Echo results...TEE next...gulp

[offwego]

I finally got the results from my last echo cardiagram..and unfortunately I am experiencing some mild shortness of breath and a feeling of my heart pounding hard under stress..

Any insight into what medications or how I may be helped by medication is very appreciated..I just started working out and have gotten my heart rate between 140-155 (max 165) on most aerobic workouts..I am praying the medication will make me feel a bit better and I can continue this exercise program that has taken me years to get started!

I'm 5 years post op Mitral Valve repair and overall am in good health..

I am of course, freaked out by all this. But in my heart (pun unintended), I have felt that I am not getting enought oxygen at times and have not been able to take fufilling deep breaths as much as I would have hoped..

Sorry to be a whiner..I know it's not that bad but I am a bit freaked out by all this..

Thanks for reading!

Age: 50
Sex: Male
Weight 170 lbs.
Height 5’ 11”
BSA 1.95 m2

RV/LV diastole
IVS, d 1.05 cm (.05-1.3 cm)
lV, d 6.20 cm (3.0-5.7 cm)
LVPW, d 0.90 (0.8-1.2 cm)

LV Systole
LV, s 5.10 cm (varies cm)
RESULTS
FS 25.22 % (greater than 25%)

AO/LA
AO DIAM, d 3.15 (2.0-3.8 cm)
LA diam 5.02 cm (2.0-4.0 cm)

Mitral Orifice
P ½ time 81.78 ms
Orifice PHT 2.69 cm2

Aortic Valve
Vmax 145.00 cm/sec
Peak Grad 8.41 mm/Hg

RV/RA/IVC
RA press, s 10.00 mm/Hg
RV Press, s 35.00 mm/Hg

Interpretation
Left Ventricle: Moderately dilated left ventricle, no evidence of left ventricular hypertrophy, left ventricular fraction is normal. Again questionable hypokinesis basilar portion of posterior wall.

Left Atrium: mild to moderate left atrial enlargement.

Right Atrium: Normal sized right atrium

Right Ventricle: Normal sized right Ventricle

Aortic Valve: Normal, tri-leaflet aortic valve. Mild aortic regurgitation. No aortic stenosis present. S/P Mitral Valve repair with annuloplasty ring present. No mitral stenosis.

Moderate Mitral regurgitation.

Tricuspid Valve: Mild Tricuspid regurgitation

Pulmonic Valve: No pulmonic stenosis

Pericardium: No pericardial effusion

Aorta: No aortic root dilation

Summary: Moderate MR, LV dilatation.

 

[gijanet]

Welcome to the group..........

Welcome to the group..........

but sorry you have to be here. You will most likely be placed on an ace inhibitor. Katie was (and still is, although a much smaller dose) on captopril, but I don't think that is used with adults very often. I'm sure someone will be along soon to give you some insight as to what adults are usually prescribed.

Katie's repair did not hold up and we were able to hold off on surgery for a year with pretty stout doses of captopril. Depending on the condition of your valve and how your body responds to meds will determine how much time you can buy before replacement. You don't want to wait so long, though, that your heart suffers permanent damage.

Welcome again and good luck. Keep us posted. Hugs. J.

 

[offwego]

thanks for the reply..I'll post the comments after I meet with the cardiac surgeon on Wednesday..Sorry Katie's repair didn't hold up either.

Well...I am hoping the medication might work out for me...and if surgery is necessary that the valve can be repaired again..who knows?

I'm slowly absorbing all the possibilities and am coming to grips with the reality that surgery might be in my future...

Well, that's what I get for not buying the extended warranty...ugh...

 

[offwego]

I am googling to find out information if Mitral valves can be 'repaired' more than once...or if it can be done through minimally invasive technique again...

 

[gijanet]

Well, actually.............

Well, actually.............

we do have one little boy (10) whose mitral valve was repaired when he was 18 months old, I believe, and his surgeon is going to try and repair it again this Wednesday. If they can't re-repair it, then they are going to replace it. I don't think this is routinely done with adults, though. I think the trend is to replace it the second time around as to cut down on the number of future surgeries. With kids, they are just trying to buy more coumadin-free time, so they risk the extra surgery required.

I'm sure you will have some more input tomorrow as there aren't too many of us hootowls on here. Thanks for the kind words for Katie. Hugs. J.

 

[offwego]

well my prayers will certainly be with you Wednesday..that's the day I see the surgeon too.

I am sure you will post afterwards...Get some good rest and take care!

 

[WayneGM]

Sorry to hear you are having issues with your mitral valve repair. I'm 2.5 years out from a mitral valve repair so naturally worry when I hear of potential problems. I can't offer any advice on meds, but do offer my best wishes that you can resolve this without surgery.

