Left Ventricle ejection fraction impaired after mitral valve replacement

[Davey]

Hi Everyone
Greetings from New Zealand. I haven't been on this site for quite some time, but have been a member since I had a St Judes mitral valve fitted in July 2000.
All is good and has been since surgery almost 14yrs ago, except my ejection fraction is only 40% from my LV and has been that way since surgery. I am Asymptomatic.
It never used to bother me but just recently after a two year check up and an echo, the new specialist was concerned at the impaired IF and suggested I was on the wrong medication, (candesartan) and should be taking low dose ace inhibitor and a blocker, both of which I am now taking.
Does anyone know if it is a common problem to end up with impaired IF after mechanical mitral valve surgery, and if so why ?
I am now 63yrs old, running a business and leading a normal life ( whatever that is) I am on Warfarin which has always been stable and home INR checking.
I guess I never worried much because the previous cardiologists and my own Doctor never made a big issue out of it, but this guy has me a bit rattled !
Look forward to any comments.
Cheers
Dave

 

[Duffey]

I don't know anything about this issue, but if it's fixable with a medication change, then it seems like it would be worth a try. I hope you update as you can. Best wishes!

 

[Davey]

Hi Duffey
Thank you for your kind thoughts. The frustrating thing is I won't know if there is any improvement until after my next scheduled Echo 18mths from now. Still a glass half full is always better than a glass half empty !
Cheers

 

[river-wear]

I think your follow-up question for the doctor should be whether your LV dimension is growing. If your heart is struggling, then your heart will become enlarged. The EF on its own isn't necessarily a huge concern. I'm glad to hear you are feeling fine.

 

[clay_from_nj]

A little research: http://www.ncbi.nlm.nih.gov/pubmed/12103379, http://www.ncbi.nlm.nih.gov/pubmed/18692655, http://content.onlinejacc.org/article.aspx?articleid=1126867, http://circ.ahajournals.org/content/91/4/1022.long. Looks like you're not the only one, Davey, and that a lot of it depends on what kind of shape your heart was in before surgery. Beta blocker and ACE inhibitor are a standard treatment for heart failure and work very well. There are different beta blockers which affect each person differently. If you have problems with one, talk to you doctor and you'll probably wind up trying another. Personally, I've done very well with carvedilol (coreg) and will probably be on it for a long time to come.

 

[Davey]

Thanks for the research links, happy to know the impaired LV function is not necessarily a big issue. Will ask about ventricle enlargement next time I see the doctor. The problem is knowing what questions to ask. Some of the specialists are not as free with the information as they should be.