Second Opinion

[Jimmyk]

I used to bike regularly, walk, jog.....hike ect.... As of now I'm not able to because of the shortness of breath, chest pains, being tired. Ect.
I'd love to be able to be active again.
The hospital seems to be moving along with the process.
I had blood drawn yesterday , picked up 3 meds for a procedure that is supposed to be done next week.
I'm allergic to all seafood, so I was told to get benydryl , prednisone , and Tagamet to counteract any allergic reactions I may have to iodine.
The tests scheduled are a TEE, and a heart Cath.
I'm assuming the valve replacement won't be to far after that.

Thanks everyone for your input.....before I joined this group, I was so terrified to the point that I wasn't going to have the surgery .
After reading stories, it's totally changed my outlook on the surgery.
I'm ready to do this, nervous? Yes....but looking to get better.
I'm a 52 year old electrician with at least another 10 years to go before retirement ...probably more...lol
thank you everyone for your kind words and encouragement .

 

[pellicle]

Hi

I take vitamin D3, I've been taking it for a number of years. The study on the woman taking alfacalcidol whose bioprosthetic valve rapidly became calcified: Alfacalcidol is an analogue of vitamin D,

actually your situation was exactly why I posted that example. I did not know how well it applied to you (but assumed you would) and thought it was a good way to bring awareness to that possibility.

Clearly the surgeons investigating that issue are not biochemists (they are surgeons) and clearly noone in that case was able to make any sound conclusion. Thus the paper raises questions not offers answers.

I hope your own issue is clarified soon to bring you some certainty and comfort

 

[pellicle]

Hi Jimmy

I used to bike regularly, walk, jog.....hike ect.... As of now I'm not able to because of the shortness of breath, chest pains, being tired. Ect....
Thanks everyone for your input.....before I joined this group, I was so terrified to the point that I wasn't going to have the surgery .
After reading stories, it's totally changed my outlook on the surgery.
I'm ready to do this, nervous? Yes....but looking to get better.
I'm a 52 year old electrician with at least another 10 years to go before retirement ...probably more...lol

I'm sure you'll do well ... a mate of mine is a "sparky" and ended up being very active doing stuff a good 10 years after retirement ... maybe a few more even.

 

[Paleowoman]

Hiactually your situation was exactly why I posted that example. I did not know how well it applied to you (but assumed you would) and thought it was a good way to bring awareness to that possibility.

Clearly the surgeons investigating that issue are not biochemists (they are surgeons) and clearly noone in that case was able to make any sound conclusion. Thus the paper raises questions not offers answers.

Yes that paper certainly raises questions. I read it some years ago before I had AVR as I was wondering if my vitamin D supplementation was acclerating the calcification on the bicuspid aortic valve. I discovered the paper related to an analogue of vitamin D and someone with a kidney problem and was the only case of its kind too. I'm sure that people with kidney problems have a problem dealing with calcium too, though I don't know much about it. There all sorts of questions that that paper raised about calcium and kidney function and calcitriol that were never followed up or answered...which they should have been, imho, since calcifiction of both native and tissue valves is something that is an issue that appears to have no conclusive answers.

 

[epstns]

pellicle - Just to "close the loop" - my comment was pretty much a "place-holder." It meant (at the time) that I heard and understood what you had written, I am not brushing it off, but I am not overly concerned about how it will all affect me. Just kind of a "OK. . . now moving on" sort of comment. I was not trying to be argumentative. Had I been arguing, we would have attracted a lot more attention!:Face-Devilish:

 

[Northernlights]

Dear Jimmy
I don't normally post here, but I thought it worth pointing out that while bioprosthetic valve calcification happens faster in younger patients, if you read the actual academic literature on prosthetic valve calcification you will see it is due to their stronger inflammatory response, not exercise or activity (homografts eventually calcify strongly, due again to the patient's immune response, which is why reoperation on them is difficult, while the Ross autograft doesn't calcify in this way since it's the patient's own tissue). The glutareldyhyde fixing common to all bioprosthetic valves, though not the homograft or Ross, is also a strong factor in calcification, and modern valves focus on ameliorating this with further treatments ( again nothing to do with 'more active people'), also small valves or those with high gradients possibly calcify faster due to mechanical stress on the cusps, and newer valve designs try to reduce this too.

But if you are concerned about exercise capability, then what is relevant is the size and hemodynamics of the valve of whatever type, where you need the largest possible EOA (effective orifice area - it's the valve area calculated by echo) for the best exercise capacity. A normal aortic valve area is c. 3-4 square centimetres - a lot more than a prosthetic valve, hence the gradients across prosthetic valves and reduced exercise capability ( VO2max). At the TEE they will be able to see the size of your valve annulus. Basically the larger the valve size the better.

So the good news is that exercise and activity is fine for anyone with a prosthetic valve , whether bioprosthetiic or mechanical, and will not shorten the valve's lifespan in any way. Heavy weight- lifting less than 15 reps is generally not recommended, and contact sports and downhill skiing are not recommended for mechanical valves due to the risk of head trauma, as with head trauma on warfarin you are more at risk of intercranial bleeding even if you are in range). However you will see that there are a good many people on this forum who decide to ignore this, and it's obviously up to you if you want to take the extra risk or to be more cautious.

Bioprosthetic or mechanical is very much a personal choice. For many, like you, reoperation is what they dread most , and thus mechanical is the obvious choice. Others really don't want warfarin's risks and testing regimen or the ticking ( though most people on warfarin seem to 'normalise' this). It's also worth mentioning that atrial fibrillation does not always mean warfarin, as there are alternative drugs which can be used, but which unfortunately are not a safe alternative for mechanical valves. Another option is to choose a tissue valve with the intention of switching to mechanical on reoperation, in order to reduce both the number of reoperations and the cumulative risks of long-term warfarin. It's a very personal decision which only you can take, according to your own priorities, in conjunction with your doctors. But since you are very anxious about surgery and at 52 would face reoperation, and are happy with warfarin, then this definitely suggests mechanical.

Nevertheless, don't worry about the replacement, though it is definitely sensible to choose a good hospital and experienced surgeon - not necessarily the nearest hospital. It really is routine surgery! Also try Adam Pick's site heartvalvesurgery.com - it's a very informative site and has a larger forum which is also very helpful.
best wishes.