Feeling a whirlwind of emotions—sadness, confusion, bewilderment, …, etc. after my recent “Bubble echo” test, which uncovered a hole in my heart.

[dick0236]

Yes. The stroke occurred on the recommended 1.5-2.0 INR. I am now settled into 2.5-3.5 and typically hang around 3.0 and plan to stay there!

I think you are making a wise decision to avoid a 1.5 INR. My only mishap with my valve, a stroke, came 50 years ago (before the INR system was introduced) and most certainly was due to a low PT (forerunner to INR). Since that time I have had an INR range of 2.5-3.5 and have had NO issues with clotting or bleeding.

 

[Chuck C]

I think you are making a wise decision to avoid a 1.5 INR.

Careful ****, you're interfering with Cryolife's marketing strategy. Expect their black helicopters to be circling your home soon

 

[Eva]

Not much of insight, but I do have either this or a similar condition. It was found a the end of MVr surgery. It's fairly small, about 3-4 mm. At that time I was told that:

• This should not cause any issues.
• It's very unlikely to grow. But if it does, there is a transcatheter method they could use to plug it.

So basically at the next echo scheduled (in ~1.5 years from now) my cardiologist also plans to use the test version "with bubbles".

I cannot quite translate your test result into the hole size, except that "it looks small". Would agree with @Deidra that by itself the hole may not explain the low oxygen issue. I wonder if something else is going on. Did your cardiologist say they understand the reason for the low oxygen?

Thank you.
Good luck to you with your next echo. My cardiologist has not yet published his “clinical notes” yet. I sent him a message and I hope to hear from him soon.

 

[Eva]

I’m sorry you are going through this.
I don’t have any experience in this, but it brought to mind my childhood friend who, at 13, had open heart surgery to repair a hole in her heart. It was in 1967 and Dr Shumway did her surgery at Stanford.
I remember visiting her and she had walked all over the hospital after her surgery. It was as if she hadn’t had OHS!
I had to have OHS at 34, but I’d lost touch with her. I saw her years later in the grocery store and we caught up. She was married to a wealthy guy, she had become a doctor of research and she had 2 children, the youngest asking me if I had a college degree! Ha ha. What fun memories!!

Thank you, Gail. You’re in my thoughts…your plate is full. Best of luck to you.

 

[Eva]

…

This is good. Sincerely hoping that none are required in the future.

Hang in there.

Thank you, Chuck for your sincere wishes. im hanging in there…I have no other choice than to accept what we cannot change and pray!

 

[Eva]

Oh Eva, I am so sorry that you have this worry on your plate about the new finding. I know how worrying this all can be. I am sending you hugs and prayers.

I don't have any good information medically to share other than my cousin had a PFO and they went through the groin to "patch it". It was a day surgery. However, this may not be needed in your case. He was also told that it is quite common. I don't have a PFO, but a new finding for me (that they are supposed to ligate on my upcoming redo OHS AV and new PV replacement) was a PDA. And no it does not stand for "public display of affection"! LOL. It is a patent ductus arteriosus. I can assure you that when first discovered recently they thought it was quite large, but after another echo, I was told it was quite small. All to say, the surgeon will ligate it because I will already be opened up, but I think they would have left it as is if I wasn't having a re-do OHS.
Feel free to reach out if you need support. Thinking of you and wishing you the very best news and outcome.

Yes, dear ottagal, this is worrying news, it came as a surprise! Now reading about it, I find it surprising that it’s too common and yet no explanation why it happens in older adults. My mind cannot stop analyzing to figure out why. I had a TEE two years ago when I had Cardioversion and there was no mention of PFO.
You are in my prayers too all the time!

 

[Eva]

Hello,
I had an AVR (On-X) and aortic graft 2 years ago last Sunday! 8 months later ai had a stroke due to a clot forming on the valve and kicking off and going to my brain. Luckily, no lasting detriments. While in the hospital recovering from my stroke they did a bubble study and, to add to the list, they found a PFO! Even with my history, the cardiologist advises to leave it alone since I’m already on Warfarin indefinitely! I have not dialed back my physical activity at all and don’t plan on it. The more I do the better I feel. Living a diminished lifestyle is not living! Not sure this is helpful to you but wanted to share!

