Mechanical valves ... but what about the ticking?

[pellicle]

A thorny subject to say the least, however people come here to "learn and inform themselves" ... there has been many a discussion on this over the years and sprinkled across many threads. So I thought that I'd start a discussion on the topic and begin with the ideas that it varies from person to person because of such factors as:

• age
• body type
• scar tissue amounts
• time after surgery (quite a few report it becomes lesser, perhaps due to inflammation reducing?)

As I see it there is little if any subjective material out there to give anyone a proper sense of what its like to have a valve which has a solid closing sound like that of a mechanical valve. Its different to that of a "leather" valve (bioprosthetic valves are not living, so are something crafted from leather not something engineered as say a car engine part).

So I thought I'd put this together to do as best as I reasonably can to explore this topic.

So from my perspective this is how I experience my valve. Firstly the physical feeling is minor but observable, and the sound experience is subtly altered by the fact that its not external to you (although I have heard it echo off the walls in particularly quiet toilets). Rather it conducts through you. Its not something one perceives as "external" because its actually you.



Note: you'll need headphones or a good set of speakers attached to your computer if you want to hear the heart beats.

PS: I mentioned in that presentation that some people hear something from their tissue prosthesis, see this reference for once such situation
https://www.valvereplacement.org/threads/edwards-tissue-valve-knocks.887302/post-892850
Best Wishes

 

[Beach77]

This is a good topic. I was concerned about the ticking when I was choosing.

• age @ surgery: 64 (Dec. 2020)
• On-X
• minimal invasive scar
• 3 years since surgery

I rarely hear my ticking internally. The only time I ever hear it, is when I'm in bed, and I have to be laying a certain way. It's not the way I normally lay, and all I need to do is move a tiny bit to not hear it. Its minimal. No one has ever heard it. When I do hear it, it makes me happy or I move a bit!

 

[dick0236]

I do not normally respond to the "ticking concerns" since my valve is the old "ball-in-cage" design. After my surgery, it sounded like someone hitting a table tennis ball with a paddle for a while but after a few months, I didn't hear it at all.

Last summer, at my annual check-up with my cardio he joked and said "it sounded like an old wringer washing machine" (for those of you who still remember the early washing machines )........ but now you can't hear it without the aid of a stethoscope.

I am sure that some have difficulty with the ticking and hopefully, it will diminish over time.

 

[pellicle]

The only time I ever hear it, is when I'm in bed, and I have to be laying a certain way.

the first time I was sure I was hearing it from outside of me was in a small concrete wall toilet ... it was like a car stereo outside (which is what I thought at first) ...

I've had interesting conversations with a friend of mine during "acceptance testing" of that above audio and to summarise:

• he'd never heard it before and he never knew that I had a mechanical valve (despite some car trips together in his EV)
• he agreed that in my (quite quiet) office that what he heard standing beside me was what he heard through my speakers on my computer (in the background) at about the same relative level
• we did this on my phone using a small bluetooth (Bose) audio speaker and he felt the same
• he was utterly unable to hear it on his laptop as it did not reproduce the bass (because of the crappy speaker)

Like you many people (including me) report that the perception of the sound diminishes over time, unless you are determined to focus on it , feel its bad and obsess over it.

I often think (but seldom say) that perhaps hypnosis could help, the results are reasonable for things like this (less so for weight loss and smoking where something physiological is involved)

https://pubmed.ncbi.nlm.nih.gov/31251710/

Of 399 records screened, 15 studies incorporating 17 trials of hypnosis met the inclusion criteria. At the end of active treatment, 17 trials produced a mean weighted effect size of 0.79 (p ≤ .001), indicating the average participant receiving hypnosis reduced anxiety more than about 79% of control participants. At the longest follow-up, seven trials yielded a mean weighted effect size of 0.99 (p ≤ .001), demonstrating the average participant treated with hypnosis improved more than about 84% of control participants. Hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when used as a stand-alone treatment.​

Best Wishes

 

[pellicle]

Last summer, at my annual check-up with my cardio he joked and said "it sounded like an old wringer washing machine" (for those of you who still remember the early washing machines ).......

