Cloudy echo & shortness of breath

[Guest]

Due to bicuspid aortic valve with severe aortic insufficiency I underwent replacement surgery in 2006. In 2013-14 I experienced significant shortness of breath that turned out to be caused by staphylococcus munching on the (porcine) tissue valve. The valve was removed and replaced (with bovine valve) in 2014. In 2017 I started experiencing similar shortness of breath and had an echo test in December that turned out to be ok with EF of 55%, but the image was very cloudy. (You couldn't see the valve.) I am wondering if this cloudiness could mean another infection by bacterial colony. Why else could it be so cloudy?

(Is it even possible to have yet another replacement?)

 

[pellicle]

Hi

sorry to read of your problems

Due to bicuspid aortic valve with severe aortic insufficiency I underwent replacement surgery in 2006. In 2013-14 I experienced significant shortness of breath that turned out to be caused by staphylococcus munching on the (porcine) tissue valve. The valve was removed and replaced (with bovine valve) in 2014. In 2017 I started experiencing similar
....
(Is it even possible to have yet another replacement?)

to answer your last question first, yes, normally it is possible to have another valve replacement. Your surgeon will fill you in on the details

However (as you should know now having had 2) each surgery brings with it greater risk of complications.

As I know totally nothing about you, I don't know your age, your general health ... nothing. So having said that one would have to ask why are you getting repeat bouts of endocarditis?
Is your oral hygene good?
Do you floss daily and correctly?
Have you been to the dentist much and when doing so are you taking antibiotic cover?

Endo is (as you should know) serious and life threatening. Yes nowadays its not 99% fatal because we can replace the valve AND we have good antibiotics.

Again not knowing much its possible that there is a treatment path for your situation which does not rely on valve surgery, which would be treatment of the infection with PICC delivered antibiotics (giving peak concentration at the location of infection, read the link below:

https://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter

Indeed even if valve replacement becomes necessary the infection will probably need to be brought under control first.

So there are options and there are treatments. Just my own opinion here but if you require a 3rd operation then unless you are over 65 I'd look very seriously towards a mechanical valve on your next "trip to the show room", cos as my surgeon said to me "you won't be wanting a 4th"

Best Wishes

 

[dlangton]

Thank you. This is very good information and is much appreciated. Another OHS seems unlikely as the numbers are good and no regurgitation is occurring. My investigation begins with the question of what might be the significance of the cloudiness of the imaging. The echo results were reviewed by a cardiologist and apparently this aspect did not raise a red flag. I am trying to avoid another cardiologist appointment due to scheduling & bureaucratic/insurance issues, but I guess I better just do it.

I am 67 and the probability of another replacement surgery seems remote but if it proves necessary, I believe you are saying that I should not consider a mechanical valve, is that right?

I didn't login properly when I opened this topic, apparently, but I was a participant on this forum years ago and it was very helpful to me, and I made some effort to give back by helping others as I had been helped but my knowledge was limited, and one tends to forget details.
Thanks for your helpful reply.

 

[pellicle]

Hi

Thank you. This is very good information and is much appreciated. Another OHS seems unlikely

I'm glad it was of use ... and that's good ... nobody wants that .

I am 67 and the probability of another replacement surgery seems remote but if it proves necessary, I believe you are saying that I should not consider a mechanical valve, is that right?

the exact opposite. As I wrote: "Just my own opinion here but if you require a 3rd operation then unless you are over 65 I'd look very seriously towards a mechanical valve on your next "trip to the show room"

As you posted as guest I had no idea of your age (which I do now), if you were under 65 then my words above are my view. However as you're under it you will stand a good chance of getting 15~20 years from another tissue valve, which would see you perhaps suitable for some of the alternative TAVR methodologies. However it may just be that (as in a presentation I've recently linked to) that you may indeed be prescribed warfarin anyway, in which case the mechanical would be a good bet too. You can be >99% confident with a mechanical you won't need reoperation from valve failure (other issues may play however irrespective of valve choice).

So basically "go with what you feel like" in that area.

Glad to hear that its looking more positive

Best Wishes