calcification of biological valves

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Phyllis

Posted this query in another thread, but didn't get any answers. I am still wondering if bovine and porcine valves calcify faster in younger patients because they are more physically active or if there is a biological reason or no known reason at this time. Can anyone shed any light on this?
 
Saw this same question posted in article or paper some where- sorry, can't remember. The researcher said the there was no exact answer to this,
but probably was a combination of both the different body chemistry between
the young and the more senior valve recipients and the activity levels between the two.

There is an old saying(I'll make it a G rating) about an old man who was boosting about his activity level now that he was in his senior years. He was heard to have said " I'm in the best shape of my life- better then when I was 17 years old" A wise sage who heard this then remarked "Anybody that age that says they are in better shape now then when they were 17, is just saying how bad of shape they were when they were 17!"

I never really understood the meaning of:
"Youth is wasted on the young"

till I got old!
 
I did find this which mentions increased calcium metabolism in those under 20, but doesn't address physical activity. Just wondering as for Dick, a very athletic 71 year old, youth is "wasted on the young"! and No, he's not in the shape he was when he was 17, but he's in pretty darn good shape! :)




An important issue that has not yet been discussed is the problem of valve calcification. Many consider calcification to be the prime factor responsible for the degeneration and ultimate failure of bioprosthetic valves. Indeed, calcification is very severe in patients younger than twenty, probably because of their increased calcium metabolism. The severity of calcification can be correlated with both the concentration of fixative used to process the valve, and with the degree of mechanical disruption of the collagen fibers. The location of calcific deposits has also been shown to correlate well with sites that are likely to experience high tensile and flexural stresses. The resultant stiffening of the leaflets from calcification likely increases stressing of the material and accelerates the mechanical damage further. Leaflet calcification and mechanical disruption therefore appear to be interrelated,although in some cases, both calcification and tearing can occur without the presence of the other. The development and implementation of anti calcific strategies such as diphosphonate loading of cuspal material, and others will surely increase. Since subdermal implants of cuspal tissue calcify faster than whole valves in situ, results from animal modeling cannot be easily extrapolated to the clinical scenario. The effectiveness of such anticalcification schemes can, unfortunately, only be shown over the course of time.
 
Fuel for the fire...

An interesting article, and makes sense, inthat the intensity of the calcification of the valves seems related to the amount of bone-building and bone-repairing activity going on, which would generally be reflected in the person's level of calcium metabolism. I could buy into that as a major causitive factor.

Physical activity could tie into this because bone density, even in older people, ties well to exercise.

There is also speculation that it has to to with damage repair responses within the body, which tend to be more active in our youth.

There are also some possible links to inflammation, which has led to a series of studies trying to link statins with reduced calcification, with varied results. To my knowledge, the FDA has not allowed manufacterers to market for that indication yet, as they require more significant and reproducible proofs than have been shown. Some doctors are prescribing statins with that in mind, though, and if your cholesterol is high anyway...

Another set of theories is that it is resultant from viral, bacterial, or nanobacterial infections. This seems somewhat plausible in us older folks, but doesn't look like it would fit every scenario for the younger valvers. A recent study - Jim From Chicago posted about it - dealt with apparently successful results from a single study of antibiotic and vitamin therapy to reduce arterial calcification, which sounds reasonably associable with valve calcification. This theory, of course, also ties into the inflammation theory. If so, then statins might be reducing the symptom (assuming they do work), without doing anything to fix the cause.

Best wishes,
 
Thanks, Bob. I knew I could count on you to dig up more studies! Dick did suffer all through his youth with strep and sore throats and at the age of 31 had his tonsils out to alleviate the problem. Not sure if this is related to Chlamydia pneumoniae infection, but it's a thought. Before AVR, the doctors thought his valve might be bicuspid, but it wasn't and was highly calcified. He's been the statin route by suggestion of his surgeon, but gave up on the statins as he never had high cholesterol and the statins, after a month, brought the levels way below normal. We were really just curious if his high level of exercise would be detrimental to preserving the longevity of the valve, but it really doesn't matter as I can't see Dick giving up his active life style and I also feel that's what brought him through the whole operation with relative ease.
 
