Are there varying levels of Moderate?

[Jkm7]

The first echo I had about 18 months ago showed what my cardio called Moderate Regurg at Mitral Valve. A subsequent one, about 6 months later, showed slight. Now, I've had a third (due to my telling him symptoms I am experiencing) and he described the regurg as Moderate.....his tone being, well, I'll call it moderate but it's really on the high end of that.

While I'm having symptoms, they are tolerable and do not really effect my every day functioning except for more fatigue than usual and getting out of breath easier and faster on my daily walks.

When will he start talking surgery in more than vague terms. Today he explained what the surgical procedure would be but seemed in no rush to recommend I see a surgeon or and implied it still might be avoidable.

All thoughts and comments welcome........PLEASE.

(For a little history, I had MI's 2 1/2 years ago and emergency bypass surgery at that time. I've done very well since with full, active life. Reconfiguring if my heart as a result of the MI's is what has caused the mitral problem. Cardio feels if he can get my heart size down, the mitral will improve as a consequence. I have been on max dose coreg. Cannot take ace inhibitor. Today he started me on norvasc. My blood pressure has never been really high but he wants to try to get it even lower.)

 

[Der Biermeister]

I've done very well since with full, active life. Reconfiguring if my heart as a result of the MI's is what has caused the mitral problem. Cardio feels if he can get my heart size down, the mitral will improve as a consequence.

It sounds like you've been very active in the last 2 1/2 years -- including what I guess is a regular walking program. So one question would be why does your cardiologist think your heart size can be reduced now if it hasn't already done so?

 

[Jkm7]

He started me on norvasc today and is hoping adding the calcium channel blocker could make a difference.

Yes.....I have been fully active and walk almost every day and he knows that. He has actually driven by my DH and me walking on a number of occassions so he doesn't doubt me.


I see you have had four bypasses. Did your valve replacement result from heart enlargement/reconfiguring after your previous OHS surgery?

 

[marky]

welcome..
I don't have any experience with bipass surgery.. so can't help with that..but it sounds like you made a nice recovery from that . Congrats

as for the regurgitation...
My cardio told me that my mitral valve had progressed to severe.. then she sent me to another cardio in the same clinic (valve specialist) who said it was at the high end of moderate..and I could probably wait a bit before surgery..
I was rapidly deteriorating.. very SOB and tired..

Started to meet with surgeons .. knowing full well the end result was surgery..

I had surgery 4weeks after the original cardio appt.
turns out the surgeon said.. it was a good thing I did not wait.. it was much worse than the tests showed..and it would have started to deteriorate my heart if I would have waited any longer..

so that is my story..
I guess the point I try to make is if the end result will be the same.. surgery.. maybe you should ask your cardio for a second opinion..or a good surgeon to get his(her) advice.

Hope that helped..
and again Welcome

 

[Phyllis]

It doesn't hurt to get a second opinion from a surgeon (or two) rather than from another cardio!

 

[Marguerite53]

When will he start talking surgery in more than vague terms. Today he explained what the surgical procedure would be but seemed in no rush to recommend I see a surgeon or and implied it still might be avoidable.

This used to drive me crazy with my own cardiologist. We got along much better when I finally asked her "exactly when do you call in the surgeon?" I would not let her be vague (she tried). She told me exactly when (valve measurement, aortic in my case and/or symptoms a, b, and c).

I moved things along faster than she was because I honestly was feeling progressively worse (and impatient). For me, however, there was no option but AVR. No repair option. Bicuspic valve was a birth defect gone stenotic. Mitrals are different. I know nothing about them. Enlarged hearts are not good. Your doctor should be watching that very very closely, I think. I don't know how the MI might have hurt your mitral. You might want to get a clearer expanation of that.

Also, echos are often quite variable, one to the next. Those small gradations shouldn't be of much concern to you. It is nice to know, though, which way they are going ! Better or worse!

If you don't feel comfortable with your progress/treatment, don't hesitate to get a second opinion. Usually doctors are very happy to have you do that. most often, it just reinforces their diagnosis.

Good luck!

Marguerite

 

[Jkm7]

I am so appreciative to all of you. Your help is priceless.

This cardio is the one who saw me through my heart attack when I appeared in the Emergency Room. He was in the doorway on his way out when I came in. (Totally unexpected heart attack with no history prior and no visits to any cardios.) He took one look at me and thought I probably needed his help. How right he was!! He took such good care of me and my quality of life thanks to him has been excellent.

I may not award him any prizes in the personality department but I'll give him extra kudos in the brains department. That, of course, is what matters.

After he saw my recent Echo, he wanted me to have another nuclear stress which I had this week. He personally oversaw (conducted) the exercise part of it and I am so grateful for that. Not only did I have the confidence of having him there (and, indeed, I would have tried to push myself harder but he stopped me and said I was working hard enough)......but it was 'priceless' time to have all my million questions addressed. He was great about 'taking care of me' but also answering anything and everything I asked.

One of the questions I asked was.......does Dr. ******* who did my bypasses, do valves? Yes, he does. Now comes my research to find out if he is the very best choice. He's the logical choice as I have had successful bypass surgery with him and have a 'relationship' of sorts. I only saw him one time in his office post op and never prior as my bypass was emergency and as a result of the heart attacks.

I'm sorry I've gone on and on but I guess I'm thinking out loud as my mind is racing. I didn't expect this to go so far, so fast almost literally out of the blue.

