Deciding whether to have Mitral Valve Repair/Replacement Surgery

[Zoltania]

May I ask how you feel now? Are you the same as you were before or even better now that your valve is functioning properly?

I feel exactly the same as before. My mitral regurgitation didn't give me any issues or perceptible symptoms until a couple of months before the surgery. So I wasn't coming back from a decline, really.

It's interesting to see the ranges of recovery experiences here on the forum. I was in excellent shape before my surgery, but the operation really knocked me down for a while, mostly in terms of energy level. For the first couple of weeks I didn't even have the energy to stand up while taking a shower; I used a shower seat. I was going for walks right away, of course, starting with ten minutes twice a day and working my way up to half an hour twice a day. Everything came back to normal, but it was a gradual process.

So when I read accounts of people who are back at work in a few weeks and doing all their normal activities quickly, I marvel at them and wonder what the difference was -- type of surgery? Duration on bypass machine? Or maybe it's just that every human body is different.

 

[bizinsider]

So when I read accounts of people who are back at work in a few weeks and doing all their normal activities quickly, I marvel at them and wonder what the difference was -- type of surgery? Duration on bypass machine? Or maybe it's just that every human body is different.

You have to read the fine print. I was back at work at my desk (I work from home, mostly writing) on Day 11. The fine print: I was also falling asleep at my desk sitting up. Like suddenly - out! It took weeks for my brain to get back in sync, and even long for the fog to fully lift. I just get pushing forward and sticking with the walking protocol. I think, in the end, it's that every human body is different.

 

[Josh48]

You have to read the fine print. I was back at work at my desk (I work from home, mostly writing) on Day 11. The fine print: I was also falling asleep at my desk sitting up. Like suddenly - out! It took weeks for my brain to get back in sync, and even long for the fog to fully lift. I just get pushing forward and sticking with the walking protocol. I think, in the end, it's that every human body is different.

Now that it has been a year are you fully100% yourself?

 

[bizinsider]

Now that it has been a year are you fully100% yourself?

Oh, yes. If I didn't have the scar I wouldn't know anything had been done. Even the fog of reaching for a word here and there (beyond the normal senior moment) seems to have lifted. I mark it this way, and this worked for me: By two months, if Covid hadn't been a thing, I would have been able to take a biz trip to NY. By six months, I wouldn't have had any issue taking a longer vacation. Keep in mind I was in decent shape going into surgery. And I did the equivalent of pre-hab for well over a year pre-surgery, including ambitious aerobic exercising and core work. (I was lucky that I knew the day was coming and did not have any symptoms that got in the way.) I think that helped. I was speaking to one guy who had the same procedure by the same surgeon and it took him six months to get back to normal, but he also said that he was considerably overweight - he said he believed that caused a slower recovery. I think as you read these forums you find a wide swatch of experiences. And that doesn't take into account post-surgical complications. But even with those the general consensus seems to be that they got on with their lives. I realize that's a long answer to a simple question but it really helped me to know the variables; I wanted my expectations to be realistic...and if all went well to underpromise and overdeliver.

 

[ejc61]

Hello,

I just joined here to share my story and get some feedback, encouragement, etc...

I'm 48yrs old, very healthy and active otherwise but was diagnosed about two years ago with Mitral Valve Prolapse which upon closer examination, including an Angiogram, determined that there was moderate to severe regurgitation due to prolapse of A2 scallop and P2 scallop. The Angio also concluded that I have normal coronaries and normal LV function and EDP with an EF of 65%. Left atrium was dilated.

My ECG showed T wave inversion in lead III and slight T wave inversion in aVF.

There is a grade 3/6 pan systolic murmur at the apex radiating to the left sternal border.

(personally I'm not sure what a lot of this means but perhaps people here might?)

I rarely experience symptoms although when lying down my breath sometimes becomes shorter and I may have more fatigue than I otherwise would at times. I can sometimes feel discomfort near my heart but it is mild and resembles heartburn.

Generally speaking I feel good but at the same time I've read that it is better to repair this now before more serious symptoms arise and the heart may become damaged (enlarged).

Aoritc valve is healthy and normal.

If you were in my shoes would you risk the surgery or live with the condition and monitor it year to year?