So he gives up his enthusiastic, active way of life, his boyish good looks, turns into a miserable, overweight, bored Couch Lump, and develops coronary artery disease from sedentary living...

I agree: no trade-off there! :D

If the chlamydia can hang around, so can other things, I would think. Removing the valve would hardly get rid of the whole colony, if one were there. My start sounds a lot like Dick's - they thought I must be bicuspid as well, for the same reason.

Best wishes,
 
calcification and calcium supplements

calcification and calcium supplements

I read somewhere here a long time ago (not very specific, I realize) that calcium supplements that are prescribed for women could actually increase the calcification of tissue valves. Although I no longer have a tissue valve (sigh!), my gynecologist would like to have more info on this issue. If anyone has any info, please pass it along. I vaguely remember (after OHS, everything is vague???) someone stating that Dr. Lytle at Cleveland Clinic may have indicated a relationship. One time I asked my cardiologist about this, but he did not know of any problem.
 
Did a search and found this, but not sure how reliable it is or if there have been any reliable studies:
"Does calcium intake affect the Mitroflow Aortic Pericardial valve?
There is concern ? still being studied ? that ingestion of calcium phosphate, with or without vitamin D, may affect calcium metabolism in some circumstances. Such supplements may increase the risk of calcium deposition in the walls of blood vessels and probably in the leaflets of implanted biological or bioprosthetic heart valves. Reduced kidney function may further increase the deposition of calcium in valve leaflets. Medical advice must be sought if oral mineral or vitamin D supplements are considered. "
 
we really should have an answer to that

we really should have an answer to that

Brenda. I agree that we really should have an answer for that. Women are counseled to increase their calcium by a significant amount as they age, and if it is causing any buildup in the wrong areas, there ought to be studies to assist us in our decisions. I am still pre-surgery but 2 separate cardiologists and my Ob/Gyn told me to continue the calcium supplements. I haven't let up and my stenosis is increasing! I'm 51. You would think there would be more definitive info... :confused:

Marguerite
 
There may be some connection, but if there is, it is not a straightforward or universal one, or they'd already have found it. There have been a few studies, but no take-home results. The quote from the study follows right along with that, inthat it is so noncommital you have to wonder why they even bothered to say it at all.

Medtronics and Edwards used to discourage tissue valve clients from using calcium supplements, but no longer do, apparently because a link could not be proven.

Calcium phosphate is often made from bones, and not the only common compound for calcium supplements. It usually contains about equal amounts of phosphorus and magnesium, with twice as much calcium as either of them (1:1:2). It also would contain smaller amounts of zinc, boron, and other minerals.

There is calcium carbonate from seashells and coral, both of which also contain some magnesium (3% to 30%). Calcium magensium carbonate from dolomite contains about a 1:1 ratio of calcium and magnesium.

Then there is calcium citrate, which has a 1:1 ratio of calcium and magnesium in its formulations, and sometimes calcium hydroxide, and sometimes - oops! - phosphrus.

Most of them also include vitamin D, as it is required for the body to metabolize calcium.

Of course, these basic types have been blurred by chemists and marketers, so they can have additives or be reformulated versions. You have to read the label.

Phosphates are very reactive compunds on their own, and may set something up to happen that might not from another compound. There's no smoking gun, but if you wanted to avoid calcium phosphate, there are plenty of other options.

You should check with your pharmacist or doctor before starting any of these, as most calcium compounds also have an antacid action in your stomach. They might not be good to take along with some other stomach medications, for example.

Best wishes,
 
calcification of the valve

calcification of the valve

I have also read an article that said that taking too much calcium can cause a problem with the valves and arteries. I have taken a lot of calcium for sometime, plus I drink milk. I still have problems with blockage in the arteries. I have good blood pressure and good cholesterol. It was a surprise to me when I found out I had a problem. It would be interesting to read about any trails they might be doing.
 
Over a year ago when I saw my surgeon at the valve clinic, a resident that was helping him and saw me first mentioned the calcium (since I gave a list of what I take) at which point I said "I have to take calcium. I have osteopenia." Then when my surgeon came in and I asked him, he said I could take calcium and not to worry about it, etc.
 

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