Mechanical or Tissue/Pregnancy

[Andrea]

Ugh

Ugh

Geez Shelba This is a horribly hard decision for you. I am so sorry that you were put in the position to have to choose. The more time that you can take to think about it, the better.

Is there anyway that you can delay the valve surgery until you have a baby? I was at moderate to severe when I became pregnant with my second daughter. They monitored me during the pregnancy and after I had the baby they still waited until she was like a year old before doing the mechanical valve on me.

I would talk to your Doctor more and see if maybe with some meds and monitoring they can keep everything stable enough to go through a pregnancy first.

 

[dwfreck]

Shelba,

Fear I can understand. I've known since September that I would need a valve replacement in the very near future, and I STILL haven't made up my mind. Fear of reoperation, fear of coumadin, fear of dying during the first operation, I've got 'em all. I think mostly it all boils down to fear of making a life-altering choice that you can't easily take back. Of course, I've already done that several times: marriage, children, becoming a Buckeye fan )). If you've chosen to get married and chosen to adopt a child, then you've made some similar choices.

A lot of the comfortable assumptions you've lived by have changed very recently (less than a month ago, right?). You're still in the "Oh, my GOSH " phase of a life change. Give yourself a little time to get used to the new conditions, and give yourself even a little more time to reach a comfortable decision. I'm not there yet myself, but from what others on the forum have said, they've all gotten to a point where they made a decision and were comfortable with it. Hang in there; the pieces will start to fall into place soon.

 

[Harpoon]

I dunno about the other stuff (I wasn't given a choice in the matter, just the remote possibility that they might be able to repair the native valve) but the coumadin thing is not as big of an issue as it can be made out to be.

It does require careful monitoring and it may require closer attention to some of the foods you eat, or at least what's in them and how often, but it's not some monster to be avoided at all cost.


Personally, I was more concerned about my recovery than what happened during surgery or what happened if I ended up on a lifetime of coumadin.

I was also a LOT more afraid of the idea of heart block and getting stuck with a pacemaker.


Coumadin means you might bruise a little more easily and it may take a little extra time for cuts to clot. Coumadin means you get a blood draw every two weeks or so, maybe less than that, maybe more for the first few months, but that's not all that bad once you find a good person to do it (yes, I've shopped around.) And, at least what I've gathered from this site, you can do home testing like you might if you were diabetic.

Tell the docs what your concerns are and ask all the questions you possibly can.

I'm not sure there really is a right or wrong choice on this, it just has different "hurdles" to overcome after you get the valve replaced. You choose based on what hurdles you're more comfortable with, what you think you're more able to overcome.

 

[Gnusgal]

Another thing to consider is the possibility of going with the mechanical valve, then going on lovenox (low-molecular-weight-heprin) while you are pregnant. Lovenox doesn't have the dangerous side effects to a fetus that coumadin has. Not all doctors are willing to use lovenox, but you might talk to your doctors and see what they think. Also, talk to Al Lodwick. He's our resident coumadin expert. He can tell you more.

I recently (this morning) read an article about a woman who had a mechanical valve and thought she would never be able to have a baby on her own, so she had a tubal. Then she started looking into surrogacy and found out from her RE that it was possible for her to carry a baby if taken off the coumadin and put on lovenox. I'll try to find the article again and post the link. I'll have to wait until I get home, though (I'm at work) because it's on that computer.

Don't know if this helps in your decision making or not.

Just know I understand completely! Even with the lovenox, I can't carry a pregnancy. It would be too risky with all of my complex problems.

 

[LUVMyBirman]

I researched to possibility of becoming pregnant with my mechanical. The data I collected at the time (five years ago) did not impress me to the point of feeling comfortable. Even with the Lovenox.

If I recall correctly...it was almost like a crap shoot weather the mother and or child could survive. There was a study about pregnant African women with mechanical valves using Lovenox....one reason the drug was pulled for all valvers for a period of time. The fatalities outweighed the benefits.

Since we already had one child prior to my MVR.....my desire to have additional childen was lower. If the roles were reversed, I might have given it a try.

Good luck to you in your decision process. Keep us posted

 

[Gnusgal]

From what I understood about the study of African women taking lovenox thru pregnancy, they did not change their dosages as they increased in weight. Which MAY have been a factor, since the determine dose by how much the patient weighs... At least, that's what I seem to remember someone saying before...

Anyway, I just wanted to mention it as a possibility to discuss. I can't have a child with or without the coumadin, so I can't really be talking... But personally, if I had the choice, I would go the route that led to me being able to have a child. Unfortunately, I am not in a position that allows me to choose... I happen to have had more than one OHS and know I can live through it again (and probably will). Of course, this is just me and everyone is different.

 

[Andrea]

Coumadin

Coumadin

I havent seen a difference in bruising and I still eat all of the same foods including the ones they say you should cut back on and I havent had any problems with levels. After the first month I went to monthly draws and it only takes a minute and I'm out of there.

To me, coumadin isnt a factor. I dont know if different people have it easier or harder with keeping levels in range. To me its just been another pill to swallow and a monthly lab draw. Dont let coumadin scare you off too much. It's really not bad

 

[Shelba]

I saw my gynecologist on Friday. She has no experience with pregnant women who have had valve replacement, so she had little to offer there. She did fill me on the horrors of pregnancy and what it does to a "regular" woman's body and heart, so she cautioned me to avoid pregnancy. She gave me the number of a high risk OBGYN who might know more and she is calling him for me. We'll see. I don't know.

