Earl

[earlburgess]

I had my mitral valve replaced in 2004. The same year I developed endocarditis which was treated successfully. In January of this year I was diagnosed as having a 20% leakage in the mitral valve replacement.

I have been informed when the leakage reaches 30% I will need to have the valve repaired or replaced. Is this a rule of the thumb? Have any of you had a similar situation? Thanks.

 

[zipper2]

Hello Earl,
Just want to welcome you to the colony
and always nice to see newcomers.
Don't have answers for you but others will be around
to answer your questions with more experience.
I had endo in 2006 didnot hit my valves,was treated with strong antibiotics
for 8 weeks iv.Just wanted to say hi

zipper2 (DEB)

 

[Lisa in Katy]

I've never heard of a % leakage. The only thing measured in % is ejection fraction, and 20% or 30% would be bad. Usually leakage is measured with words like moderate or severe. The "rule of thumb" is changing. It used to be that doctors waited until you were almost dead to replace your valve. Well, that's probably an exaggeration, but they wanted you to have several symptoms. Now most doctors recommend replacing while you are still healthy (if the leakage is at a certain point). Since you've been through this before, and not very long ago, you should have a pretty good idea of what to expect.

 

[earlburgess]

Earl

I was literally within weeks of dying when my condition was diagnosed in 2000.My mitral valve was leaking very severly at the time and I was in CHF. My EF was between 15 and 20. The doctor's first choice was a heart transplant but I was 65 at the time and he had never received a heart for anyone past 57.

My doctors did not want to do surgery but I convinced them to do so anyway. Their second choice was to send me home on medication to live as long as I could.

My EF is now 35 and I can do much of what I want to except for being limited by my strength. I can not walk very far and can not carry much weight.

I have a friend who also had a valve replaced. His per-cent of leakage was just under 30% at the time and he was almost too weak to climb stairs. His doctors informed him he was badly enough to have the valve replaced. A nurse at The Cleveland Clinic told me surgery was recommended at the 30% level. That is where my information come from.

Thanks for the reply.

 

[Ross]

To us, it's always been expressed as +1 to +4 regurgitation. We've never heard it expressed as a %. Interesting. I'm assuming that 20% is +3 or moderate regurgitation and they're waiting for +4 or severe regurgitation.

 

[Cooker]

Welcome to the zoo ....

 

[Lisa in Katy]

Ross is right. The words are a general term that relates to the actual measurements and can be applied to the sound or the leakage. The sound is graded on a scale of 0-6. For instance, my murmur prior to surgery was quite loud and could be heard easily without a stethoscope. It was a Grade VI/VI (or 6 out of 6), which of course would be severe. My ejection fraction was high (I can't remember the exact number but 80-90%, I think), which is an indication that the heart is pumping very hard. My regurgitation was 4 to 4+ with a jet, which is also severe. The sound and leakage do not always correlate. I lived with these numbers for quite a while, because the school of thought then was to wait for physical symptoms - SOB, difficulty walking short distances, palpitations, chills, sweating, etc. Now most doctors know that healthy hearts recover better, and there is no "gold standard" for a particular value. They look at everything together. They do know that people with normal EF have a much better chance of recovery because this indicates that the left ventricular function isn't compromised.

Anyway, I'm still not sure what the nurse is referring to, but nothing I can find from Mayo, Cleveland, or Texas Heart mentions a % leakage. Perhaps instead of referring to the leakage, the goal is to raise your EF to 30% so you will have a better outcome?

 

[WayneGM]

I don't have an answer to your question, but welcome to VR.

 

[earlburgess]

Earl

Ross and Lisa:

The first echo and stress tests I had after surgery indicated I had a "small" leak from the new mitral valve. In January of this year I had my annual physical, stress test and echo. After review of the test results, my cardiologist thought it was necessary to also do a cath. He informed me the grafts were all very clean but the new valve was now leaking 20%. He had never had it put in per-cent before. As I said, I have a friend who was advised to have his valve replaced when his leakage reached 30%.

Today I found an article on wikipedia.org. If you are interested it is located at: http://en.wikipedia.org/wiki/Mitral_regurgitation

The article gives a chart on determining the degree of mitral regurgitation.

Mild regurgitation--------------------<20%
Moderate regurgitation----------------20 - 40%
Moderate to severe regurgitation------40 - 60%
Severe regurgitation----------------->60%

MayoClinic.com also has a very good article on mitral valve regurgitation.

I hope this information is of benefit to you. It clears things up for me.

Earl

 

[Lisa in Katy]

Interesting. A new term that after 22 years with mitral insufficiency and 10 years with a mechanical valve, I've never heard. Add it to the list Ross! It's called the regurgitant factor.

Based on what I read on that link and another, I'm sure mine was in the 80% range before I had surgery, and had been there for many years. That's why I had such a high EF - my heart was having to pump super hard to get enough blood forward to make up for the backward flow.

I'm still surprised that they would quantify the point that surgery is needed. What makes 30% the magic number? It's usually a combination of factors, but the more fit you are, the better the outcome.

 

[skeptic49]

Earl, Thanks for posting the link. Very interesting.

Jim