 

[Pegasus]

Really sorry that you are having problems with your valve repair!! My husband had one 2 yrs. ago so naturally I don't like hearing anyone's repair not holding up. However, I have read in a research paper (lost the link) that in most cases the valve can be re-repaired. I hope it won't have to come to that though.
You will be in my thoughts!! Thankfully you are otherwise in good health and that always helps!

 

[perrypiratesdad]

I'm not very familiar with a repair. What exactly do they do? Reform the valve so it does not produce any regurgitation?

My other question is this. With repair, is it open heart with bypass, or do they do it some other way? If it is true open heart, why not just get the valve replaced with your valve of choice?

 

[WayneGM]

I'm not very familiar with a repair. What exactly do they do? Reform the valve so it does not produce any regurgitation?

My other question is this. With repair, is it open heart with bypass, or do they do it some other way? If it is true open heart, why not just get the valve replaced with your valve of choice?

In my case it was a full OHS. I had torn chordea (sp???) so the valve wasn't closing properly, but no other heart issues. The valve was otherwise in good condition. The Surgeon implanted a small o-ring that essentially reshaped and strengthened the valve, and then he sewed up the torn area as good as new. In theory repairs can last forever, and since you still have your natural valve, there's no need for coumadin other than the first few weeks as a precaution while the area heals. Potential longevity, no coumadin, and use of your "natural" parts makes repairs desirable if one is possible. However, depending on the extent of the original damage, or other complications, sometimes the repair doesn't hold up. Like any heart valve choice, there's no guarantee there won't be a re-op.

 

[Jkm7]

Having one's native valve is always best. My biggest nightmare was a failed repair. My cardio and surgeon knew I certainly wanted a good repair but worried about one that wouldn't last long. This was my second OHS and want it to be my last, of course.

My surgeon tried for over an hour to repair it and in the end replaced it with bovine per our agreement. When I woke and learned I had the replacement I think a little piece of me was relieved. I felt very insecure about the repair.

My surgeon has told me they are doing very serious studies right now at Mass General for percutaneous valve surgery and he expects they will perfect the method before I (probably) would have to worry about further valve repair/replacement. I interpret that to mean within 15 or fewer years.

 

[offwego]

Curious if rerepairs can be done minimally invasively..any one ever hear of this?

I'll post the results of the meeting the heart surgeon tomorrow..

I just got back from a 3 week cross country drive..5000 miles...the altitude in the western states was really bothering me..I was literally panting for breath as we climbed higher in the car.

Unfortunately I do feel that the valve has been getting worse for the last year..My cardiologist was always very reassuring and didn't really take seriously my complaints of not getting what I call 'fufilling' deep breaths..

I also recently learned to swim (yes in my 40's) and have had tremendous problems swimming for any length of time without having difficulty getting enough oxygen..I am certain the valve has playing a huge part in this...As well as the out of breath I have been feeling at the gym..The problem has been of course that these complaints are written off as being 'out of shape' or getting older but deep down I knew and know the valve has not been working right.

I am trying to reconcile my feelings and fears with a positive approach and I am hopeful for good news that it can be held off with meds and eventually repaired (assuming the doctor agrees of course) and that I will FEEL even BETTER.

I don't feel that bad other than increased heart pounding under stress and a shortness of breath..

sorry for rambling..I admit I am pretty obsessed with this..

 

[rocksoldier]

welcome! let us know how the meeting with the surgeon goes....trish

 

[offwego]

Interesting link of Mitral Valve re-repairs...

http://www.aats.org/annualmeeting/Abstracts/2006/AM06_36.html

 

[Duff Man]

sounds like the repair method is safer. I'd be looking for someone that's good with the robotic type.

 

[offwego]

Update time..

Saw Dr. Galloway, Head of Thorasic Surgery at NYU. He scheduled me for an echo/exercise test and not the TEE I was expecting. He prescribed 40 mg Diovan for the shortness of breath I am experiencing.

I asked him a few questions anyway in the event I would ever need surgery to deal with the Mitral valve again. He said it would probably be 50/50 if the valve could be repaired again..I was surprised the odds were so low. I asked his opinion of valve choices and he said he would recommend a tissue valve.

He said the surgery could be minimally invasive. I asked his opinion of robotic repair and he said that the robot does the same job only it takes much longer. He didn't seem to be a big proponent of it.

He was very patient and has a great disposition.

I wish I had more faith that I won't need surgery again. I just feel I will. I just took my first dose of Diovan and hope it makes me breath a bit better.

Well, guess it could have been worse!