Criteria for MVR?

[ALCapshaw2]

My understanding is that AVR is recommended when the Aortic Valve Area is reduced to the range of 1.0 to 0.8 cm sq.

Is there a similar criteria for the Mitral Valve?

How small can the MV area become and still function normally at rest?

'AL'

 

[bvdr]

Al, Go to the AHA/ACC guidelines for the management of patients with valvular heart disease......in Reference Source forum under "Must have..."

Every time I try to find something, more or less in stone, I end up back to the guidelines. When I had my mitral valve was replaced my mean gradient was 11 and my MVA was 1.4cm. I did have moderate mitral regurg as well as mild/moderate aortic and tri-cuspid regurg. I know things are somewhat different when multiple valves are involved. So much goes by symptoms.

 

[Missy]

My cardiologist told me that it was 0.9. They let mine go a little longer than that because I lived so far away it wasn't caught and it seemed to progress so fast in such a short time.

 

[PapaHappyStar]

I want to point out this website:

http://info.med.yale.edu/intmed/cardio/imaging/

Has some great diagrams of the heart.

Why does the mitral valve have two flaps instead of three like in the rest of the valves? You can see that the mitral valve is much bigger than the aortic valve, why? It probably has to hold close and firm under a great deal of stress from the LV pump during the
Isovolumetric Contraction and the Rapid Ejection cycles,. The left atrium collects blood from the lungs and a stenosed mitral valve leads to issues in pulmonary capillaries because of increased pressure in the left atrium, also stenosis can alter the cardiac cycle by making the left atrium "late" to close, causing arrythmia problems ( i guess tricuspid valve problems cause even worse arrythmia issues probably beacuse it affects the right atrium where the electronics lives and it also handles more inlet pressure ). So the mitral valve probably reaches severe stenosis at a larger area than the aortic ( depending on the size of the heart of the individual concerned )

I also wonder why nature didnt design any redundancy into the heart... I think we have a tendency to overemphasize our own importance in the biological hierarchy and function... evolutionarily we are only important until we reproduce and after that we are pretty much expendable ( hows that for a controversial statement ).

There is an interesting statistic about the heart:
If you look at maximum lifespans in the mammals they are about the same if you count time by the number of heart beats i.e. the total number of heart beats in a mammalian lifetime is almost invariant across species. I read this in a numerology book.

 

[ALCapshaw2]

I want to point out this website:

http://info.med.yale.edu/intmed/cardio/imaging/ Has some great diagrams of the heart.

Why does the mitral valve have two flaps instead of three like in the rest of the valves? You can see that the mitral valve is much bigger than the aortic valve, why? It probably has to hold close and firm under a great deal of stress from the LV pump during the
Isovolumetric Contraction and the Rapid Ejection cycles,. The left atrium collects blood from the lungs and a stenosed mitral valve leads to issues in pulmonary capillaries because of increased pressure in the left atrium, also stenosis can alter the cardiac cycle by making the left atrium "late" to close, causing arrythmia problems ( i guess tricuspid valve problems cause even worse arrythmia issues probably beacuse it affects the right atrium where the electronics lives and it also handles more inlet pressure ). So the mitral valve probably reaches severe stenosis at a larger area than the aortic ( depending on the size of the heart of the individual concerned )

SNIP

VERY INTERESTING information Burair!
Thank you for sharing it.

I felt I had reached my full recovery potential 18 months post op. At 24 months post op I began having 'irregular' heartbeats (mostly PAC's) that seemed to be triggered by caffeine (mostly from chocolate...my only remaining source). Then another month later, I began having exercise induced A-Fib. After reviewing my ECHO REPORTS, I noticed a linear progression in Mitral Valve Area from 2.5 to 2.0 to 1.5 sq cm at one year intervals. YIKES!

I just met with my surgeon (after a 5 HOUR wait) and he kept saying something along the lines of "it's very unusual to see progressive MV deterioration in an (older?) adult patient". I hear that ("very unusual"J) a LOT ! Story of my life... He also stated that at 1.0 sq cm I would probably become very symptomatic which correlates with Missy's input. Valvuloplasty and MVR have been mentioned by my Cardio. Right after my AVR, my surgeon said that a third surgery would be 'high risk' (actually even worse than that, but revised downward after our recent 'review'). This next year is going to be 'interesting'.

One more 'unusual' observation: The surgeon also said it is "unusual" for Radiation Therapy to cause valve deterioration, but we have at least 4 or 5 Hodgkins and other radiation treatment survivors here on VR.com

How did I get to be so 'special'?

'AL'

 

[bvdr]

Al, just a thought....... if your mitral valve problem is limited to stenosis, rather than mixed stenosis and regurgitation, then do consider a mitral balloon valvoplasty before it becomes too severe. Since you have up until recently been mainly an aortic guy , you may not have paid a lot of attention to non-surgical mitral valve procedures. The balloon valvoplasty (or sometimes called balloon valvotomy which is more technically correct) is very similar to cardiac catherization/balloon angioplasty and it is done by a highly specialized interventional cardiologist. When done by somehow highly skilled it is very effective in increasing MVA. A down side is that it also sometimes increases any mitral regurgitation that is present. Your's is one case where you may want to seek out an expert interventional cardiologist for his take on it rather than a surgeon. Let me know what happens, OK?

As you said, it is interesting about possible links to radiation. My aortic valve had gone from 2.8 to 1.4 in 15 months. I am due for another echo in March so we will see if there has been any progression. I have the diagnosis of rheumatic heart disease but there is always those radiation treatments adding another question mark.

 

[bvdr]

Al, I think I wrote down the wrong numbers for my aortic valve so I do not think it has progressed as rapidly. I know it was at 1.4 last March and that was quite a decrease but I'm sure it didn't start at 2.8. I don't have the figures in front of me but I need to correct what I wrote. Sorry.