(I fully realize that it is my decision but I'm curious as to your thoughts)

Thank you so much in advance.

Hello Josh,
I think the mod to severe regurgitation needs to be followed more closely than annually. I was close to your age with sever regurge, asymptomatic, pretty normal EF and and a clean heart cath. You have alot of detail so it's good you're being proactive. My TEE showed my mitral valve to be torn and that was one of the deciding factors along with my atrium being slightly enlarged over 4 cm. My cardio thought it was time. A conversation with cardio and surgeon both pointed out that intervention while young and fairly healthy is better than dragging it out until your older.

 

[Iggy]

Hi and welcome,
You should definitely be monitored for MV regurgitation and see if it progresses. Usually doctors will call it if you need the surgery. I first learned about MV regurgitation when I was 28, and it was like no biggie from my doctor's perspective. The leaking kept progressing gradually and I started getting echos every 6 months to monitor. I didn't have a conversation with doctors for needing a surgery down the road or anything, and didn't ask questions why they needed to monitor. Then I got busy with life, changed insurance and all my doctors had to change. Luckily my then new GP didn't like the murmur and sent me for another echo. And I had surgery two months after that to fix my mitral valve. It failed 8 months after OHS and I had my second OHS right before covid pandemic hit to get my MV and tricuspid valves repaired.

My personal advice:
Find surgeons who specialize on your specific valve, mitral valve. That is due to the fact that you usually have one shot for a repair so use it wisely. I learned the lesson the hard way unfortunately, as my first repair failed because the surgeon simply didn't have the skill to do it well. You have a much better chance at having a lasting repair with the surgeon that performs 400 MV repairs a year vs 50.
good luck!

 

[Marco2]

Hello,

I just joined here to share my story and get some feedback, encouragement, etc...

I'm 48yrs old, very healthy and active otherwise but was diagnosed about two years ago with Mitral Valve Prolapse which upon closer examination, including an Angiogram, determined that there was moderate to severe regurgitation due to prolapse of A2 scallop and P2 scallop. The Angio also concluded that I have normal coronaries and normal LV function and EDP with an EF of 65%. Left atrium was dilated.

My ECG showed T wave inversion in lead III and slight T wave inversion in aVF.

There is a grade 3/6 pan systolic murmur at the apex radiating to the left sternal border.

(personally I'm not sure what a lot of this means but perhaps people here might?)

I rarely experience symptoms although when lying down my breath sometimes becomes shorter and I may have more fatigue than I otherwise would at times. I can sometimes feel discomfort near my heart but it is mild and resembles heartburn.

Generally speaking I feel good but at the same time I've read that it is better to repair this now before more serious symptoms arise and the heart may become damaged (enlarged).

Aoritc valve is healthy and normal.

If you were in my shoes would you risk the surgery or live with the condition and monitor it year to year?

(I fully realize that it is my decision but I'm curious as to your thoughts)

Thank you so much in advance.

Hi Josh

I have a mitral valve prolapse (congenital) and I am a few years older than you are. My regurgitation became severe around 3 years ago, and also at this time I also found out my aortic valve has severe regurgitation too.

I had no symptoms at the time but the surgeon suggested surgery before my left ventricle started to dilate. My EF was and still is preserved at 60%. I got a second opinion and was told to monitor and have an echocardiogram every 12 months, and to report any symptoms such as shortness of breath immediately.

I must stress that the reason I was told this was because my general health was good and I had no symptoms. Also taken into account was the fact that I would need a repair on the mitral valve and I wanted a tissue aortic valve and the fact that I would need another round of surgery in around 10 years to either replace my tissue value and or replace my mitral valve.

So three years on and I am now on the list for surgery. I still don't have symptoms, but I have noticed that I get easily fatigued, and my left ventricle has now dilated to 5.9cm diastolic. (1cm increase in 12 months).

I hope this helps somewhat. It's a hard choice to go for surgery when you feel fit and have no symptoms, so if I was you I would get a second opinion on the timing of your surgery.

I also totally agree with @Iggy do your research and find an expert in the field of MVR. You should be able to find all the information online regarding how many repairs a year a particular surgeon has done.

Marco