Pros and Cons for mitral valve surgery?

[Carrie]

I'm making a list of pros and cons regarding having a surgery now if they say I'll need one eventually. I've had no problems thinking of the benefits, but are there any cons to having a repair or replacement done early? What are the reasons a doctor might want to wait on a repair/replacement of a mitral valve if a person is symptomatic and wants it done and is otherwise healthy?
(I want to be prepared in case that's the answer I get. If I need it done, I'd rather do it a.s.a.p. and I want to be prepared to argue my case, but I'd like to know why they might counsel waiting.) Thanks!

 

[MikeHeim]

Sorry, I don't know of any cons. The entire journey towards surgery I was scheduling appointments as quickly as I could get on someone's schedule. At the time, I was having a tough time living with myself due to the activity restrictions and the knowledge that I had a heart problem that was only getting worse with time. I just wanted everything over with! When I finally met with the surgeon, he suggested that I have surgery within the next six months. Two weeks later I was on the operating table.

 

[Ashley]

Hi Carrie,
I guess the only con I can think of is that they might want you to get the absolute maximum amount of mileage out of your natural valve, so that when you have it replaced - that valve will last longer too?
Otherwise I am with you - I want it over with too!

Good luck!

 

[jeffp]

If you're already having symptoms, waiting only makes the syptoms worse and the heart less fit to heal after surgery. I had some mild murmur since I was a kid and mild hypertension for the past 20 years. Never any other symptoms. Always been healthy as a horse. Went and had echo done at my PCP request and cardio said minimal regurgitation, see you back in 5 years, keep taking your BP pills. 8 months later the cordae tore from one leaflet of the valve and I went into CHF. Ignored it for a few days and wound up on the OR table. I actually glad I never had the time to worry over what to do for months as you do. Up side of the whole thing...my blood pressure's fine now. Down side...had to have surgery. Sure beats my wife being a widow (and spending my moeny with some other guy!)

 

[Debrinha GT]

That's a great question!?????

That's a great question!?????

I don't really know the answer either, but I hope that BobH or any of the other experts comes forward soon with some answers. All I can say is that I've had three mitral valve replacements already (all of them tissue) within the past 30 years and I'm in the waiting room for my fourth. Anyway, I remember that on one occasion during a doctor's appointment my husband asked him if I could have the surgery right away and he said it wasn't as simple as that. It's a delicate surgery and it's not just a case of "get rid of it now" just to get it out of the way. Of course, they do take a lot into consideration before making a decision and they won't go to the other extreme either. I suppose that every case is different and they must weigh the pros and cons based on the patient's history and all that. When I went to see my surgeon last time over a year ago, I did ask him how they would know the best time and he told me that one of the criteriaa they use is the exams as well as how the person's feeling. In my situation he said that unless there's a rupture or something, he'll only perform the surgery once the opening to my valve has reached 1,00cm2. Again, the same might not go for you so try and discuss this with your doctor next time you see him.
Débora from Brazil

 

[barry70]

I have 4+ severe MR, no symptoms thus far and so far, my heart is handling it well and my heart size is normal. As you can imagine, I have received various opinions too. Majority of surgeons (I met a few) would operate on me now. One told me that I am too healthy and to come back when things change. So, what I am doing now is having echos every 6 months and the second my cardio sees changes in my heart size (Left Ventricle and/or Left Atrium) and/or if I develop symptoms, I know I will be having surgery soon thereafter. So, I know it is in my future - just don't know if it will be this year or in ten years...but eventually. The one good thing in my case about waiting is that hopefully the technology will advance enough so by the time I am ready to get my valve fixed, maybe they won't have to cut me open to do it. Time will tell.

 

[Marty]

Sooner better than later!

Sooner better than later!

I'm making a list of pros and cons regarding having a surgery now if they say I'll need one eventually. I've had no problems thinking of the benefits, but are there any cons to having a repair or replacement done early? What are the reasons a doctor might want to wait on a repair/replacement of a mitral valve if a person is symptomatic and wants it done and is otherwise healthy?
(I want to be prepared in case that's the answer I get. If I need it done, I'd rather do it a.s.a.p. and I want to be prepared to argue my case, but I'd like to know why they might counsel waiting.) Thanks!

