Leaky mechanical AV & MR grade III

[ManiSham]

Hi everyone,

Hope you all are doing great. I have been checking the forum for a while but posting after a long time. After my routine check - up last week I’m a bit upset and thought maybe you could help me or share similar stories.

I had my AV replaced (almost 10 years ago) with a mechanical valve. My mechanical aortic valve has a leak since my heart was inflamed at the time of the surgery and once it reverted to the normal size after the surgery the mechanical valve is not proportionate. I also have a Grade III Mitral Regurgitation (ejection fraction is 60%).

All these years my condition has been stable and I was able to go through a successful pregnancy five years ago. However after my last check up my doctor recommends that I get a patch on my AV (catheterization). She said that whether I get the patch or not I will most probably have to go through another replacement in about five years for the AV or both AV and MV.

She also mentioned that mechanical valves generally lasts only for about 15 years which contradicts with what my surgeon said and what I have read online which is that it lasts a lifetime, has anyone heard about this? I switched to this doctor last year after my usual Consultant Cardiologist retired and he too told me that mechanical valves can be relied on to go on forever.


Has anyone gone through the similar situation?

Looking forward to your responds

Regards
M

 

[pellicle]

Hi

I had my AV replaced (almost 10 years ago) with a mechanical valve. My mechanical aortic valve has a leak since my heart was inflamed at the time of the surgery and once it reverted to the normal size after the surgery the mechanical valve is not proportionate. I also have a Grade III Mitral Regurgitation (ejection fraction is 60%).

do you know if its leaking at the leaflets or around the stiching ring where its fitted into the heart? If its been identified as at the leaflets has anyone attempted to see if there is some buildup on the valve?

For instance this thread has some information on what may cause leaks which is also treatable without surgery

http://www.valvereplacement.org/for...raphicnof-why-we-don-t-neglect-our-ac-therapy

She also mentioned that mechanical valves generally lasts only for about 15 years which contradicts with what my surgeon said and what I have read online which is that it lasts a lifetime, has anyone heard about this?

I think they are confused ... to my understanding, if a person with an aortic mechanical requires reoperation its is typically not due to valve failure, but aneurysm or some other blockages as in that slide set above for instance. Valve failure is quite rare.

 

[dornole]

Well that sounds sucky and weird . . . though, the patch would be a cath procedure? That would be great if it worked.

I don't have experience to share except to note that EF is seemingly a really different measure when you are talking mitral vs aortic. It's not as reliable an indicator for surgery and the % are different. I found this helpful:

http://www.ccjm.org/index.php?id=107937&tx_ttnews[tt_news]=355505&cHash=1f8e3bf5d7b5935cf480a4dc2370745f

I just feel compelled to say that since I am not sure if the many aortic patients on this forum are aware how different it is and since you mentioned EF of your mitral.

 

[neil]

Sorry to hear about your problem and just to wish you good luck

 

[Heart Of The Sunrise]

Do not know where you live , but my surgeon is also fabulous at repairing AV's.

 

[cldlhd]

Do not know where you live , but my surgeon is also fabulous at repairing AV's.

Ya he just did mine in February. I had my follow up last week and he said there's zero leakage and everything looks great. I had the valve repaired using the David procedure, replacing the root, ascending and hemi arch.

 

[Midpack]

Well that sounds sucky and weird . . . though, the patch would be a cath procedure? That would be great if it worked.

I don't have experience to share except to note that EF is seemingly a really different measure when you are talking mitral vs aortic. It's not as reliable an indicator for surgery and the % are different. I found this helpful:

http://www.ccjm.org/index.php?id=107937&tx_ttnews[tt_news]=355505&cHash=1f8e3bf5d7b5935cf480a4dc2370745f

I just feel compelled to say that since I am not sure if the many aortic patients on this forum are aware how different it is and since you mentioned EF of your mitral.

To my knowledge, LVEF is a single value, telling the percentaje of blood that leaves the left ventricle when pumping. You do not have an "Aortic EF" and a "Mitral EF".
However, it is true that for severe mitral regurgitation (MR), an EF below 60% is usually a surgery indicator, but for say aortic stenosis, 55% may be ok. My assumption (i am not sure about this) is that EF computes all the blood leaving the ventricle, and with MR, some of the blood actually goes back to the left atrium (instead of going out by the aorta). So, in order to guarantee enough blood supply, EF is monitored to be above 60% in severe MR.

Sorry if i have misread your post.

 

[tom in MO]

I have a mechanical valve, and they are not routinely replaced like a tissue valve, that's why I chose one. Replacement of a mechanical valve is not common and is usually due to some difficulty not related to the function of the mechanical valve itself, such as damage to surrounding tissue due to endocarditis.

 

[ManiSham]

I'm going for a second opinion today, I will update you'll after that.

Thank you

 

[dornole]

However, it is true that for severe mitral regurgitation (MR), an EF below 60% is usually a surgery indicator, but for say aortic stenosis, 55% may be ok.
Sorry if i have misread your post.

Well, you explained it a lot better than I did. : ) The article I read said to consider that EF may be "elevated" when MR is the concern, which would track with what you said and also with your reasoning why, if I read you right. From the paper re: MR:

"In the asymptomatic period, preload increases (due to left ventricular dilatation) and afterload decreases (due to the low pressure outlet in the left atrium). At this stage, the cardiac output is normal and the ejection fraction is above normal. The ejection fraction does not accurately reflect ventricular function in this situation, however, because the left ventricle is pumping a lot of blood into the low-pressure left atrium rather than into the systemic vessels (which are at a higher pressure than the left atrium). In fact, a “normal” ejection fraction in patients with severe chronic mitral regurgitation indicates that there is underlying left ventricular impairment."

