mechanical valve for pulmonary valve??

[skimomck]

Was just told by another cardiologist (not ours but a friend) that a mechanical valve can not be used in the pulmonary position. I did not think that was the case, so if any one can comment or has info about this please let us know.
Cindy

 

[Yaps]

My husband

My husband

has pulmonary hypertension, but as of the moment his valve is ok..but your question had me wonder, as Ive got a st judes mitral..so I went ahuntin this is what I have found...
Pulmonary Valve Surgery at Mayo Clinic in Rochester
If valve damage becomes more severe and medications do not control the symptoms, surgery to repair or replace the valve becomes necessary.

Heart surgeons agree that, whenever possible, a heart valve should be repaired instead of replaced. Valve repair may be performed to separate fused valve leaflets, sew torn leaflets or reshape parts of the valve. Heart valve repair leaves patients with their own normally functioning tissue, which is resistant to infection and does not require blood-thinning medication.

In some cases, however, the valve is too damaged for repair and must be replaced with a prosthetic (artificial) valve.

See more information about heart valve repair and replacement

I hope this helps, looks like a mech valve can be used..Love Yaps

 

[Bryan B]

Cindy,

That was my understanding too...unfortunately I don't remember why that is the case. I do know that since the pulmonary valve is under less pressure than the other 3 heart valves (and particularly the aortic valve), a tissue valve should last much longer when placed in the pulmonary position. I would be writing all these questions down (including the keloid and bleeding issues) to ask Teddy's surgeon in order to make an informed decision.

 

[tobagotwo]

Yaps, a tissue valve is usually referred to as a prosthetic valve. Carbon valves are usually referred to as mechanicals.

It doesn't surprise me that they don't use mechanicals there, as there is less room, and the blood doesn't move as fast, making it a bad spot for clots. As well, the mechanicals take (or used to) a bit more effort to open, and that is the laissez-faire side of the heart.

Not to worry. With the new valves and the less brutal pulmonary position, thirty years is still within reach (the doctor will say less, as he doesn't want expectations). And warfarin-free.

Best wishes,

 

[Bryan B]

Bob,

The clotting issue rings a bell with what I was reading back before I had made my valve choice pre-surgery. I was researching the life expectancy of the pulmonary homograft and how and what they could replace it with if necessary down the road.

 

[skimomck]

I really appreciate all the input. We anticipate not having much time between the cath and setting a surgery date and making a decision on a valve if there is any chance Teddy can go to college as planned. The clotting issues with the pulmonary valve makes sense. Our concerns with any of the tissue valves is that the last only lasted for 3.5 years and it was a Synograft valve that was suppose to have avery long life. It concerns us he will do the same with any valve that is put in, but hopefully not. Thanks for all your input, it is so helpful at this stage. His cath is Wednesday.
Cindy

 

[Bryan B]

Cindy,

I don't have any stats, but I believe the tissue valves (porcine and bovine) are less likely to react the way the homograft valve did. And even if he were able to get a mechanical valve, there is no guarantee that he won't have problems with that as well. With some people, their body tends to grow tissue around the mechanical valve that may end up causing problems with the flaps on the valve. Hopefully your surgeon can shed more light on what your options are and what he thinks the best choice is based on his past experiences.

 

[Karlynn]

Cindy,
Hopefully you will have much clearer information as to what went on with the valve after the cath is done. And hopefully it will be something that was a "fluke" and you won't have to worry about with other tissue valves.

Sorry for my confusion on mechanicals. I was brain-freezing, read Ross and thought you were speaking of the aortic valve.

Does your son form keloid everywhere he scars or just in some places? I form keloid as well, but only in certain parts of my body. I do form it on my chest, so there was some concern as how my mechanical valve would seat itself. But so far, almost 13 years later, it is looking good and only showing a bit of calcification, but no issue on the scarring.

Where does Teddy go to school? My daughter will be in her second year at Michigan State. We'll be heading up there in a week and a half to take her back.