I recall a Dr saying when I was sitting on the "bench" and he was approaching with stethoscope in hand "boy, they sure put a Diesel into you didn't they"

I laughed and said something wry (as I tend to do)

 

[Woodcutter]

I had a routine checkup with my cardiologist this past week and learned something about the ticking that I had never thought about. He had a student with him, and after I had shared that "I can hear it when I want to" and (to the med student) "yup, the doc here told me years ago that if I ever stop hearing it, get checked", the doctor spent some time instructing. What was new to me was that he explained about listening for two clicks per beat. With the mechanical valve there is a distinct click when the leaflets fully close and another when they open against the stops. The docs were listening with a stethoscope of course.

[Just to be clear: I've never heard anything other than one click per beat . . . when I want to! ]

 

[pellicle]

Just to be clear: I've never heard anything other than one click per beat . . .

I have occasionally heard a double click .. I've assumed it was some sort of rapid ectopic or something ... I'm not dead yet so I'm guessing I'm ok (have had multiple examinations since then too).

As I've mentioned elsewhere, I attribute my early self diagnosis of tachycardia (confirmed at a hospital) to me having a good 'feel' for my heart rate and beat.

 

[Timmay]

Age: Currently 52

Body type: 5’10”, 165-170lb. Other people say that I am thin/skinny and not fat or overweight.

Scar tissue amounts: Full sternotomy. Keloid-ish on the bottom inch and half. Hardly anything in the middle. The top part of the zipper has two points where it is keloid-ish.

Time after surgery: Year and a half

Other pertinent information: I have my own Aorta. I don't have a replacement. They had to do an aortic root enlargement to fit a 23mm On-X valve.

My thoughts and experience with my On-X mech valve and the "clicking" ...

• Generally speaking, I am not aware of my clicking. A day can pass without me noticing it.
• Yes, I can hear my own clicking. However, it needs to be a quiet room. I generally don't hear it in my house because there is a lot of white noise: dogs, air cleaners, music, computers, humidifier (in the winter), etc. When in a bathroom with the HVAC not running, I can totally hear it - quite easily too! I can also hear it in my grandmother's house where it is dead quiet.
• Older people never seem to hear my valve. Young people can. In a relatively quiet meeting room with my team from work, the young guy asked me if the clicking was my watch . I think that my On-X produces a higher pitched clicking in my body type that allows younger people with intact audible frequency ranges hear my valve.
• Yes, I do have the double click. But, you have to really pay attention to it. The tone is different on each part of the overall click. Plus, you have to keep in mind that the double-click happens relatively close together so it is perceived as a single click.
• I can't really sleep on my left side anymore. The click reverberates up through my chest and into my throat. Sleeping on my right side is, for the most part, ok.
• When I go camping, I play white noise on my phone because the clicking is a bit annoying. Notice that I said "a bit annoying" and not "unbearable", "aggravating", etc. I absolutely could still fall asleep without the white noise. However, I am very accustomed to white noise and enjoy it (I have tinnitus from years of loud music and playing in a hardcore band).
  • I know people with Misophonia that would 100% not be able to live with a mechanical valve. It would quite literally drive them crazy. PLEASE keep in mind that these same people are also driven crazy by someone chewing potato chips in the same room (perspective is important).

And to wrap things up, I am incredibly happy that I went with a mechanical valve. Setting myself up for the least amount of surgeries possible brings great comfort to me. That said, for me, Open Heart Surgery was a whirlwind and something that I never want to do again. If I could make any change at all, I would have asked for a St. Jude's valve. They are smaller and less bulky and my gut tells me that it is better suited for my body type.

 

[pellicle]

Hi Tim

I know people with Misophonia that would 100% not be able to live with a mechanical valve. It would quite literally drive them crazy. PLEASE keep in mind that these same people are also driven crazy by someone chewing potato chips in the same room (perspective is important).

do you think that hypnotherapy would help (I have no idea, but the idea seems promising) ... (maybe not for the chips, esp in a movie)

 

[nobog]

I had a routine checkup ...... What was new to me was that he explained about listening for two clicks per beat. With the mechanical valve there is a distinct click when the leaflets fully close and another when they open against the stops. The docs were listening with a stethoscope of course.

[Just to be clear: I've never heard anything other than one click per beat . . . when I want to! ]

I find that hard to believe - the load on an open leaflet is virtually nil - some valves (OnX, ATS) don't even open all the way to their "stops". That man has a very good stethoscope!

