Mechanical Valve Clicking

[kenkahle]

I am 52 years old and am facing AVR surgery next month at the Mayo and have chosen to go with a mechanical valve due to my age. I am trying to determine which valve to go with and have come up with the following list: Regent (St. Jude), On-X, Open Pivot (ATS - Medtronic), Top Hat (Carbomedics). I work for Medtronic as an engineer (not in the heart valve division) and have been fortunate to have access to folks in our heart valve division to learn a fair amount about heart valves and to get their opinions about the various valves. Of course they are swayed towards the ATS/Medtronic Open Pivot valve as one would expect... I do believe the valves listed are all good valves and would all serve me well.

However, I do fear the fact that they make a clicking sound when opening and closing. This could be quite bothersome to me as I can't stand the sound of clocks that tick tock! My cardiologists are reluctant to give me any opinions on which one is the quietest. I have scowered the internet and have found a fair amount of contradictory information with that regard (sound level). I would GREATLY APPRECIATE any personal experiences or information that you may have gathered on the sounds levels of these valves implanted in the aortic position. I do realize the loudness varies from person to person but want to make my decision based off data as opposed to flipping a coin.

Thanks!

 

[ski girl]

Ken, I have a St Jude and it's a noisy bugger . I too hate ticking clocks, dripping taps, etc. and it took me about nine months to be able to sleep in a quiet room. Others hear my valve when I stand near them, and I hear it almost all the time.

However I'm fairly thin which doesn't help, and when I asked my surgeon why the valve was so loud he said I have a very strong heart. Maybe he was being nice?

That's my two cents, I did get used to it but I'd be happier if I didn't sound like a ticking time bomb.

 

[Gail in Ca]

I have a carbomedics top hat inside a hemashield graft. My surgeon wanted to give me the largest valve possible, and gave me a 25mm valve.
I am also on the lean side. It took me at least a year to be able to ignore the sound. I finally came up with what it sounds like, a basketball hitting a hard wood floor.
I have asked people if they hear it and only my cardio hears it at my appointments. My husband hears it at night, but he can fall asleep in 5 seconds no matter what the noise. It is now a part of me. Do I wish I couldn't hear it? Sure, but it is what it is!

 

[Heart Of The Sunrise]

I have one of the larger ON-X valves. I only hear it late at night usually in bed. It is not unpleasant.
It is just kind of there. I am very happy I went with this valve. My target INR is now 2.0 to 2.5 per my cardiologist.
This is lower than the 2.5 to 3.0 set by my surgeon. Coumadin has not been an issue.

 

[T in YVR]

For what its worth there was a study of 188 On-X patients in Britain looking at a wide range of things, one of which did touch on valve noise. (published in the British Journal of Cardiology). Here is the bit about the On-X valve and noise results from the respondents.

"Survey of patients with an OnX replacement heart valve:
There were 188 patients. Valve noise was noticed by 136 (72%) and the noise was described as a continuous nuisance by six (3%), a nuisance some of the time by 40 (19%), rarely a nuisance by 37 (20%) and not a nuisance by the remaining 53 (28%)."

I suppose it depends on your individual tolerance level and if it would drive you bonkers or not. I'm going On-X because of the many good things I have heard about it, as well as my surgeon's preference to use this valve. Not sure if noise will differ much across valves. On-x says they are quieter, but maybe that is Marketing hype. Apparently the bigger the valve the more the potential noise. I'm 6'0 180 lbs, and he said mine would be on the bigger side based on body size (they're not sure until they get in there).

T

 

[Heart Of The Sunrise]

Tony- I am 6'0, 190 lbs. You will probably be in the 25mm range like me, my guess. Thanks for the study info.:thumbup:

 

[T in YVR]

Yeah, the surgeon mentioned 25 - 27 mm or so to me....hopefully I am one of the people that finds it "not a nuisance"! Ticking clocks bug me, so I hope its not too bad. My surgeon said I will just have to pump alot of weights and increase my chest size to muffle the sound

 

[clay_from_nj]

I have the Open Pivot and have to be in a very quiet room with my head at just the right angle to even hear it. I'm 5'8" and couldn't hear it right after surgery at 190# and still can't hear it at 160# unless I really try to. One time my wife and I were standing in our bedroom and I said, "Didn't we move that old clock into the bathroom? I could swear I hear it ticking somewhere, muffled, like maybe in the closet." It was my valve - I moved and couldn't hear it anymore. (The only time we both consistently hear it is during certain "adult" activities, though it really isn't a bother then.)