Breath deeply and keep hanging on. I'm praying for you and Teddy.

 

[Abbanabba]

Well this thread has certainly given me some more information that I had previously. I was under the impression they didn't use mechanicals for pulmonary replacements because the technology hadn't been developed for this valve due to the lower incidences of it needing to be replaced. Whether this is right or not, I don't know, it was something I read (or heard) somewhere along the line.

I was told a porcine or bovine valve would have a life expectancy of 10-15 years, 20 if you were lucky, but then there also seems to be some evidence they tend to wear out sooner in younger people as they work their hearts harder - in general. Again, this is just what I've heard somewhere or other.

Re the clotting issue..... is this that much of a big deal if you have to take anticoagulents with a mechanical anyway? Or does it mean you have to take higher doses due to the higher clotting risk? Hmmmmm - I'll have a load of questions to ask my new cardio!

A : )

 

[Gemma]

Hi Cindy,

I was also under the impression you couldn't have a mechanical pulmonary valve, but I came across this study when I did a Google search. It's only a very small study but I would imagine more research has been done since then(it was in 1997). Suggests tilting disc valves, instead of the bileaflet ones which are most commonly used today, as there's a lower clotting risk. May be worth discussing with Teddy's surgeon, rather than the cardiologist, as he's likely to know more about it. (speaking from experience ).

Gemma.

--------------------------------------------------------------------------------
http://jtcs.ctsnetjournals.org/cgi/content/abstract/115/5/1074

SURGERY FOR CONGENITAL HEART DISEASE

Mechanical valves in the pulmonary position: A reappraisal
Luca Rosti, MDa,b, Bruno Murzi, MDa, Anna Maria Colli, MDa, Pierluigi Festa, MDa, Sofia Redaelli, MDc, Lubitza Havelova, MDa, Lorenzo Menicanti, MDa, Alessandro Frigiola, MDa
From the Department of Pediatric Cardiology/Cardiac Surgery, San Donato Hospital,a San Donato Milanese; the Department of Pediatrics, Regina Elena Hospital,b Milan; and the Department of Pediatric Cardiology, Ospedale Pediatrico Apuano,c Massa, Italy.

Received for publication July 18, 1997. Revisions requested Sept. 17, 1997; revisions received Dec. 1, 1997. Accepted for publication Dec. 9, 1997. Address for reprints: Luca Rosti, MD, Ospedale San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy.

Objectives: To evaluate midterm results of mechanical valves in pulmonary position in patients with pulmonary regurgitation and right ventricular dysfunction as an alternative to bioprostheses. Patients: Mechanical valves (six tilting disc valves and two bileaflet valves) were implanted in eight patients previously operated on for tetralogy of Fallot (n = 7) and truncus arteriosus (n = 1), with severe right ventricular dysfunction caused by massive pulmonary regurgitation. Results: All patients survived prosthesis implantation and are currently well. At follow-up (3 months to 9 years), they do not show signs of valve failure, and right ventricular function has dramatically improved in all but one, who still shows moderate ventricular hypokinesia. Conclusion: After operative correction of congenital heart defects in selected patients who show severe dysfunction of the right ventricle caused by pulmonary regurgitation/stenosis, mechanical valves may represent an alternative to bioprosthetic valves. The selection of the valve type is still a matter of debate. However, according to literature data, complications seem to have occurred only in patients with bileaflet mechanical valves in the pulmonary position, whereas no thromboembolic episodes or valve failure is reported in subjects with tilting disc valves in the right ventricular outflow. Tilting disc valves might perform better in the right ventricular outflow than bileaflet valves.

 

[skimomck]

Thanks again for all the info and help, I can't tell you how helpful all of this is. We actually don't have a surgeon here in town because Teddy's Ross was done in Oklahoma because at the time he was one of the top for doing the Ross Procedure and we were adviced to take him there. At this point we just have a pediatric cardiologist who is doing an adult congenital clinic. Dr. Elkins is still following his patients but has retired from doing surgery and we have spoke to him. He wants the cardiologist to call him after the cath.

