Possible Second OHS due to Aortic Valve being small from previous surgery

[nobog]

Here's the problem with valve mismatch -

Mechanical valves open the same every time and one valve is the same as the next, so all anybody needs to do is to look up the pressure drop (or EOA) in a technical paper and have at it.

Tissue valves are a different story. Each one is different. There will be a difference in pressure drop from one to another. In some cases it could be a 100% difference (i.e. 10mmHg vs 20mmHg). Tissue properties and assembly can make a significant difference.

Pericardial valves will typically have a lower variation than porcine valves. One cannot tell how "good" a valve opening will be by looking at the valve, this must be measured in a pulse duplicator or similar.

 

[iren_999]

@Paleowoman
I will try to dig out all the information needed to you so you can compare it with your results at a later time. I really appreciate you (and all) here for your support on this!

 

[iren_999]

Here is my recent Echo exam results attached.

 

[nobog]

a EOA of 1.0 cm2, which depending on your size, is getting "small".

 

[Paleowoman]

Hi @iren_999
My EOA is only 0.75cm2 so smaller than yours.
I couldn't work out what your pressure gradients are as the results are in a foreign languge, maybe it's those 46/25 Hgmm and 48/27 Hgmm figures ? If so, the first number would be peak 46 and 48, and mean 25 and 27. Mine are peak 56 mmHg and mean 35 mmHg

 

[iren_999]

Is mine good or bad enough for an immediate redo surgery? Or, maybe I should just go the route as you are and when it gets to a point were I am out of breath then consider surgery?

I have an appointment with my general physician and will bring the same results with me for her to also look at.

 

[Paleowoman]

Is mine good or bad enough for an immediate redo surgery? Or, maybe I should just go the route as you are and when it gets to a point were I am out of breath then consider surgery?

Hi @iren_999 If you needed immediate redo surgery the surgeon you saw wouldn't have kept you hanging about, plus you'd have bad symptoms. I think you should get a second opinion from another cardiac surgeon at a different hospital. Since your measurements don't appear, if we've understood them right, to be "severe mismatch" and you have no symptoms and the other surgeon said your heart and valve are okay, find out about timing for any redo based on your worry that you may be too old for surgery otherwise. You need to put your mind at rest about this.
My cardiologist thoght I was due for immediate redo surgery three years ago but both of the cardiac surgeons I saw said no but to have regular expert echos to check my heart and the valve and symptoms, so that the timing for surgery would be right.

 

[Superman]

iren_999, sorry to see this anxiety you’re being subjected to. I just skimmed the thread. I’ve had two OHS’s, but at much younger ages.

I would not be keen on a third. I’m 47 now. Doesn’t get any easier with practice, unfortunately.

With no damage and you not feeling anything; I’d be inclined to take the monitoring approach as some appear to be indicating in their responses.

Seems weird to bring it up based solely on measurements with no adverse impact noticed by you or on the cardiac muscle - unless I missed something.

 

[iren_999]

Got back from my regular doctor and she looked at my results. She referred me to another cardiologist who also does ultrasounds of the valve. She told me if the gradient pressure increases significantly compared to my current echo exam results, then that means I do need to have the surgery.

For those of you who had several OHSs or valve mismatches, did you go with the minimal invasive route or the full incision?

Reason being for this question, because my first surgery was minimal invasive and maybe that is why some surgeons who go with the minimal invasive route have a harder time pinpointing the size of the valve or maybe its harder for them to see the valve as the valve is tucked inside of the heart.

 

[Paleowoman]

maybe that is why some surgeons who go with the minimal invasive route have a harder time pinpointing the size of the valve or maybe its harder for them to see the valve as the valve is tucked inside of the heart.

Hi @iren_999 - as I wrote earlier in this thread, the surgeon uses a “sizer" to measure the space where the replacement aortic valve will go after they have taken out the old valve. Being the right size for the space does not mean it’s the right size for the patient’s body ! This is why they measure your weight and height before surgery - they can choose a different valve or different placement if they know there will be mismatch (that’s the mistake my surgeon made, she didn’t chose a different placement - and perhaps that’s your surgeon’s mistake too.) It’s also why they measure your weight and height before echo. My valve, which is smaller than yours, is the right size for the space where the aortic valve goes but the wrong size for my body size which is why it’s called “patient prosthesis mismatch”. I didn’t have minimal invasive route although the surgeon had planned to do that, she ended up doing full sternotomy.

Really good you are seeing a cardiologist who specialises in echocardiogram. Do let us know how it goes.

 

[tom in MO]

Got back from my regular doctor and she looked at my results. She referred me to another cardiologist who also does ultrasounds of the valve. She told me if the gradient pressure increases significantly compared to my current echo exam results, then that means I do need to have the surgery.

For those of you who had several OHSs or valve mismatches, did you go with the minimal invasive route or the full incision?

Reason being for this question, because my first surgery was minimal invasive and maybe that is why some surgeons who go with the minimal invasive route have a harder time pinpointing the size of the valve or maybe its harder for them to see the valve as the valve is tucked inside of the heart.

