Patient Prosthesis mismatch / effective opening area

[realkarl]

Bill: Thanks for your insightful reply. Let me answer a few items.

The surgeon didn't actually give me any understandable explanation but just encouraged me to exercise hard and give it 6 months.

A few months out and still far behind where I was pre-surgery, I asked my surgeon the same question, and he gave me the same answer: "Be patient and give it time". Before deciding on getting a PM, I asked his advice, and he replied that "there's not much you can not do with EF=43%"... Yeah, that's perhaps true, but there's also how fast I can go (hiking, bicycling, rollerblading, whatever else), and enjoy what I am doing without straining too hard!

My cardiologist offered that the cardioplegic solutions do not offer perfect protection during the period of time the heart is bypassed

My surgery was indeed somewhat lengthy and the longer the heart is stopped, the longer the recovery. That's something to keep in mind.

You say you think you have reached the limit based on a peak HR of 145-150

I am on 2x25mg daily, which according to literature is the maximum therapeutic dosage. That's what I meant with 'maxed out'.

consider [...] perhaps metoprolol which has greater effects on heart rate than Carvedilol.

I mentioned this to my cardiologist early on, and that's when he said that he was not concerned about resting heart rate, and that recent literature and studies showed that Carvedilol worked much better than Metoprolol in terms of protecting and improving the heart function. I will ask again next appt. though.

I think I can finally say I have caught up to my pre-op level as well, and improved in terms of cardiac asthma during/after exercise, but I have far left to a year before that. I am more optimistic again though, but I am really glad I received my biventricular PM, or I think I would have been stuck. I am looking forward to my next echo, which I don't know when will be. I haven't had one since 3 months out, but I have a PM interrogation and cardio appt in a couple of weeks. The PM stats will show my high resting HR, and I will certainly discuss my concern about this then, as well as the effect of my 1.4 cm^2 calculated effective valve area on exercise capacity.

Karl.