 

[Timmay]

Hi Tim


do you think that hypnotherapy would help (I have no idea, but the idea seems promising) ... (maybe not for the chips, esp in a movie)

I wouldn’t be surprised? Hypnosis seems to have helped a lot of people in this world with things that I wouldn’t have thought possible: Quitting smoking, discovering past lives, etc. I guess you need to be open to suggestion? Not sure. I’ve never been hypnotized.

 

[Woodcutter]

I find that hard to believe - the load on an open leaflet is virtually nil - some valves (OnX, ATS) don't even open all the way to their "stops". That man has a very good stethoscope!

I had never thought about it before but it does make sense to me. The (kinetic) energy and momentum of opening movement get dissipated somehow/somewhere. In a native or biologic valve it will be the compliance of the soft (relative to a mechanical structure) tissue.

I did learn a new word last week from Dr. Google after hearing my cardiologist: auscultation

Turns out there are books on auscultation! Anyway, here's a blurb from a Cleveland Clinic note:

The importance of auscultation
Each valve type and position has a unique set of normal sounds (TABLE 2). Murmurs are common, and many are normal. However, a new or changing murmur may indicate a problem.
Sounds from mechanical valves. With mechanical valves, mechanical clicks should be heard as the valve opens and closes. With the bileaflet tilting disk valves, the opening click should be softer than the closing click; i

https://www.ccjm.org/content/ccjom/... softer, then the valve may be malfunctioning.

 

[pellicle]

I find that hard to believe - the load on an open leaflet is virtually nil - some valves (OnX, ATS) don't even open all the way to their "stops". That man has a very good stethoscope!

personally I think its on the close

 

[pellicle]

With the bileaflet tilting disk valves, the opening click should be softer than the closing click; i

just wearing my pedantic hat for a sec a bileaflet valve is not a tilting disc valve and whoever wrote that needs a quick slap.

they are really not much like each other.
From:
https://www.researchgate.net/public...with_retrospective_ECG_gating_on_256-slice_CT

 

[nobog]

If you substitute "occluder" for "disk" all is well

 

[Chuck C]

On the occasions when I hear my mechanical valve, the sound you created in the video is almost exactly what I hear, not really a clicking, but a thumping of sorts.

St. Jude mechanical valve. 33 months ago.
Mini-sternotomy.
Bentall Procedure, with dacron graft replacing my aortic root and part of my ascending aorta.
I'm 5'10, 185 pounds with 19% body fat. (Just had it tested, so why not include the data, lol)

I usually don't hear my valve at all. Even in a quite room I can't hear my valve.
No one has every heard my valve unless their head is on my chest, even if sitting next to me in a quiet room. My wife has good hearing and can only hear it with her head on my chest. She actually likes the sound and finds it comforting.

I can hear my valve when exercising hard. I use to hear it when I would do moderate exercise, but now my heart rate needs to ago above about 150 bpm for me to hear it.
I sometimes hear it a little when lying down, but depends on my position.
A new discovery, which I made about 2 hours ago, while putting up our Christmas lights: I can hear it when I look straight up and reach my arms up above my head.

I do jiu jitsu, which is basically wrestling, except that we try to choke each other out, rather than try to pin our opponents. My favorite submission is the North South Choke, which I utilize often. When executed properly, your opponent's head is against your rib cage. Whenever I execute this choke/strangulation my opponents tell me that they hear my valve. My classmates joke about it and call it the ticking of doom, because once they can hear it, they are usually past the point of no return and need to tap out

You can see the position in this video and you can see why the bottom person would hear the valve. If the bottom person also had a mechanical valve, the top player should be able to hear his valve as well.



I can't think of any way in which the sound of my valve has negatively impacted my life.

