Mitral Valve Repair Surgery Timing

[barry70]

I have posted before and I now have advanced measurements from an echo this week that correspond to the new study by Dr. Enriquez-Sarano from a couple weeks ago. I'll post the major findings below. I will say that the consensus amongst the surgeons I am speaking with and Dr. Sarano himself is that I will very likely need surgery in the next few years, but it is not needed just yet. Dr. Sarano says to revaluate in a year (based on the info below) and that I am "not so bad" yet. I'm leaning towards getting this done in the next year or so to get it over and done with. Any thoughts?

.37 cm2 Effective Regurgitant Orifice ("ERO") by the flow convergence method.

Prominent late systolic billowing if both leaflets consistent with MVP.

3-4+ ("near severe" MR) mid-late systolic MR.

1+ Tricuspid Regrurg.

LA = 3.5

LVIDd = 5.5
LVIDs = 3.7

EF = 60%

Mildly dilated Aortic Root (4.2)

Trileaflet Arotic Valve

Mild (1+) Tricuspid Regurgitation.

All else is normal - normal estimated pulmonary artery systolic pressure too.


Thanks for your input.

 

[Nan]

Hi Barry, I am by no means knowledgeable in this topic, but it seems to me that if Dr. Sarano himself is suggesting you can wait and be watched carefully, that it would make sense to do so. Especially since he is the one who is advocating early surgery for mitral valve regurg.

I can certainly understand why you would want to get it over with, on many levels, especially since the research seems to be showing that recovery and survival rates are better when it is taken care of earlier. But the time still has to be right.

The most important thing, in muy opinion, is for you to be listening to your body. If it is telling you that things are not right, then you may need to pay attention to that and try and move toward surgery earlier.

Good luck, and keep us posted!

 

[Christina L]

Barry,

Barry,

I agree with your doctor. You really don't want to have to have surgery any sooner than you need to, but you need to have it as soon as it is necessary!! Kind of a tricky situation.

My cardiologist tested me every four months, which is what I would suggest that you do. I felt really good physically (or so I thought) and when he told me one of my measurements had changed in my heart and it was "time" I was floored. However, looking back I was having shortness of breath in the night, which I attributed to our cats who sleep with us. After my surgery, the shortness of breath in the night has not recurred and my exercise tolerance is fantastic post surgery.

Your left atrium (LA) measurement sounds very good. I think mine is around 4 and haven't asked what it is since my surgery. It is best that I don't know too many details and my cardiologist realizes that. I am a worrier.

Also watch yourself to see if you have any symptoms that change such as more shortness of breath, etc.

Where will you have your surgery done? Do you know yet? I also have/had mitral valve prolapse with both leaflets flail and thickened. That is the "best" type of valve to be repaired successfully - MVP is congenital and much easier to repair (and stay repaired) than a valve that has been damaged by rheumatic fever.

Stay on the board - you will get so much support and strength from those of us who have walked this path before.

Christina L.

 

[Bill Hall]

Barry - When I had my second opinion at CCF, they told me I should have my surgery in the next 6 months. Previously, my cardiologist in NJ, told me my measurements had not changed in 3 years. I never had any symptoms even up to surgery. So, your question is relevant. What one cardiologist thinks is fine, another may see surgery. At least that was my case. Also, the surgeon told my wife, "Why did they wait so long." I'll bet that another cardiologist would have suggested surgery much earlier, but of course we will never know.
Bill

 

[weekycat]

Have you had a TEE?

Have you had a TEE?

When I first found out that I had MVP, I was told that I may need surgery "down the road", maybe in 5 or 10 years...maybe never.

Well....I ended up having my mitral valve repair within 6 mos. Up until that point, I hadn't had any symptoms really...other than being tired most of my life and an occasional "twinge" in the chest area.

I had only gone to see a cardiologist to be cleared for another unrelated surgery...he asked me if I ever had any chest pain or pressure or a cough.

Coincidentally...I had felt some chest pressure just the night before and had developed a cough...(my husband had a chest cold at the time...so I assumed I'd caught it from him)....WRONG!

I asked him if the symptoms could come on that quickly...he said, "Yes if one of your chordae tendenae has ruptured". Well...he set up a TEE for me in the next couple of days...and that confirmed it, not one, but TWO of my chordae tendenae had busted, and my leaflets were basically flapping in the wind. Smart Doc!

Anyway, that was mid-April of 2002, and I had my surgery on May 30. Most doctors these days say sooner is better...especially if they can repair instead of replace I believe.

 

[BillCobit]

3-4+ ("near severe" MR) mid-late systolic MR.

LVIDd = 5.5

EF = 60%

Mildly dilated Aortic Root (4.2)

All else is normal - normal estimated pulmonary artery systolic pressure too.

Thanks for your input.

Barry - appears you have significant heart enlargement, but your EF is still normal. Sounds like you're in the zone where docs think you need surgery some time soon but are reluctant to pull the trigger...and so you have to figure out whether you want to do it earlier v. later and act (or don't) accordingly.

Some reading material below - maybe you've seen this as it's been frequently posted on this forum.

Class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities.
Class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion.
Class III: patients with marked limitation of activity; they are comfortable only at rest.
Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest.

ACC/AHA Guidelines for Treatment of Patients with Valvular Heart Disease.
http://www.acc.org/clinical/guideli...ar/3205p149.pdf
__________________

 

[barry70]

Bill, I think my "end-systolic diameter" number is still fine. In that chart the <45mm refers to my end-systolic number, and not my diastolic number. I am at 37, so my heart is not enlarged at all....yet anyway. The only thing a little bigger than it should be is my aortic root.

Anyway, yes I 've seen that chart many times and I am not sure how much it is going to be used going forward now for aysmptomatic patients with the new study that came out a couple weeks ago.

Thanks for all the replies!

 

[BillCobit]

Bill, I think my "end-systolic diameter" number is still fine. In that chart the <45mm refers to my end-systolic number, and not my diastolic number.

Oops...good thing I'm not a heart doc!