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If I wanted to off myself I wouldn’t want to die with heart failure. Miserable prolonged agony. Severe shortness of breath water retention with swollen legs inability to lie flat. Not a great way to go. Better to fix the valve and recalibrate.

I always wonder why anyone would sign up for this trial. The upside would be no testing and maybe less bleeding. The downside could be a stroke. That would make me very uncomfortable. I am amazed how a trial like this gets people to sign up. The other issue that comes out is sometimes...

I am curious what was the decision making process in 2004 when you had a homograft last only 5 years just prior. It looks like you lucked out going 16 years but you could easily have just gone another 5. Also you ended up with a pacemaker and this fistula that you mentioned. The only positive...

I have a friend who is a doctor. He is well enough off but he needs to get the best deal on things that he buys. So he will scour the internet looking for deals and spend countless time "researching" his potential purchase. Then he finally pulls the trigger. Not infrequently after he buys...

I have had the privilege of three open heart surgeries with 3 aortic valves. 1977 porcine-51/2 years fell apart 1983 St.Jude started warfarin. 2006 aortic aneurysm new valve also St.Jude again. Surgeon said “you don’t want to be opened up again “ (age 58). So warfarin for 39 years. Annoying...

With single valve disease depending on the status of the heart there may be other issues that develop. For example in my case I had aortic stenosis repaired with a St. Jude and had no valve problems with it. But I did develop two things both of which needed to be dealt with. One was an aortic...

Bicuspid aortic valves can do one of three things they can remain relatively OK , they can tighten up impeding the outflow of the heart , or they can loosen up and allow a reflux of blood to the heart from the aorta. Or a combination of the last two. The heart muscle can compensate to a degree...

You mentioned that you are self testing. The next step is to learn to dose the INR appropriately on your own. This will enable your son to deal with the issues directly. He will be doing this presumably for the rest of his life unless some magic valve comes out that doesn't need...

I am a super sub-specialist in my field of ophthalmology. So I often see patients who have seen several other levels of doctors who don't have a clue to what is going on. I often can tell almost immediately since I have seen these things many times. One phrase I like to use is "you don't know...

I don’t have any magic thoughts on alleviating stress. But thinking specifically about what fears you have and understanding how these fears may play out may be helpful. First fear of dying. Possible but rather unlikely in a otherwise healthy person having surgery in a solid medical...

The actual flow across the mitral valve is relatively slow from the left atrium. When the ventricle contracts the mitral should be closed and is subjected to a high pressure gradient but no flow. The aortic valve has a high gradient when open with ventricular contraction. I believe the...

I had a sort of similar story except I was much younger (age 29) when I got a tissue aortic valve in 1977. It lasted 5 1/2 years and I got a St. Jude in 1983 and went on warfarin. The problem you face is that if you have another tissue valve it is very likely it will behave like the first or at...

When drugs/devices are certified by the FDA the products are evaluated by panels of “experts” who review the data and vote on approval or not. The FDA gets the data ready from the manufacturer and makes sure it was done appropriately. I am sure that most of the FDA people are honest and not in...

Sometimes there can be significant anemia after surgery. Blood is lost. If the blood count is significantly reduced blood transfusions may be useful/needed. When I had my second surgery in 1983 replacing a failing tissue valve with a St. Jude in the aortic position I had two units of blood...

My practice is involved with a large number of drug studies on eye drugs for various retinal conditions. When these studies are initiated a lot of thought goes into trying to design the study as likely to work as possible. Recently one of the drug companies had a failed study. They analyzed...

I am not sure that this is an accurate statement. Once these devices are out in the real world the reporting on problems becomes much less stringent. Having a stroke with a mechanical valve is a known complication and would not necessarily trigger a report to the FDA. Usually the device...

I am a physician in the US with as one can see an extensive cardiac history. I also happened to have spent some time in the UK for some medical training on two different times in my career. So I know a bit about how things work in the UK albeit somewhat dated. First as far as the mitral...

I just saw your post about your bacterial endocarditis. It is unfortunate that you had such a short course of IV antibiotics on the first go round. Generally people are placed on high dose IV antibiotics for extended periods - like 6 weeks for bacterial endocarditis especially with artificial...

Of all of the things you mentioned the low oxygen saturation stands out significantly. With an ejection fraction of 60-65% you are not in major heart failure. So I think the issue is why do you have such low oxygen saturation levels? Between the cardiologist and the pulmonary doctor hopefully...

I was 29 when I had a porcine aortic valve placed for aortic stenosis that had gotten severe. The valve lasted 5 1/2 years. Then I got a St. Jude which went 23 years until I developed a large aortic aneurysm and had aneurysm surgery with another St. Jude. That was 16 years ago. So for me nearly...