I would suggest not worrying about minimally invasive or not. You want the surgeon to be comfortable and have the access to get it correct this time.. Mine was supposed to be "normal" but the surgeon could make a smaller than usual sternum cut, so it wasn't minimally invasive, but not the full month either.

 

[iren_999]

Hello everyone!

Just went to my cardiac facility today and got a EKG. The doctor said it looked fine, but however, he strongly recommended that I need to have the aortic valve replaced sooner or later as gradually it will start damaging the heart.

My echo exam is scheduled in 2 weeks from now.

My question is, is there a more practical less intensive way to correct my aortic valve mismatch by performing a TAVR rather than having them cut me open again?

The doctor who performed my EKG today, said that the easy part of the surgery is changing the valve and inserting a new valve that should fit my size correctly. He explained that the most difficult part would be the incision of the chest itself as the incision from my previous surgery before still has some residual stitches that they would have to inspect.

So my question now, is there a way to perform this by a TAVR method?

 

[Keithl]

I would suggest not worrying about minimally invasive or not. You want the surgeon to be comfortable and have the access to get it correct this time.. Mine was supposed to be "normal" but the surgeon could make a smaller than usual sternum cut, so it wasn't minimally invasive, but not the full month either.

AMEN! I wanted my DR to do whatever he felt was right and he wanted full crack and I was fine with it, with nurseryman replacement graft they like as much space as they can get to see everything. My recovery was great and 15 months later the damn tube scars are worse than the entire sternum scar, which is barely visible.

 

[user 15848]

Dont know much about this, but did hear that when a Valve-in-Valve is done, the second one is smaller so it can fit on what ever it left after the old one is sucked out; which makes sense; Hope and wish all goes for you well and as per your wishes, but, from my understanding a valve in valve procedure is not for all situations, just a thought, again, hope all goes as per your wishes,

 

[Paleowoman]

Just went to my cardiac facility today and got a EKG. The doctor said it looked fine, but however, he strongly recommended that I need to have the aortic valve replaced sooner or later as gradually it will start damaging the heart.......
.....So my question now, is there a way to perform this by a TAVR method?

Hi @iren_999 - Your doctor said that "it looked fine" and that you will need to have the aortic valve replaced "sooner or later". Your doctor said it looked fine and he didn't say the aortic valve needed replacing now. As I've written previously, mine is too small but it is not damaging my heart yet so I have annual echos to monitor myheart so that when the time comes which indicates that my heart is beginning to get damaged or the valve is degenerating, I will get replacement surgery.

When you have your echo in two weeks you will know more as an EKG doesn't tell a doctor the state of your aortic valve or of your left ventricle. I have always had a normal EKG, even the day before I had aortic valve replacement. Once you have the echo you will be able to know the pressure gardients across the valve and if the left ventricle is enlarging which would indicate damage to your heart. Do keep us posted !

It would be impossible to replace your too small aortic valve with TAVR as you would get an even smaller valve then as the TAVR valve has to fit inside the current valve.

 

[iren_999]

My concern is that I am 76 years old and the longer I wait, the surgery (when the time comes) may be too risky.

As for your case, you are still younger than me and of course, in case you need another surgery at least it will come with lesser risks due to your younger age.

 

[Paleowoman]

Hi @iren_999 Yes it's true I'm younger (67) so your age is something to consider. But read this from the forum which was posted a few weeks ago - an 83 year old who had surgery and with two valves replaced and another repaired: Triple Valve Replace/Repair 83 year old Mom This was truly inspirational.

However it is always your choice and decision along with your cardiac surgeon's advice - your echcardiogram will give you and the surgeon more information.

 

[carolinemc]

Hello everyone!

Just went to my cardiac facility today and got a EKG. The doctor said it looked fine, but however, he strongly recommended that I need to have the aortic valve replaced sooner or later as gradually it will start damaging the heart.

My echo exam is scheduled in 2 weeks from now.

My question is, is there a more practical less intensive way to correct my aortic valve mismatch by performing a TAVR rather than having them cut me open again?

The doctor who performed my EKG today, said that the easy part of the surgery is changing the valve and inserting a new valve that should fit my size correctly. He explained that the most difficult part would be the incision of the chest itself as the incision from my previous surgery before still has some residual stitches that they would have to inspect.

So my question now, is there a way to perform this by a TAVR method?

Nothing to it getting cut open, since they are doing better on the surgery time these days. I have a Aortic valve replacement back in 09-15-2001. Healed just fine as the timeline went. What they do it take the Aortic valve out and lay it on your chest they replace it with the new one., You will be fine.

 

[carolinemc]

Is mine good or bad enough for an immediate redo surgery? Or, maybe I should just go the route as you are and when it gets to a point were I am out of breath then consider surgery?

I have an appointment with my general physician and will bring the same results with me for her to also look at.

And never start worrying till the surgeon tells you it is time. I knew mine was time when I heard the echo and heard the murmur so loud I could hear my heart break. Just relax and they will let you know, your surgeon and cardio. Relax. Have a great day. And Hugs for today.