I had no reason to mention surgery until he did. Yesterday/today was the first my cardio mentioned it and he didn't imply he means tomorrow but he also is watching me so closely, he wants to see me in only a short month. That most assuredly has to 'send me a message' he wants a close rein on me. That certainly gives me a feeling of confidence that I have his attention which is comforting but nevertheless very frightening.

I had my chest slit open a mere 2 1/2 years ago, it is still sore today (whenever we are getting rain/snow, I know it before the weather man )........

My cardio still implied there is a chance that if my BP lowers further, it could reduce the regurg.

Doesn't seem there's much to lose by trying. Certainly I'll pay him the respect to try his recommendation and keep my fingers (eyes and toes) crossed that I get lucky.

Thank you for letting me ramble.
My head is dizzy from all this.

 

[Barbara Stewart]

Varying levels of Moderate?

Varying levels of Moderate?

I don't know about that, but my cardiologist spent an entire year trying to get my blood pressure down enough to stop the regurg in my mitral valve. It was futile and I thought it would be. By the time I actually had surgery, my valve was in such bad shape it could not be repaired. Truthfully I can't say it would have been repairable a year earlier, but I was headed for surgery sooner or later and I would have preferred sooner. I didn't know then what I know now and I did not have the support and knowledge base that this site has offered me since.

Let us know what happens with your heart. I can't remember if you said you'd seen a surgeon, but I would if I were you. The ultimate decision is yours and knowledge is power.

Barbara

 

[Georgia]

I'm sure you don't want another surgery; and perhaps in your case it's best to wait as long as possible because it's a second surgery.

But honestly, you're symptomatic and the symtoms are progressing. That bad valve is putting your heart at risk. Having had the problems you've had, I doubt that it's going to tolerate the regurg for very long.

You have some breathing room; make use of it by seeing a surgeon. Check out valve specialists. I know the other guy did a great job; but is he the best you can get to for mitral valves?

Many of us have issues with really liking our cardiologists. But you need to be very proactive about your care. Cardios tend to be conservative about surgery - sounds good to those of us who take comfort in thinking we might avoid this whole cutting thing. But they're not doing anyone a favor by letting the heart enlarge beyond recovery.

Remember that valve surgery comprises only about 10% of ohs; cardiologists just don't see as many of us as those with more common problems. When valves go bad the deterioration accelerates. You can get in trouble pretty fast.

Best of luck.

 

[joanne6]

My understanding is that surgeons generally wait until there is severe regurg. I did not have echos frequently enough. Mine went from moderate to severe and it came as a shock to me that I needed OHS.
I was told to find a surgeon who does at least several hundred valves a year. I also looked for one with a high repair vs replacement rate. I was lucky to find one with those qualifications who also believes strongly in the minimally invasive route.
Keep posting and asking questions.

 

[Jkm7]

I think your advice to start researching surgeons is good. Rather have information available to me at my leisure than be forced into hasty decisions.

I had my bypass at Massachusetts General and was extremely pleased with my surgeon. I have inquired and he also does valves but I have no idea how often/how many. That is something I need to research. If he does valves frequently, he is who I will ask to do any surgery I might need. If he does few, that would present a different situation.

My choice would be to return to Mass General were I to need future surgery so my research will focus on Surgeons from that facility that specialize in mitral valve.

Anyone have any suggestions? Have any of you had your surgery at Mass General?

Thank you, as always, for your wonderful help.

 

[joanne6]

When I was doing my research I learned that Brigham and Women's is one of the best hospitals in the country for valve surgery. I don't remember the names of specific surgeons though.

 

[ALCapshaw2]

MANY Cardiologists like to postpone surgery as long as possible. That's OLD THINKING. Waiting often allows further (and possible PERMANENT) Damage to occur in the heart muscles and walls.

Surgeons KNOW this and prefer to operate SOONER rather than later while before further damage is done. Another BIG FACTOR is that OHS is now a Highly Refined Art with EXCELLENT SUCCESS RATES. For first time patients the Mortality Risk is 1% and Stroke Risk is another 1%. For us 2 timers, those numbers go up SLIGHTLY, but no where near the almost certain fatality that could occur if you DO NOTHING.

At this point, it would be best to go Surgeon Shopping and let a SURGEON decide when it is best to operate. There are many good surgeons in the Boston area but I don't recall their names. You may want to pose that question as a new thread. You may also want to ask your bypass surgeon how many Mitral Valve Surgeries he does per year (200 is a good number), and how many SECOND surgeries he does per year.

'AL Capshaw' (Bypass and AVR 3 years later)
(FWIW, I had my Bypass done by a respected local surgeon. I went to the Best Heart Hospital in my state (UAB, ranked #13 in the USA) for my AVR.

 

[Jkm7]

When I was doing my research I learned that Brigham and Women's is one of the best hospitals in the country for valve surgery. I don't remember the names of specific surgeons though.

I agree that Brigham and Women's is reknowned. Unfortunatley, my sister died in that hospital so I have huge reluctance to be a patient there.

All of my physicians are Massachusetts General 'related' and I did receive such excellent care there when transferred to Boston at the time of my heart attack and had my OHS there at that time.

The familiarity factor does matter in some respects and it is a fine facility.
I'm settled that is where I will go but now I need to decide which surgeon is the best choice.

Of course, the one who does the most mitral valves and second OHS would be top of my list of who to meet with first.

I also know that it can be very detrimental to wait too long.

Thank you all for listening and helping me. It is sooo stressful as everyone here well knows.