Heart Attack/Mitral Valve Repair

[Jkm7]

Hi: I had a heart attack about 3 years ago. Had bypass surgery and did extremely well. Good recovery. No restrictions on my full life with lots of travel etc

About a year and a half ago, my PCP first heard a murmer during regular check up. Echo and nuclear stress with my cardio followed. Diagnosed with mild/moderate leak at mitral valve due to damage from my heart attack. I have some heart enlargement but it has remained constant and is not very severe. Wall thickness is okay.

Cardio has been watching and redoing echos. Went from mild/moderate to mild at about 9 months. Latest echo showed moderate. Cardio said it had worsened slightly.

I walk daily, eat a very healthy diet, weight is normal, don't smoke and drink wine moderately. My controlled blood pressure is fine and cholesterol total is 130. Cardio says my lifestyle is good and to 'keep it up'. He says he cannot tell me mitral valve repair surgery is not a part of my future. I'm sensing he thinks it probably will become necessary. He has described the repair procedure to me and has made enough surgical references for me to know how he is thinking.

So, what are my chances this valve can stay at moderate for a long time and not require repair? Or is it a foregone conclusion that few (if any) stabalize and remain consistently at moderate?

My cardio is cautious with me and has scheduled another echo for four months from the last.

Would others here who have mitral valve regurgitation due to heart attack damage share some advise for me??

Thank you.

 

[PegB]

You're doing the right thing by just getting regular follow-ups with your echoes. I don't know if mitral regurge following a heart attack is different from just a regular regurge, but you could be fine for years to come. They'll be checking for heart enlargement as well as the amount of leakage in the valve. Sounds like you have a way to go yet. I was in the mild to moderate range about twenty years ago. Things can change quickly though, so in between your echoes, you will want to notify your Dr. if you start experiencing any symptoms such as extreme fatique, or shortness of breath.

I would try to put it out of my mind in between visits though, and not "pre-worry" over something that might never happen. You sound like the picture of good heath now!

 

[bvdr]

This is just my personal opinion. When a MI causes damage to an area that involves the mitral valve the greatest danger is when the insufficiency is sudden (acute) and the rest of the heart has not had a chance to adapt to the changes. This would usually show up very soon after the MI---probably within days or weeks. From what you state, it seems like yours developed later on and I would think you would have a better chance of stablizing and not requiring surgery later on. Echoes can vary so much that hopefully the next one you have may be back to mild. Your situation is a little different than those who have valve problems that cause resultant heart muscle damage in that your heart muscle itself is the cause of your problem. It sounds like you are doing really well with your lifestyle and general health over-all. I think you can be pretty optimistic. There is always the chance that you had some undiagnosed valve problem before the MI but that probably isn't the case.

 

[Jkm7]

Thank you both for very helpful answers.

Betty.....You are very correct about the abrupt insufficiency immediately following my MI though the valve problem developed months later. They had me on a balloon heart pump for days before they felt they could do the bypass surgery. When I awoke from the surgery, they still had the pump in place for at least two more days.

The MI damage to my heart is at the location where the threads that support the mitral valve attach to the heart wall. The valve supports are not as strong as they once were therefore the leak at the valve. I suffered some heart enlargement but not a great deal. The enlargement has contributed to 'pulling the valve wider open' if I correctly understand what my cardio explained.

It seems my situation is a little different than some other mitral valve issues. But leaking nonetheless .... whatever the cause. I don't recall during the time I've spent on this forum reading of anyone else having valve surgery due to heart attack damage rather than the usual causes of MV regurg. My cardio has said if surgery becomes necessary, it is for repair, not replacement so that is encouraging to me.

All information anyone can share with me would be so very welcome.
Facing a second OHS isn't fun.

I truly appreciate all the wonderful information you very generous, kind people share. Thank you.

 

[Jkm7]

I was so hoping there was someone else here who has valve problems resulting from heart attack damage. I didn't think it was uncommon but maybe it is?

It would be so helpful to understand whether Mitral Valve regurg no matter what the cause usually progresses in the same way or if maybe I could be lucky and it might stabilize seeing as the enlargement has not worsened.

Something else to ask my Cardio at my next visit.

 

[bvdr]

When acute mitral regurgitation occurs following an MI very agressive management is needed for the patient even to survive. It seems like that is exactly what happened to you and you are very blessed to still be here. Quite a while ago we did a poll on what was the root cause of member's valves. I know we had that as a catagory but I don't remember how many were in it.

I know you want to know if mitral regurgitation progresses in a similar manner regardless of the initiating cause but I really don't know the answer. I would think that if your heart continues to strengthen then your chances of a surgery due to worsening regurgitation would lower. I would be interested in what your cardio says though since your heart is having to deal with an unnatural condition.

If you do end up needing valve surgery perhaps you could have it through a heartport procedure and avoid going through the scarring on your anterior chest and sternum. I hope you won't but regardless please stay around and be part of this forum since you do bring another perspective. I'll try to find that poll for you. Also, if you go to our resource forum you will be able to find a complete Cardiac surgery book accessible that may also have some good information for you.

 

[bvdr]

Here is a link to that poll: http://www.valvereplacement.com/forums/showthread.php?t=10742

and here is the link to the textbook: http://cardiacsurgery.ctsnetbooks.org/

and here is the section in the book:http://cardiacsurgery.ctsnetbooks.o...#FUNCTIONAL_AND_ISCHEMIC_MITRAL_REGURGITATION
(from what I quickly scanned, I may be wrong in you being at less risk for progression unless, and hopefully it is the case, your left ventricle is no longer enlarging)

 

[Jkm7]

Thank you, Betty. Really interesting reading.
You've been a tremendous help to me. I feel I have a better
understanding after reading the textbook you linked.

I'm greatly appreciative.