Emma
Well-known member
I couldnt attach the email conversations I had with Catheran from On-X to my emails, so sorry to people who asked to see it, but I'm copying it (in parts) to here as some people may be interested in it and I'm sure there's no harm in it as Catheran would say the same to anyone who asked her for this information anyway I'm sure. I was basically trying to find out if a 25mm valve like Chloe's is a large one or if it is only small adult size - seems it will do her for some time (growth wise anyway) which is what her surgeon said anyway - being a mum I like to have this confirmed, so here's what Catheran replied to me about the valves.
(Before I go any further, can i just say i'm not saying On-X is definately any better than other valves that are available, just posting this information cos its about the valve Chloe has so the only one I know about - thanks)
Here's the replies from On-X...
Love Emma
xxx
... Thank you for your questions. How is Chloe? We hope she is well and growing and into mischief as little children can be.
To answer your questions:
The size 25 mm valve is built from our largest orifice or opening. It has optimal flow which means that the gradient of flow (difference in pressure from one side of the valve to the other) is as low as possible no matter what age or size the patient is. This means that Chloe cannot have a valve with a better flow in it. Therefore, the surgeon concluded she will not have to have surgery on the valve again for flow or growth reasons.
Most adults worldwide have a size 25 in the mitral position. We only make one other size in the mitral position and that is 23 for really small hearts.
As a company, we do not make recommendations about the level of INR except to say that the surgeon or cardiologist should follow the recommended guidelines for INR for patients with implanted. These recommendations are published by the American Heart Association/American College of Cardiology (AHA/ACC) and the American College of Chest Physicians (ACCP). The AHA/ACC recommend an INR of 2.5 to 3.5 for patients with mitral mechanical bileaflet valves (On-X) and the ACCP recommends a target INR of 3 in the mitral position for bileaflet valves (On-X).
(THEN I GOT THIS ONE WHEN I ASKED YET MORE QUESTIONS...)
... Thank you for the nice update on Chloe. You have a healthy attitude about her and are a very good mother to be asking questions!
We do make larger size sewing cuffs and have valves named 27/29 and 31/33, but they all have that optimal flow size 25 orifice. If manufacturers go larger than optimal size (lowest gradient) then other undesirable outcomes appear such as more noise, more turbulence, more valve damage.
(AND AGAIN... lol)
... That is okay, Emma. I really enjoy the educational part of my job especially for patients and family.
Yes, there are larger cuff sizes for larger valve annulus sizes. The annulus is where the natural valve attaches in the heart. Since Chloe already has a heart that is large enough to accomodate the larger heart valve, she will probably not need a new replacement. Having the valve in place will probably take care of any growth in that particular area or the annulus. So I think she is safe in that regard based on what I know about valve surgery (I have participated in about 2000 cardiac procedures in 8 years when I was in hospital as a nurse). The best person to ask, however, is Dr. Haw. He should not mind if you ask. Most surgeons really enjoy education as well. I know Dr. Haw and he is very nice besides being a great surgeon.
Would you like me to ask him?
Catheran
(and thats the end of the emails - Mr Haw is Chloes surgeon, obviously, and I didnt feel a need to ask him as Catheran kindly answered all my questions fully! - lovely lady! Emma xxx)
(Before I go any further, can i just say i'm not saying On-X is definately any better than other valves that are available, just posting this information cos its about the valve Chloe has so the only one I know about - thanks)
Here's the replies from On-X...
Love Emma
xxx
... Thank you for your questions. How is Chloe? We hope she is well and growing and into mischief as little children can be.
To answer your questions:
The size 25 mm valve is built from our largest orifice or opening. It has optimal flow which means that the gradient of flow (difference in pressure from one side of the valve to the other) is as low as possible no matter what age or size the patient is. This means that Chloe cannot have a valve with a better flow in it. Therefore, the surgeon concluded she will not have to have surgery on the valve again for flow or growth reasons.
Most adults worldwide have a size 25 in the mitral position. We only make one other size in the mitral position and that is 23 for really small hearts.
As a company, we do not make recommendations about the level of INR except to say that the surgeon or cardiologist should follow the recommended guidelines for INR for patients with implanted. These recommendations are published by the American Heart Association/American College of Cardiology (AHA/ACC) and the American College of Chest Physicians (ACCP). The AHA/ACC recommend an INR of 2.5 to 3.5 for patients with mitral mechanical bileaflet valves (On-X) and the ACCP recommends a target INR of 3 in the mitral position for bileaflet valves (On-X).
(THEN I GOT THIS ONE WHEN I ASKED YET MORE QUESTIONS...)
... Thank you for the nice update on Chloe. You have a healthy attitude about her and are a very good mother to be asking questions!
We do make larger size sewing cuffs and have valves named 27/29 and 31/33, but they all have that optimal flow size 25 orifice. If manufacturers go larger than optimal size (lowest gradient) then other undesirable outcomes appear such as more noise, more turbulence, more valve damage.
(AND AGAIN... lol)
... That is okay, Emma. I really enjoy the educational part of my job especially for patients and family.
Yes, there are larger cuff sizes for larger valve annulus sizes. The annulus is where the natural valve attaches in the heart. Since Chloe already has a heart that is large enough to accomodate the larger heart valve, she will probably not need a new replacement. Having the valve in place will probably take care of any growth in that particular area or the annulus. So I think she is safe in that regard based on what I know about valve surgery (I have participated in about 2000 cardiac procedures in 8 years when I was in hospital as a nurse). The best person to ask, however, is Dr. Haw. He should not mind if you ask. Most surgeons really enjoy education as well. I know Dr. Haw and he is very nice besides being a great surgeon.
Would you like me to ask him?
Catheran
(and thats the end of the emails - Mr Haw is Chloes surgeon, obviously, and I didnt feel a need to ask him as Catheran kindly answered all my questions fully! - lovely lady! Emma xxx)