Oh sorry Buck83. I’m glad you’re ok. I’m keeping same activity level t as I’m enjoying my exercises, yet it’s on the back of my mind if strenuous exercise had something to do with it! I started exercising regularly two years ago! But I maybe wrong This is why I shared this to find out if there are any common grounds.

Also, it’s wise to keep your INR around three. I had atrial flutter this past March and when I was discharged, the attending cardiologist recommended I go to Coumadin clinic. I wish I didn’t agree. They lowered my dose once when I’d not have lowered it myself if I was managing it. As a result, I had, luckily, a minor TIA in my eye! Now, I’m managing my INR again and I always try to stay around the higher end.

 

[3mm]

... I go to Coumadin clinic. I wish I didn’t agree. They lowered my dose once when I’d not have lowered it myself if I was managing it.

Did you tell them you did not want to lower your INR target?

3 months after installation of my On-X aortic valve , my Coagulation Clinic asked if I wanted to lower my range to 1.5-2.0. I said no, my cardiologist and I had agreed to use a target INR of 2.5. The coagulation clinic nurse agreed to use 2.5 as a target. I do not know if my cardiologist actually told the coagulation clinic this, or if the Coagulation clinic simply relied on my verbal statement.

 

[Eva]

@3mm, No I did not ask to lower my INR range! My INR range should be 2.5-3.5, as I have St. Jude aortic and mitral mechanical valves and my surgeon said my INR could safely extend up to 4 in my situation.

So, when my INR was 3.6, they asked me to lower my dose by .5 mg for one night, which was very unnecessary (and stupid) and I should have refused! But I went along with their recommendation maybe to let them realize their bad judgement. Regrettably, this led to a decrease in my INR to 2.2, resulting in a transient ischemic attack (TIA).

Don’t listen to Coumadin clinic…they are not in a position to decide your INR range.

 

[dornole]

Eva, would you mind sharing what symptoms you had with the TIA in your eye, and the testing done to confirm ?

Just got back from the ER with vision symptoms - no recent stroke, but I remain concerned about TIA.

 

[Sheenas7]

Hello,
I had an AVR (On-X) and aortic graft 2 years ago last Sunday! 8 months later ai had a stroke due to a clot forming on the valve and kicking off and going to my brain. Luckily, no lasting detriments. While in the hospital recovering from my stroke they did a bubble study and, to add to the list, they found a PFO! Even with my history, the cardiologist advises to leave it alone since I’m already on Warfarin indefinitely! I have not dialed back my physical activity at all and don’t plan on it. The more I do the better I feel. Living a diminished lifestyle is not living! Not sure this is helpful to you but wanted to share!

When I had my mechanical valve replaced at Cleveland clinic as a byproduct of the surgery they pin pricked my septum causing me a ventricular septum defect. I believe they called it a shunt. They did a TII test and decided it was small and they would not repair it. I’ve lived w it since 2001 and it has not grown or caused me problems. I don’t know if this is similar but good luck and keep the faith. Sheena

 

[Eva]

Eva, would you mind sharing what symptoms you had with the TIA in your eye, and the testing done to confirm ?

Just got back from the ER with vision symptoms - no recent stroke, but I remain concerned about TIA.

A few years ago, a visual disturbance in my left eye looked like a descending grey *shade* that temporarily obstructed my vision. Luckily, my ophthalmologist examined me promptly and advised me to check my INR upon returning home by which time my vision was ok again. Regrettably, I do not recall the precise INR value now, but it was lower than 2.5.

Most recently, during my exercise session, I saw a circular, black ball! surrounded by (flashes of golden stars which sometimes are related to migraines)!!.
My experienced gym instructor stopped my activity, asked me to rest, and helped me perform gentle stretches.
Upon his advice, I checked my INR at home…it was 2.2.

No testing was done to confirm TIA other than the word of the ophthalmologist and my PCP when I mentioned this to him.

