your height and weight, because I have always had this curiosity as to whether the much larger size of the On-X valve contributes to the thumping. For medium-ish individuals like myself (5’9”, 170lbs), the larger valve potentially takes up more room when considering the ratio of space available to valve external area, and could potentially conduct sound better to the rest of the body.

The difference in size between an On-X and a St. Jude valve is quite dramatic. If I could do it all over again I wouldn’t have bought into the hype of the On-X and would have gone with the tried and true St. Jude’s valve.

Click to expand...

Hi Tim, I am 6’4” and about 195 pounds. I have the 23 mm On-X because they could not fit in a 25 mm but I got surgery at a top hospital and they had paid a lot of attention to the possibility of ppm and they feel 23 mm will work fine but obviously I would have loved a 25mm. I think it is hard to tell if a 25 mm would make the thumping worse.

I’ve heard the st Jude may be quieter, but some people complain a LOT about it too, I think it depends more on your body type and the “resonance box” that our thorax is.

In regards to the valve itself, I don’t regret it and you shouldn’t regret either. I think both valves are great, they have some pros and cons. I have seen some comments and some articles where they doubt the validity of the PROACT trial for the reduced INR of On-x but the reality is the new data came out recently (May 2024) and the results of the On-x in aortic position are actually better than what they predicted based on PROACT. Also, let’s face it, both companies ( Abbott and Artivion) and for profit corporations and their goal is to increase shareholder value ( increase share price however they can). The reduced INR ( if true) is a good selling point, why is Abbott not getting it in the US? I believe they are doing it in China though…Even if the valve line of business in the USA is not their main source of revenue (it’s probably very small) it would definitely help as Onx is gaining market share in the mechanical segment ( and this is true internationally). It can’t be just Artivion marketing department is great, I am sure Abott marketing staff are not silly either, anyhow…both valves seem to be great so we are lucky to have the choice

Hi

Windfinder said:

I have the 23 mm On-X because they could not fit in a 25 mm

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basically that's as big as it goes ... the size of the hole is maxed out at 23mm


Page 6

https://www.onxlti.com/wp-content/u...-On-X-IFU-Booklet-English-Website-Version.pdf

So as far as I know the other sizes are to accomodate the hole they cut in your heart (also called annulus IIRC).

I believe someone here can clarify this more.

So basically I'm saying "I think you got effectively the biggest they make" (when it comes to effective Orifice Area)

Best Wishes

pellicle said:

Hi



basically that's as big as it goes ... the size of the hole is maxed out at 23mm

View attachment 890500
Page 6

https://www.onxlti.com/wp-content/u...-On-X-IFU-Booklet-English-Website-Version.pdf

So as far as I know the other sizes are to accomodate the hole they cut in your heart (also called annulus IIRC).

I believe someone here can clarify this more.

So basically I'm saying "I think you got effectively the biggest they make" (when it comes to effective Orifice Area)

Best Wishes

Click to expand...

Pellicle, I think the 25 mm gives you 23.4 mm internal which is exactly 2 mm more than the 23 mm that gives you 21.4 mm….am I missing something or you jumped a line….

Windfinder said:

or you jumped a line….

Click to expand...

Seems to be that, sloppy work on my part.