Good luck Manisham, I hope you got good info from your second opinion today.

 

[ManiSham]

hi All,

It seems that my mechanical AV is wearing out (which is a very rare case) so doctors are contemplating another OHS in the future. At that time if my MV also need to be repaired or replaced that too will be done. However there is a panel of Intervention Specialists coming down to my country in June so they will review me to see if anything else can be done.

I want to share my last Echo on the forum FYI but both file types got rejected (word & jpeg). I think the jpeg is too big let me resize and try again later.


Thank you everyone for your responses and kind words of encouragement.

Regards
M

 

[pellicle]

Hi there

It seems that my mechanical AV is wearing out (which is a very rare case) so doctors are contemplating another OHS in the future.

it is indeed particularly rare, so rare in fact that I'd be seriously questioning their diagnosis. Did you read the thread I mentioned above? Those images (copied again below) could be without appropriate medical imaging be misinterpreted for valve wearing out

I'm sure that nobody wants to have another surgery.

Just recently there was another member here who had a mechanical valve that was causing problems, her surgeons were talking replacement, however she found that the therapy used to treat the above sort of coagulated valve worked for her and she did not need another OHS

http://www.valvereplacement.org/foru...389#post850389

I received TP-A in six hour infusions ever day for 6 days. I had to remain on bed rest and had neuro checks every hour advancing to every two when infusion not running. Heparin was administered in between infusions and I needed a PIC line as my arms were bruised beyond recognition!
They then transferred me to a step down unit on Plavix, ASA and Heparin IV.
It was expected they would see some improvement in 3-4 days but nothing happened and they were considering stopping the TP-A but did do a last sixth dose.
had a fluoroscopy 2 days after completion of the last dose and shockingly it had worked!!!! The valve is closing albeit maybe not tightly.

with respect to posting images, I load them onto flickr and post them here as a link, just copy paste the image url and put it inside img tags ... conversely flickr has a share image and you can choose BBCODE as the method and it looks like this:


the face of skepticism by aquinas_56, on Flickr

 

[ManiSham]

hi Pellicle

I was surprised myself since I was so sure that my mechanical valve will be ticking away till I'm old and wrinkly. However I'm going for a third opinion and an echo is due this Friday. I will not take any risks and will avoid OHS as much as possible.

Since there is a group of experts coming down in June I hope to get myself checked again then. I have also sent my latest echo report to a hospital in Queensland through a personal contact to get the cardiologist's opinion. After going through your post, I'm hoping to mention this to the doctor I'm seeing on Friday. I hope that its all just a big mistake!

Will keep you updated!

regards
Manisha

 

[pellicle]

Hi

... I have also sent my latest echo report to a hospital in Queensland through a personal contact to get the cardiologist's opinion. After going through your post, I'm hoping to mention this to the doctor I'm seeing on Friday. I hope that its all just a big mistake!

Since you mention Queensland (perhaps Brisbane) , my cardiologist was Chris Raffel at Prince Charles. The Surgeon I used was Dr Homayuon Jalali (he had worked with Drs G Stafford and Obrien who were very experienced in Homografts (a paper on one of their long term followups 29 years too, not the plinking 10 years so common today... http://www.ncbi.nlm.nih.gov/pubmed/11380096)

I hope that helps in any way. It would be good if its all just a mistake ... IMO it probably is

Best Wishes

 

[pellicle]

PS

I was surprised myself since I was so sure that my mechanical valve will be ticking away till I'm old and wrinkly.

some other "readings"
http://www.valvereplacement.org/for...jude-aortic-valve?16405-St-Jude-aortic-valve=

Typically the St. Jude valve should last the lifetime of the patient. Mechanically it will not fail, but there have been incidences where it had to be replaced because of leaks around the sewing cuff or infection set up on the sewing cuff. With proper follow up, lifetime should be your answer.

http://www.valvereplacement.org/for...n-time-to-failure?15679-mean-time-to-failure=

If you are talking about valves that are implanted today, the mean failure rate of a mechanical valve due to defects or wear is well beyond the human life span.
Even with older valves, most people pass on with valves still working well. I read a case study where one man had an old Starr-Edwards that was 38 years old. One woman post here last year the she had an old Kay disc valve that was still working fine after 32 years. Now, Mech. valves have to be replaced for other reasons as Geebee said, but it is rare.

Will keep you updated!

please do

 

[ManiSham]

hi everyone

According to my latest report (two echos and a TOE) it shows that my MR is actually between Grade 1 - 2. However there is a deterioration in my mechanical AV plus a Grade 3 AR. According to the cardiologists the decaying of mechanical valve may happen when medication is changed ( I shifted from Warfarin to innohep couple of years ago for a while).

My doctor suggests that I get a 'plug' through catheterization to stop my Aortic Regurgitation however they are still not clear whether the leak is through my valve or from the stitches.

Has anyone had a similar situation and has anyone got a plug to stop leakages?


regards
MS

 

[ManiSham]

the same message keeps saving twice and I don't know how to delete it!

 

[pellicle]

Hi

Sorry to hear of your leaks. I feel that its likely to be the stitches as a site. Yet I would not discount the points I made earlier with thrombosis causing blockage to the valve.

With respect to

the same message keeps saving twice and I don't know how to delete it!

What browser do you use? I have found with some browsers on XP that e site does not effectively redirect your browser and leaves you feeling your post failed, causing one to type it again. I moved to the latest version of Google Chrome so that my posts worked here.

 

[Eva]

"Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for characterizing the defect location, size, and shape. "

You may read more about plugging here: http://interventions.onlinejacc.org/article.aspx?articleid=1207195

Good luck and keep us informed (I may need to have this done too).