Mechanical Valve Gradient Increasing

paulwk · Mar 23, 2011

Hi, I'm 42 with two AVR's. Last one was a St. Jude Mechanical two years ago. I just got back from my cardiologist for a follow up to an echo I had done due to having chest pain, which has gone away. As a matter of fact my cardio doesn't hear the murmur he heard two weeks ago. But he still wants to do a TEE next week to get a better look at my valve. He said that a clot may have broken off and went harmlessly through my body, or it could be something else. He said my gradient has also increased.

I'm not quite sure what that means. The valve they put in me was actually too small for my body. But it was the only one that could fit. And I'm wondering if that could be the problem? He also, unfortunately in front of my wife, said guys like me die young because of mechanical valve complications. But could having no chest pain for the past ten days and no sound of a murmur be good news? Or does the increased gradient mean I'm heading back to the OR again.

Thanks in advance for answers!

ALCapshaw2 · Mar 23, 2011

I would want to know more about his 'insensitive' comments about mechanical valve failures causing "premature deaths in guys like you".

First, what does he mean by "guys like you".
Second, what kind of "failures" is he talking about.

One 'known' issue (with ANY kind of valve) is Pannus Tissue Growth which can impede the movement of the leaflets. This could result in an increased gradient. Hopefully he would be able to see that while performing the TEE. One of our members, Robthatsme, recently had his St. Jude Aortic Valve replaced because of Pannus Tissue Growth after 10 years of service. He requested (and received) an On-X Aortic Valve for replacement because it has a built-in barrier to ****** / prevent valve leaflet impingement from Pannus Tissue Growth.

FYI, a valve that is "too small" for your body is referred to as "Patient-Prosthesis Mismatch".
Having "small arteries" and a "large body" can result in this situation.

'AL Capshaw'

paulwk · Mar 23, 2011

Thank Al, his comments were a little unsettling. I'm not sure what he meant. This is something I'm going to ask him about. Plus I guess the chest pain may have been chest wall pain, not part of my valve issues.

This would be my third OHS before the age of 43, so I'm more concerned and, honestly, really tired of it. I'm not even sure I want to go through another one.

tobagotwo · Mar 23, 2011

If the valve is a smaller size than you should have, any increase in heart rate or stroke force will easily up your gradient (pressure of the blood passing through the valve), and you'll always contend with that if you're nervous or afraid. It can be affected by something as simply as how you're lying on your side for the echo.

Although I don't know what your gradient was, it's probably still lower than what you were experiencing prior to your surgery. Hopefully, it's the size of the valve that is having the gradient effect, which would make it situational, rather than persistent.

If you have a pannus issue as Al has suggested could be the case, you will probably wind up back in surgery eventually. Did you have a pannus (scar tissue) issue before? If not, then it's not as likely. If you do wind up in surgery again someday, pick a different surgeon who will consider if he can do some renovating to allow a larger valve size to be used.

And unless there's something we didn't hear about him, I would vote to dump the cardiologist, too. Was the surgeon who gave you a valve they described as "too small" a referral of his? Find someone who doesn't think you're one of the "guys like me" who "die young." You don't need his callous comments to make you feel worse.

Best wishes,

paulwk · Mar 24, 2011

tobagotwo, thank you for the reply! I really appreciate it. I haven't had scar tissue issues before. And I'm glad you brought up stress, because, like many Americans, money has been a stressor in the last year. Add to that some marriage problems. So, I could see the correlation between the valve and my stress.

The Cardiologist is actually a really great guy. I think he is overworked, and didn't think before he spoke. He is usually an upbeat, friendly, and competent doctor. My surgeon is considered top notch as well. It was actually the previous surgeon who made a mess of things. I think my last one had a lot of cleaning up to do. He said that he wanted to put a bigger valve in, but it wouldn't have worked. He did mention that I need to keep the weight off because of this, but I'm pretty thin so I don't think that's the problem.

I'm really just confused on the murmur suddenly going away, and the chest pain, but the gradient increasing. It's pretty weird.

paulwk · Mar 28, 2011

Thanks for the comments Bob. That just put my mind at ease a little.

Before my first surgery I had a grade 4 murmur and was pretty close to the end. The valve replacement saved my life and made it better then ever. Before the second surgery I was pretty much asymptomatic. I had pain, sorry for this, but had pain during ***. I went in and the Cardiologist said my pig valve was shot.

This time, I've had chest pain that suddenly disappeared, but an increase in heart rate(from 60 a minute to 80.) The murmur he heard is also gone. I have had some chest pain since my last appointment. But it's mostly when I get stressed about having another OHS. So your analysis makes sense. Thanks again.