What did you see? What was your vision symptoms?

 

[dornole]

I had a opaque gray that obscured my entire field of vision except for a clear "peephole" in the center, in my left eye only. Then my vision opened horizontally, like a window shade. The whole thing lasted about 2 minutes. I had a couple others where only the top left quadrant was obscured that same week.

Ophthalmologist sent me to ER and had an MRI which was negative for any active stroke processes, though I apparently did have a lacunar infarct in my right cerebellum probably years ago.

I am supposed to follow up with neurology but there are no openings till August. I am on Eliquis and have been more than 99% compliant with the doses.

 

[Deepak khanka]

Hi Buck
Sorry to hear this. On the other hand I also have a small PFO which was detected in a MRI prior to my first surgery.
The consultant at that time said this must have been from birth and nothing needed to be done . I had other challenges during my first surgery I.e accidental damage to my coronary artery.During my second surgery nothing was mentioned about the PFO.
However I have a question for you as you have an On-x . Do you take a small aspirin. 75/80 mg along with your daily tablets ?

 

[geff]

Oh sorry Buck83. I’m glad you’re ok. I’m keeping same activity level t as I’m enjoying my exercises, yet it’s on the back of my mind if strenuous exercise had something to do with it! I started exercising regularly two years ago! But I maybe wrong This is why I shared this to find out if there are any common grounds.

Also, it’s wise to keep your INR around three. I had atrial flutter this past March and when I was discharged, the attending cardiologist recommended I go to Coumadin clinic. I wish I didn’t agree. They lowered my dose once when I’d not have lowered it myself if I was managing it. As a result, I had, luckily, a minor TIA in my eye! Now, I’m managing my INR again and I always try to stay around the higher end.

hi buck can you tell me if you were testing you INR on a regular basis before the stroke and were you getting blood tests done prior thanks

 

[Buck83]

hi buck can you tell me if you were testing you INR on a regular basis before the stroke and were you getting blood tests done prior thanks

Yes. I tested weekly at home and reported to the Coumadin Clinic who kept me 1.5-2.0, based on my cardiologist’s order. I was 1.7 the day of the stroke when I got to the hospital. Unlike many others on here, I have a great relationship with my Coumadin Clinic. They only monitor me and help keep me therapeutic based on my cardiologist’s order.

 

[Eva]

Yes. I tested weekly at home and reported to the Coumadin Clinic who kept me 1.5-2.0, based on my cardiologist’s order. I was 1.7 the day of the stroke when I got to the hospital. Unlike many others on here, I have a great relationship with my Coumadin Clinic. They only monitor me and help keep me therapeutic based on my cardiologist’s order.

Was INR 1.7 result test done at the Coumadin clinic or you self-tested at home and you reported it to the C Clinic? Again, glad you’re now on the higher level.

 

[Buck83]

Was INR 1.7 result test done at the Coumadin clinic or you self-tested at home and you reported it to the C Clinic? Again, glad you’re now on the higher level.

I tested the day before at home and was 1.8 and when the ambulance got me to the hospital they did a blood test because they can’t administer clot busting meds over a certain INR. My INR at the hospital was 1.7.

 

[geff]

wow when you hear reports for strokes with the mechanical valve it sways you towards the bovine valve yet i read on this site that that valve had malfunctioned after only a couple of years very hard to make a decision of which valve to go ahead with when you hear feedback not good from both of them i just hope when the time comes in a few more weeks i make the right decision

 

[Buck83]

Hi Buck
Sorry to hear this. On the other hand I also have a small PFO which was detected in a MRI prior to my first surgery.
The consultant at that time said this must have been from birth and nothing needed to be done . I had other challenges during my first surgery I.e accidental damage to my coronary artery.During my second surgery nothing was mentioned about the PFO.
However I have a question for you as you have an On-x . Do you take a small aspirin. 75/80 mg along with your daily tablets ?

I took an aspirin when my INR was 1.5-2.0. But when the cardiologist raised me to the new range they said it wasn’t necessary anymore.