Carrie, Mayo's, right in your back yard has been pushing early surgery for years. They have marvelous stats right up there with Cleveland Clinic and Inova Fairfax. Don't delay, ask to see Dr. Enriquez-Sarona or one of his associates without delay. Warm regards Marty

 

[Carrie]

I was wondering about Mayo since they're supposedly so good. I will see what comes of my followup appt on the 7th after the echo and make a decision at that time. Thanks for all the input everyone; I really appreciate it!

 

[Harmony]

Carrie Has your Cardio told you that you need to see a surgeon? Do you know the degree of reguration you have? Usually if your regurg is 4 and you have enlarged Left ventricle and Atrium , sob, and other symptoms it is probably time to see a surgeon. Mitral Valve usually progresses slowly however the cordae can snap even with mild regur. I know of 2 people who had mild regurg one a male in his 40's and a female in her 60's and had to have immediate surgery due to Cordae breaking. I have moderate to severe regurg it goes from 2 to +4. I have seen 2 surgeons who want to operate. My Cardio feels as I do not have enlargement of Left Ventricle or atrium no sob and my heart is very good. I can wait if I choose. There is no urgency now to operate. I have seen eight other Cardios who agree. I may be wrong in waiting but I feel well so I wait. It is difficult to choose open heart surgery when I really have very few symptoms.

 

[Carrie]

No, I haven't been seen for this in over 20 years because no doctor ever told me I should be followed for it. (I started out in the Active Lifestyles with a question about exercising and all you smart people told me to see a doctor, hehe...) I am experiencing increased symptoms and have an echo and followup scheduled, so right now, I know nothing. I haven't ever been seen by a cardio, but I am hoping my doctor refers me without me having to insist on it. We'll see what happens, but I am a "planner" and I have a hard time not knowing what they're going to find or what we're going to do about it, so I am preparing for all the possiblities I can think of.

 

[Harmony]

Carrie I wish you the best of luck with your upcoming echo. Somewhere between 5 and 10% of people with MVP ever progress to needing surgery so the odds are in your favor that you will not need surgery. My Cardio has a patient who is 90 with severe regurg and years ago was told to have surgery but she never wanted it. I have met her she looks about 60 is very bright and told me she feels good. Think happy thoughts and please post your results. Again the best of luck

 

[Marty]

Timing surgery for MVP

Timing surgery for MVP

An old but clever doctor detected my MVP during an insurance physical in 1961. The cardiologists at Georgetown were not sure what was causing the click till Barlow worked it out in the 70's. I continued to feel well until about 1995.Then I attributed my symptoms to old age. My GP didn't worry at all about my heart. Then in 1998 I ruptured chordae and develped a loud machinery murmur with acute shortness of breath at times. Had a mitral valve replacement and no longer have symptoms of old age( now 79). Can walk three miles on the treadmill in 40 minutes with no SOB, only aching knees.
Did I wait too long? Maybe. But it takes a long time for MVP to develop into
severe mitral regurg and then that can take years to go into heart failure.
However if you wait till you go into heart failure the results of surgery are not so good.

 

[Karlynn]

Carrie I wish you the best of luck with your upcoming echo. Somewhere between 5 and 10% of people with MVP ever progress to needing surgery so the odds are in your favor that you will not need surgery. My Cardio has a patient who is 90 with severe regurg and years ago was told to have surgery but she never wanted it. I have met her she looks about 60 is very bright and told me she feels good. Think happy thoughts and please post your results. Again the best of luck

(Needed Note: This is by no means a criticism of your post Harmony.)

Be careful of this statement. Not because it's not true, but because some doctors tend to hang on to this with all their "life" and, particularly if you are young (below 45), try to attribute your symptoms to many other things. I had a doctor prescribe Valium for me because , yes I had MVP, but I was young so couldn't possibly be having problems associated with it, so must be making it up in my crazy little mind.

A good doctor will not dismiss your description of symptoms without ordering echos and possibly other tests, to make sure. When someone presents with your symptoms and MVP - they should be looking to it first for the cause of your symptoms.

If they tell you your symptoms are not due to your MVP - make them explain exactly why they believe this ... and then come here and tell us.