I just got a call from the cardiologist this morning asking if they can try doing a balloon procudure during the cath. When his valve originally started to stenosis after the first year the cardiologist told us they would just balloon it if needed and when I spoke to Dr. Elkins (Oklahama) about it and he said that could not be done with that valve. I just got cut off from the cardiologist and he is calling me back, but I am a little concerned about all of this. They tend to deal with congenital stenosed valves vs. calcified valves and I think there is a different treatment plan for each. I am awaiting the phone call so I will let you know.

Karlynn, Teddy will be in his second year at Western Washington University in Bellingham, Washigton (on Puget Sound) a skier and sailors meca, he is on there sailing team. But Michigan State does have a sailing team, I would feel a lot better about him being there, its a lot closer to home.

Cindy

 

[tobagotwo]

Animal tissue valves do not have the same issues that a human valve (homograft) does, and are not subject to the rejection reaction that your son had with the Synergraft homograft valve.

In fact, for different reasons, another homograft might not produce the same problem. However, I would be loathe to try it and find out.

Unfortunately, I think your doctor was steering you right on the other point. Balloon valvuloplasty is not likely to be a realistic option.

Best wishes,

 

[vlamus]

My understanding is that due to the low flow of the PV, a mechanical valve can easily clot even with anticoagulants on board. Tissue valves are preferred. However, this past year I attended the Adult Congenital Heart conference and met up with several folks that have had mechanical PV implanted. They had them placed several years ago. Not sure if they are used any more or not. When I had my PV replaced at Mayo 18months ago, they never mentioned that a mechanical was an option. I got a porcine and only have to take a baby aspirin a day.

Vlamus

 

[Bryan B]

Cindy,

If you would like to get in touch with my surgeon let me know and I will forward you his contact info. He is the Chief of Pediatric Cardiothorasic Surgery at Duke Medical Center, and specializes in congenital defects (in children & adults), Ross Procedure, transplants, etc. I have a followup appointment with him Monday and will ask him some of these PV questions.

 

[skimomck]

Bryan,
Thanks for the offer, I would love the name of your surgeon. We did end of speaking to Dr. Elkins on Friday and he ended up speaking to our cardiologist. They agreed to try to balloon his valve because in its present state he will need surgery. So if they can reduce the gradient to a value that they felt somewhat comfortable sending him off to college in three weeks we will plan on replacing it when he returns next summer. That will give us some time to make a decision on which type of valve to use. We are also aware that it may not reduce the gradient and also that he could have a complication and they will have to replace it immediatly. Teddy is handling it very well. Thanks for all your help.
Cindy

 

[Bryan B]

Cindy,

I hope the valvoplasty works for Teddy! Here are a couple of links that give contact info for Dr. Jaggers. I know most everyone thinks their surgeon is the best (and rightly so), but I'm glad Dr. Jaggers is about my age (maybe a little younger), because I can't imagine going to anyone else if I needed surgery again.

http://www.dukehealth.org/DukePhysi..._result?unid=2A437D6CE9E8C1EC85256DFD006A92B6

https://faculty.duke.edu/faculty/info?pid=3635

 

[gary48]

Tissue Valves

Tissue Valves

I really beleive they are the way to go-I had a valve sparing surgery-but in case that didn't work-I was prepared for the tissue (porcine valve)-I am a runner I have ran with guys who have had mechanical valves and tissue valves-there is alot of concern over longevity of tissue valves-I believe the longevity has something to do with the patient and there lifestyle. Anyways with all the advancements-(assuming you get 10 to 15 years) you will have another choice to make and probably better options. Either way open heart surgery IS STRESSFULL-but I got alot of support on this site. Hey-I got some info from this site-my surgeon Dr. Deeb at the University of Mich. was also very helpfull.