One of the topics people have asked me about is after a valve replacement "How long does it take to heal?" I've come to think that the question is misleading in that it presumes there is a date by which one is finished healing but this has not been my experience. Instead, I think it is better to think in terms of healing milestones because not everything happens at once. This is on my mind today because yesterday I had a checkup.
For those who know nothing of my past, my aortic valve was replaced in September, 2009 after several months of rapid decline. After surgery, my recovery went surprisingly well during the early months. A week after surgery, I was walking outside in my neighborhood and picking up the threads of my life again. I started driving at five weeks and began Cardiac Rehab at six weeks. At the end of six weeks, I returned to work part time for two weeks before I felt ready to work through the day. Around the six month mark, I had completed Cardiac Rehab and had been doing well until I began experiencing a very low pulse rate at least once every day; sometimes it dropped into the 40s. My Cardio agreed that I could reduce the dosage of the beta blocker, Metoprolol, which is frequently given to patients after heart surgery. A few weeks later, I was able to stop it all together and my pulse rate stabilized.
I began to feel much better after discontinuing the beta blocker but around nine months I noticed I was still experiencing periodic swelling, especially, in my legs and hands and sometimes I noticed I was short of breath. I was then diagnosed with "Diastolic Dysfunction" which it turns out is common after valve replacement. Essentially, the left ventricle can pump blood out normally but has become stiff so it cannot fully relax and does not fill properly. One then experiences mild congestive heart failure. The most obvious symptoms are the edema/swelling in the extremities and shortness of breath. This stiffness was caused by the heart trying to compensate for the bad valve; it did so by thickening which led to the stiffness. To treat this, I was prescribed a calcium channel blocker, verapamil, and an ACE inhibitor, lisinopril. It was hoped that with time, these would help my left ventricle to relax as it continued remodeling itself over time.
The checkup yesterday revealed that my left ventricle is showing significant improvement at two and a half years after my AVR. My doctor repeated what she said earlier that, formerly, it was believed our hearts healed for only a few months after surgery but it is now understood that remodeling can continue for at least several years after the valve is replaced. I think this is wonderful news for all of us. After the rapid changes in health we experience right after surgery, this slow improvement is more difficult to appreciate since it isn't visible day by day or week by week. Still, knowing that healing can continue for a surprisingly long time is very encouraging. As we learn to exercise more regularly and eat more thoughtfully, it is good to know that these changes in our lives are supporting our hearts' continuing recovery.
For me, personally, I've noticed that my leg are not swelling often and that I can wear the ring on my right hand again. I've also noticed in the past couple of months that the occasional shortness of breath has diminished. These are just indicators, however, that healing is continuing. I find this very encouraging as I hope you will also.
The potential for experiencing Diastolic Dysfunction also raises questions in my mind with respect to the timing of surgery. When we see in the report of an echo cardiogram the phrases such as "mild concentric left ventricle hypertrophy", we should ask what it means for us and our recovery. I think it would be well to discuss this openly with our cardiologists because as a heart valve degrades there is the potential for suffering long term and even permanent heart damage which will limit recovery to something less than full.
Larry
For those who know nothing of my past, my aortic valve was replaced in September, 2009 after several months of rapid decline. After surgery, my recovery went surprisingly well during the early months. A week after surgery, I was walking outside in my neighborhood and picking up the threads of my life again. I started driving at five weeks and began Cardiac Rehab at six weeks. At the end of six weeks, I returned to work part time for two weeks before I felt ready to work through the day. Around the six month mark, I had completed Cardiac Rehab and had been doing well until I began experiencing a very low pulse rate at least once every day; sometimes it dropped into the 40s. My Cardio agreed that I could reduce the dosage of the beta blocker, Metoprolol, which is frequently given to patients after heart surgery. A few weeks later, I was able to stop it all together and my pulse rate stabilized.
I began to feel much better after discontinuing the beta blocker but around nine months I noticed I was still experiencing periodic swelling, especially, in my legs and hands and sometimes I noticed I was short of breath. I was then diagnosed with "Diastolic Dysfunction" which it turns out is common after valve replacement. Essentially, the left ventricle can pump blood out normally but has become stiff so it cannot fully relax and does not fill properly. One then experiences mild congestive heart failure. The most obvious symptoms are the edema/swelling in the extremities and shortness of breath. This stiffness was caused by the heart trying to compensate for the bad valve; it did so by thickening which led to the stiffness. To treat this, I was prescribed a calcium channel blocker, verapamil, and an ACE inhibitor, lisinopril. It was hoped that with time, these would help my left ventricle to relax as it continued remodeling itself over time.
The checkup yesterday revealed that my left ventricle is showing significant improvement at two and a half years after my AVR. My doctor repeated what she said earlier that, formerly, it was believed our hearts healed for only a few months after surgery but it is now understood that remodeling can continue for at least several years after the valve is replaced. I think this is wonderful news for all of us. After the rapid changes in health we experience right after surgery, this slow improvement is more difficult to appreciate since it isn't visible day by day or week by week. Still, knowing that healing can continue for a surprisingly long time is very encouraging. As we learn to exercise more regularly and eat more thoughtfully, it is good to know that these changes in our lives are supporting our hearts' continuing recovery.
For me, personally, I've noticed that my leg are not swelling often and that I can wear the ring on my right hand again. I've also noticed in the past couple of months that the occasional shortness of breath has diminished. These are just indicators, however, that healing is continuing. I find this very encouraging as I hope you will also.
The potential for experiencing Diastolic Dysfunction also raises questions in my mind with respect to the timing of surgery. When we see in the report of an echo cardiogram the phrases such as "mild concentric left ventricle hypertrophy", we should ask what it means for us and our recovery. I think it would be well to discuss this openly with our cardiologists because as a heart valve degrades there is the potential for suffering long term and even permanent heart damage which will limit recovery to something less than full.
Larry