Am I the only one that walks around talking to myself saying, "I just don't know what to do. I just don't freakin' know." ? I hope not.

It was a week ago last Friday that I was given this valve choice, so I guess I'll give myself some more time to think about this. I do know that if I go for the Bionic Woman valve that I will not even attempt pregnancy. That is the only thing I KNOW for sure.

Thanks, everyone!

 

[Harpoon]

I wouldn't know what to do with your dilema either....


There are pros and cons to both sides of the decision you're trying to make and I don't know that one is better than the other given the information you have, and have shared here so far.

Maybe it becomes one of those "faith" things... I dunno.

Talk to the high risk ob/gyn, amybe give them the name of your cardiologist and whatever so they can talk to each other.

 

[dwfreck]

Shelba,

You're not the only person who's saying, "I just don't know." There is at least one more, namely me.

I don't normally question a doctor's opinion (at least not other peoples' doctors' opinions), but I would question your gynecologist's opinion. Did she really use the phrase "horrors of pregnancy" to describe the changes a woman's body goes through? That doesn't sound to me like the kind of doctor who spends a lot of time supporting and encouraging women who are bringing new life into the world. And was her recommendation to avoid pregnancy based on the CURRENT condition of your heart (needing valve surgery) or the FUTURE condition of your heart (restored to more normal function by the valve replacement)? You may be "high risk" now, but may be "average risk" after your surgery (assuming you pick a tissue valve).

Dont' get me wrong. I know, at least from an intellectual and second-hard perspective (my wife's been pregnant twice), that pregnancy is medically hard on a woman's body. I don't know anyone, male of female, who has been completely prepared for the changes that pregnancy brings to a woman and a couple; and that's not counting the change of becoming a parent. You should approach pregnancy with some caution under any circumstances.

It sounds like you have a lot of strong feelings about pregnancy, and justifiably so. It may help to separate the question of whether or not you want to get pregnant from the question of which replacement valve you want. Yes, the answers to each question affect one another, but it sounds like you need to determine whether you can and want to get pregnant before you'll be able to pick a replacement valve.

Finally, it sounds like you're proceeding through a difficult set of decisions by gathering as much information as possible about your options. The information-gathering can take a long time and each new piece of information can change your decision; I know from personal experience! Hang in there, and know that you will eventually gather enough information and come to a definite decision that you're comfortable with.

 

[Shelba]

This afternoon, I had an appointment with a OBGYN whose patients are exclusively high risk. He has dealt with quite a few woman who have undergone valve replacements, tissue and mechanical.

He told me that if I go for the mechanical valve, that I can still go through with pregnancy. He has had more than a few patients with mechancial valves who have delievered healthy babies. And the women made it through fine.

He was very positive about pregnancy after valve replacement.

If I choose the tissue valve, he still wants to put me on heparin. In fact, I would be put on heparin 4 weeks before trying to conceive.

He was very helpful. And it was wonderful to talk to a doctor that has dealt with heart valve replacement pregnancies.

 

[bvdr]

I'm so happy for you. It is so nice when you find competant health care providers.

 

[fisher6476]

Keep searching!

Keep searching!

Shelba, Dale and all,
There are an awful lot us of that had to make the same decision as you will have to make. We all have different circumstances and we have made our decisions based on what we think was best for us individually. I suggest you gather as much information as possible, get second and third opinions if neccessary. The more knowledgeable you become, the less fear plays into your decision.
I haven't done a study here but there are many members here who have chosen mechanical, and many who have chosen tissue. Some have chosen repair where aplicable. In the final analysis it will be completely up to you to make the decision. I for example was told by my PCP and my Cardiologist that I would have my Aortic Valve replaced with a mechanical valve and that I would be on blood thiiners for the rest of my life. In thier minds that just the way it was going to be. After meeting with my surgeon I chose a tissue valve. My Point is several Doctors im my case had a difference of opinion and I Had to make the final decision.
As far as the pregnancy issue goes, I think the same theory applies here. If it were me I would make sure I learned as much as possible about all the issuse involved. I would seek more than one or two medical opinions. Then I would make the decision I thought was best for me and i would try not to look backwards.
One thing that I think is true for all of us is that we have no crystal ball. How our individual decisions will play out over time we really do not know!
I know how difficult it is for you but keep searching, learning, and asking questions and I hope your individual answers will become clear.
Steve

 

[suz]

Shelba,

I just wanted to wish you the very best. I came to this site to research options for my Dad's valve replacement and found it a tremendous resource. At 75, my dad went the tissue route as he loves to travel and ski so the mechanical was not an option for him.

I noticed your post and just to share with you my feelings that pregnancy was the most incredible experience I have ever had. I had an unplanned pregnancy which sadly ended in miscarriage at 11 weeks, but I am truly thankful to have experienced it. This is coming from a career focused woman who never planned to have children. I see it as my little miracle.

I have been on boards and there are many women who are cancer survivors and women that have medical condition who do have successful pregnancies. You may want to consult a specialist on this. There are lots of specialists in the area of ob/gyn! Lots of women take medications to prevent blood clots during pregnancy. You must be overwhelmed by all of this news, but there are lots of docs out there that can help you with your decision. The secret is to find the best and the brightest.

best,
suz