Back in the waiting room...

[pellicle]

I really can't believe anyone would recommend tissue for someone in their 20s,

Common when women wish to have children. Warfarin causes problems in gestation and needs to be switched to daily heparin injection.

 

[Lisa from LJ]

Common when women wish to have children. Warfarin causes problems in gestation and needs to be switched to daily heparin injection.

As a woman who knew I'd eventually be having valve replacement from the age of 14 on, and who made the decision at 28 and again at 30 to get pregnant before the replacement, even though it could have ended with an early baby and me in the OR, I know that. I just hope the surgeon told her that the life of the tissue valve after going through two pregnancies would be significantly affected. As my cardiologist said, "A pregnancy is like a 9-month long game of basketball where your heart doesn't get much time to rest."

 

[Lisa from LJ]

Here is my biggest concern:

"The surgeon said she has never actually put in a mechanical tricuspid valve."

I feel that "It's the way I've always done it and I"m not willing to change now is the problem."

 

[pellicle]

Hi

As a woman who knew I'd eventually be having valve replacement from the age of 14 on, and who made the decision at 28 and again at 30 to get pregnant before the replacement, even though it could have ended with an early baby and me in the OR, I know that. I just hope the surgeon told her that the life of the tissue valve after going through two pregnancies would be significantly affected

I'm betting strongly that they underplayed that risk ...

I think its interesting that in places like India they still fit mechanical valves in younger women who need a valve replaced and expect them to just manage heparin injections.

https://www.valvereplacement.org/threads/aortic-valve-replacement-03-2016.888682/post-918474

https://www.valvereplacement.org/threads/mechanical-valve-and-pregnant.866326/#post-913828

also any post by Shiv on this topic: this whole thread

https://www.valvereplacement.org/threads/pregnancy-on-mechanical-valve.887847/post-902113


So (as Shiv says) rheumatic fever is a driver for valve replacements and women need to have mechanical valves for both durability (being around 19 often enough) AND manage heparin during the correct trimesters if pregnancy is desired (and why shouldn't it be).

(I've learned so much outside of my required box of "warfarin management knowledge" by being here these last 12 years)

So I'm sure that India has far more younger female patients

Here is my biggest concern:

"The surgeon said she has never actually put in a mechanical tricuspid valve."

I feel that "It's the way I've always done it and I"m not willing to change now is the problem."

agreed ... so my view is "run, don't walk" out of that trap.

 

[dornole]

I think Elcarim is in a bit of a tough position with this being a tricuspid valve. From reading the ACC/AHA guidelines Section 8 (https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923) this kind of damage to tricuspid valves from pacemaker leads is an increasing problem. In addition it seems like mechanical valves are rarely used for tricuspid due to very significant thrombosis risk. Did a quick google (paper here: https://onlinelibrary.wiley.com/doi/10.1111/jocs.16209) and:

"Tricuspid valve (TV) prosthetic is associated with an 11.7 times higher risk of thrombosis in comparison with other heart valves and it may occur in approximately 20% of the patients during the first postoperative year."

and

"The results of the present study showed that recurrent thrombosis requiring intervention is a major complication of mechanical TV"

"As mechanical TV replacement is rarely performed, there are little data about the outcomes in large studies."

All of which indicate to me that Elcarim's surgeon may have excellent reasons for never doing tricuspid mech valve replacements.

Wishing you best of luck, Elcarim. It is a serious bummer that this happened to you but sending best wishes for a successful replacement, improved quality of life, for the new tricuspid to last as long as possible, and for the catheter-based TTVRs now in clinical trials to be an option for you if needed down the road.