 

[OldManEmu]

I have attached a link to a post operative study conducted in Germany on patient’s perceptions of mechanical valve noise and its impact on the patient’s quality of life, which was published in the European Journal of Cardiac-Thoracic Surgery.

http://ejcts.oxfordjournals.org/content/24/1/52.full.pdf

 

[Julian]

(The only time we both consistently hear it is during certain "adult" activities, though it really isn't a bother then.)

Adult activities?!?! LMAO! That comment made my day!

Oh by way I have an On X with graft. The ticking at first wasn't bad, but the thumping was depressing the first several months. I thought it would never fade into the background. Over the past 2 years it has quieted down a lot.

Trying to determine which valve is quieter might be like splitting hairs.

 

[JimL]

I use a fan at night for white noise, so I don't hear my valve. Otherwise, it's usually very comforting to hear the valve, much better than hearing it stop.

 

[big_L]

I'm two weeks after surgery with a St. Jude in the aortic position. I can hear mine click occasionally, but it is not bothersome. I'm still trying to adjust to the pulse/heartbeat change (feels like I have twice the heart I did before). This bothers me more at this stage than the clicking.

My surgeon (Also at Mayo) didn't spend a lot of time discussing valves with me. He told me the bulk of the mechanical valves they use are the St. Jude. I wanted them to use the valve they were most comfortable with and I also wanted one that's been used many, many times. So, I'm happy with the St. Jude.

 

[Stopper]

I am 3 1/2 weeks post surgery with a St. Jude 27 mm in the aortic position. I am 6'2" and 210 lbs. I to can not stand being around a ticking clock. Well, my valve ticks very loud. My first two weeks post surgery I would lay in bed listening to the ticking and I had a tough time falling asleep. At 3 weeks I am not paying as close attention to it, and I am sleeping pretty well. I know in time I probably won't notice it like I do now. My wife can here it 10 feet away when it is silent in the house. She has not had a problem at night with it. I am to a point that I hear it when I am in a quiet place, but have gotten use to it during my normal daily routine. Best of luck with the selection, I don't know if there are any correct answers. Many Blessings and Good Luck!!!

 

[pellicle]

Hi

I have the ATS and don't hear it ticking. However I do hear my heartbeat as something from inside my head, like a thump that is conducted through my body. I expected this is related to scar tissue as this was my third op. There are times when I'm aware of it, oddly enough its not during exersize (cycling or stuff like that). When I wear earplugs (operating loud tools) I can hear it more.

Other than that I don't mind so much.

 

[dick0236]

The study referred to by OldManEmu concluded that "few people (5.4%) suffer from noisy heart valve prosthesis" and that's probably about right. When mine was done, I was 5'9", 140lbs. The valve was, is, a 1"(23mm) plastic ball in a metal cage and, as I recall, sounded like a slow Ping-Pong match.....and everyone around me was aware of the noise. That sound diminished pretty quickly, as my body/heart healed......and it has been many years since I got a strange, puzzled look from someone standing close to me.....and I'm still kinda small, 5'8", 170lbs.

 

[MarkU]

I've had my St. Jude for almost 13 years. I noticed the clicking for the first month or so post op, but now can't hear it unless I'm in a quiet room and focus on it. I do have a thick torso which probably helps to mask the sound a bit.

Mark

 

[kenkahle]

Thank you so much for your replies!

The link to the study provided by OldManEmu was very interesting to read - anyone with similar concerns should go through it as it provided lots of good information. The question I have after reading it is this: Do all valves make the clicking sound - with some variation in volume - and it just boils down to whether or not the sounds is bothersome to you personally?

I am wondering if there are any similar studies and perhaps any that might be more recent. Please keep replying everyone - I am learning so much.

Thanks again everyone,
Ken

 

[Mister_James]

You get a mechanical valve, you will hear the ticking - there is no two way around it, question is how soon will you be able to adjust to not hearing it. You can hear your wall clock ticking if you focus on it but at some point you learned to ignore the noise and focus on other things.

In your day to day activities, you don't hear or feel your heart beating unless you push yourself out of your normal range and run or exercise. yet if you take up Yoga, you will be able to focus and hear your heart beat.

 

[Leah]

I have an ATS and I only hear it lying down or sometimes in the bath. It doesn't bother me at all

 

[DannaT]

I have a carbomedic mechanical valve and have only heard it "tick" maybe 3 times...more like a faint clicking noise. The rest of the time it's more of a thumping type sensation in my chest like a strong heartbeat. It is not bothersome at all. It's just one of those things you grow used to and don't even think about as time passes. I am currently about 8 weeks post op.