 

[ChuckM]

• Generally speaking, I am not aware of my clicking. A day can pass without me noticing it.
• Yes, I can hear my own clicking. However, it needs to be a quiet room. I generally don't hear it in my house because there is a lot of white noise: dogs, air cleaners, music, computers, humidifier (in the winter), etc. When in a bathroom with the HVAC not running, I can totally hear it - quite easily too! I can also hear it in my grandmother's house where it is dead quiet.
• Older people never seem to hear my valve. Young people can. In a relatively quiet meeting room with my team from work, the young guy asked me if the clicking was my watch . I think that my On-X produces a higher pitched clicking in my body type that allows younger people with intact audible frequency ranges hear my valve.
• Yes, I do have the double click. But, you have to really pay attention to it. The tone is different on each part of the overall click. Plus, you have to keep in mind that the double-click happens relatively close together so it is perceived as a single click.
• I can't really sleep on my left side anymore. The click reverberates up through my chest and into my throat. Sleeping on my right side is, for the most part, ok.
• When I go camping, I play white noise on my phone because the clicking is a bit annoying. Notice that I said "a bit annoying" and not "unbearable", "aggravating", etc. I absolutely could still fall asleep without the white noise. However, I am very accustomed to white noise and enjoy it (I have tinnitus from years of loud music and playing in a hardcore band).
  • I know people with Misophonia that would 100% not be able to live with a mechanical valve. It would quite literally drive them crazy. PLEASE keep in mind that these same people are also driven crazy by someone chewing potato chips in the same room (perspective is important).

I am almost in this exact same boat, almost point for point. My first trip to the bathroom after leaving ICU following surgery, my wife was helping me shower for the first time in days, and we both could actually "HEAR" it.. from the OUTSIDE with my ears. It had a more thumpy sound, I'd call it more like a clunk than a click. No highs.

What I hear otherwise is conducted through the body. Much higher pitch, definitely closer to a click and I hear/feel it in my throat. Its more like a crunch, radiated up through my throat. It really comes down to a few things.. if I don't have it on my mind, I'm not reading this forum, someone doesn't ask, or I don't find myself in a completely quiet setting, I never hear it. As soon as I think about it, and I listen for it, I can hear it. As I sit and type this, I know that a majority of the time when I go to sleep, its not on my mind and I'm not thinking about it, so I don't hear it at all and will fall right to sleep. I do have a white noise generator going. If it comes to mind and I think about it and start hearing it, either the white noise machine takes care of it, or there are certain positions that I can get into in bed and not hear it at all. Perfectly flat on my back, arms by my side and I can neither hear (nor feel, as I posted about previously) the "external" sound nor the "internal" sound. But this is about the ONLY position that i can get into that its actually not audible in any way.

So to me, since I don't obsess over it, once its out of mind, its out of my hearing. FWIW, in my radio room right now typing this, the washing machine is filling behind me, and I can't hear it at the moment at all unless I pause and try to listen for it.

 

[Timmay]

… Perfectly flat on my back, arms by my side and I can neither hear (nor feel, as I posted about previously) the "external" sound nor the "internal" sound…

I’d like to draw attention to this.

Prior to surgery I only slept on my side. Never on my back. You could say that I was a 100% side sleeper.

Surgery changed that. I am now a 90% back sleeper. I just can’t sleep on my side like I once did. Maybe it was the couple months of forced back sleeping after surgery. Maybe it is the fact that I can’t sleep on my left side due to the reverberation. I’m not sure. However, surgery did drastically change how I sleep.

 

[ChuckM]

I’d like to draw attention to this.

Prior to surgery I only slept on my side. Never on my back. You could say that I was a 100% side sleeper.

Surgery changed that. I am now a 90% back sleeper. I just can’t sleep on my side like I once did. Maybe it was the couple months of forced back sleeping after surgery. Maybe it is the fact that I can’t sleep on my left side due to the reverberation. I’m not sure. However, surgery did drastically change how I sleep.

I know I "pushed through it" after surgery. I'm probably way more a side sleeper than on my back (I snore so it keeps my wife awake!), but obviously spent all recovery time on my back until my chest healed. No matter how hard I tried, it was painful within a few minutes of trying to lay on my side. But that slowly went away and now I'm good on either side, stomach or back. Just depends.

Obsessing over worrying about the click is much worse than the noise itself. I was so worried that I'd hear it and go crazy, thats how I found my best position, but I really don't pay any attention to it any longer. I just turn up the babbling brook machine, and drift off.

 

[3mm]

I snore

Chuck - I have read that snoring is a sign that a person may have sleep apnea, which can increase the risk of afib, which is a risk for all of us who have mechanical valves. Have you been checked for sleep apnea? I was checked 2 weeks ago; fortunately, I don't have it. I'm also fortunate that by the 2nd day after surgery I could sleep on either side. I just use a couple pillows to brace my hips and chest.