High blood pressure and mechanical valves

[Magnus]

When I was being released from the hospital my surgeon came by for the standard pre-release pep talk and among various other things he mentioned that I should "avoid having constant high blood pressure". Now, being all doped up on pain meds at the time, I don't remember the reason he gave for this. Obviously having high blood pressure is never a good thing, but it sounded like it was an extra bad thing with a mechanical valve. Does anyone know why/what could happen? My blood pressure's fine right now btw; I'm just curious.

 

[tobagotwo]

High blood pressure is tough on the heart and all of the natural valves in it, your kidneys, your arteries (including those in your brain), and can affect your gastrointestinal system and a variety of other sytems in your body.

However, whatever blood pressure your body can produce (and still live) is well within the specs of your mechanical valve. There is some possibility that if you have connective tissue problems, it could create stress on the attachment area and exacerbate any perivalvular leaks you might have, but it would have to be severe and longstanding even to be a primary cause for that.

Best wishes,

 

[MrP]

As a BAV patient, you also need to be concerned with the possibility of developing an aortic aneursym (even after valve replacement). High blood pressure increases this risk, and therefore, managing your blood pressure is especially important for this reason..

 

[Magnus]

Thanks for the replies. I'll also ask my cardiologist next time I visit him; he probably knows the specific reason they caution you about the blood pressure.

On a side note, I went out on my first run after surgery yesterday. I can now say I know why all through junior high and high school I would feel tired after 1-2 minutes when jogging during P.E. It wasn't me being lazy or out of shape - it was my bicuspid valve. Yesterday - even after basically having been sitting still for 6 months - I just floated through the 3 km jog. Amazing stuff.

 

[MrP]

I was the same growing up. Glad you are running now. I am running about 2 miles ( a little more than 3km) each day now...truly amazing stuff I agree.

 

[Sean]

Dear Magnus,

I can't remember where I heard it ( I may have even thought it up myself ), but having chronicly high bp while on coumadin may increase your chances of stroke. Something you may want to ask your doctor about.

 

[Mb]

Dear Magnus:

My husband;s surgeon also told him the same thing. Not to get the BP high for long periods of time, nor the heart rate.

He told us that the mechanical valves do not close the same way a tissue valve does, and when the BP or HR are high, they don;t have a chance to close all of the way, there by stressing the heart. He has taken a beta blocker since that time.

This past fall, about the 4 year mark, my husband had an episode of high blood pressure and heart rate. (High being 160 over 100 for his BOP), that lasted about 9 hours. We went to the ER as he was having chest pain. They brought everything down with nitro and another beta blocker. Took about 3 hours to get him back down though. They kept him overnight. He felt really really punky during the episode.

Marybeth

 

[MrP]

Here's some interesting research indicating postoperative blood pressure control is more important than prosthesis selection....may be of interest to you and others.

"Impact of postoperative blood pressure control on regression of left ventricular mass following valve replacement for aortic stenosis.
Kazuhito Imanaka, Osami Kohmoto, Shigeyuki Nishimura, Yuji Yokote, Shunei Kyo
OBJECTIVE: Considerable left ventricular (LV) hypertrophy sometimes remains after aortic valve replacement (AVR) for aortic stenosis. For this issue, most previous studies have focused solely on transprosthetic pressure gradient, although true problem is not the pressure gradient itself but an elevated LV pressure. This study investigated the impact of blood pressure on postoperative LV mass regression, which had been overlooked in previous studies. METHODS: Seventy-nine adult patients with pure aortic stenosis who were treated with AVR using bileaflet mechanical valves underwent echocardiography before surgery, around 6 months later ('early'), and 2-3 years later (31.7+/-14.7 months, 'late'). Patients were divided into two groups whether postoperative systolic blood pressure was below (n=47; N group) or above 130 mmHg (n=32; H group) following recommendation of WHO-ISH and JNC 7th report. Preoperative LV mass (g/m2) did not differ significantly (232+/-80 vs. 243+/-76, P=0.91). RESULTS: LV mass became significantly smaller and regression was significantly more effective in N group than in H group both at 'early' (145+/-43 vs. 180+/-54, regression against preoperative value 34.6+/-19.1 vs. 19.9+/-26.6%, P=0.007) and 'late' (132+/-41 vs. 178+/-51, regression 41.1+/-16.0 vs. 21.0+/-27.0%, P<0.001) evaluations. Regression between 'early' and 'late' evaluations was significant only in N group (P=0.012). The LV mass index returned to the normal range at 'late' evaluation in 52.1% of N group and 12.5% of H group patients (P<0.001), and 25 out of 29 patients without residual LV hypertrophy were N group patients. Multivariate analyses revealed that preoperative LV mass index (P<0.001) and postoperative systolic blood pressure (P=0.007) showed significant influence on postoperative LV mass index, and postoperative systolic blood pressure alone significantly (P<0.001) influenced the regression ratio of the LV mass against the preoperative value. No prosthesis related variables (size, orifice area index, pressure gradient) had significant influence. CONCLUSIONS: For LV mass regression after AVR, postoperative blood pressure appeared to be more important than prosthesis selection. Controlling the systolic blood pressure below 130 mmHg was beneficial, which coincided with recommendation of WHO-ISH and JNC 7th report despite the pressure drop due to prosthesis in the aortic position.
Eur J Cardiothorac Surg. 2005 Jun ;27:994-9 [Pubmed] [Scholar] [SelectDrop] [HideShow] "

 

[jiniani]

Good stuff

Good stuff

Your words "floated through 3km" is very assuring. I'm waiting for my aortic valve replacement (BAV since birth). I was also wondering, why I couldn't perform like other kids in long distance runs? I would out run others in a shorter race, but wouldn't able to keep up the speed. Recently, I was beaten left and right by 50 yr old guys (i'm 36)!!! Cannot wait to kick some butt after the surgery!!
-sk