Significant Drop in Ejection Fraction after Mitral Valve Repair Surgery?

[AndyChas]

I had an appointment with my local cardiologist today and an echo test. The mitral valve repair (undertaken 28/1/09) seems to be holding up (just 'trivial residual regurgitation'), but my left ventricle ejection fraction has plummeted from .60 the day after the operation (measured by echo) to .41. The cardiologist said someone of my age and fitness should really be at least .52, but he also said it was early days yet and that once I resumed my normal exercise patterns (which I'm slowly building up to), hopefully it will return to that kind of level. The report diagnosis states that I've got normal left ventricular size and mild atrial dilation, which I'm hoping is an indication that the heart enlargement isn't too bad.

I've had 5 echo tests now but apart from a synopsis of the immediate post-op echo I only have a copy of today's report. However, the cardiologist said my very first echo in October 2008 gave a LVEF of .69, which I gather is a bit high. I've done a search of the forum and I also gather that echocardiographs are not the most reliable measurement of LVEF, but the large swing in my results since October last year does seem slightly worrying.

I suppose I'm also wondering whether anyone else here has had a similar experience? Five weeks out I'm still feeling pretty tired at times (this feeling seems to have merged with some lightheadedness in the last week or so; it's quite difficult to distinguish between them!). However, I seem to be recovering very well and don't have any problems walking swiftly on a treadmill set to a 8-10/20 difficulty gradient for 30 minutes (I don't feel out of breath at all, although I haven't yet tried jogging at a slightly higher speed).

Thanks,
Andy

 

[tobagotwo]

Well, your heart is still working itself out after the sugery, so there are going to be some variations. The ejection fraction should go down from the high sixties, hopefully winding up in the fifties somewhere. Along with it, your Ventricular Hypertrophy should also be reducing.

But it takes time, months, maybe up to a year. During that time, your blood pressure will have unexpected ups and downs, you may have bouts of palpitations, you may have times when your heart doesn't seem right, and others when you seem to be right in the groove.

I'm not saying don't watch your heart, but I am saying don't watch it too closely. You'll wind up demanding and getting permanent treatment for temporary issues. What kind of meds are you on? Maybe you're on too much of something. They often prescribe beta blockers, but a side effect of too much beta blocker could be what you're describing. Talk to your cardiologist about that.

Your heart is changing its size and shape (the term is "remodeling"), the left ventricle is shrinking back to its normal size, and likely so is one or more of your atria. This causes some imbalances and some short-term false starts. It's basically redesigning itself and its rhythms.

Keep your cardiologist up to date on things that disturb you greatly about your heart, ask questions to understand, but try not to obsess on each new tick it shows (we all do it after OHS). EF is greatly variable. Chances are, your doctor wants to do another in two or three months. It may be a different story then.

Best wishes,

 

[ALCapshaw2]

Bob H makes some good points (as usual

I would add that it would be wise to get copies of ALL of your EchoCardiogram Reports.

Also note that the measurements are Highly Dependent on the care / quality of the technician.

I'm thinking that "waiting and watching"
(i.e. repeat echo in 3 or 6 months) would be prudent.

Be sure to report any 'symptoms', but give yourself some time before becoming overly concerned. Recovery is a SLOW process :-(

'AL Capshaw'

 

[briansmom]

FWIW, my son's EF dropped from 45% right after his last surgery down to 28% about 6-8 weeks post op which caused a mad scramble to discuss a transplant again. they made a couple of med changes - added a diuretic and adjusted beta blocker - and his EF went back to about 40%. It has stayed there for 2 years now.
My point is it went back up so I agree to be a little more patient. My son is not the "normal" patient you get here though.

 

[AndyChas]

Bob, Al and Deanne, thanks for the wise advice and reassurance. I'm not really worried about it, more surprised by the extent of the change; just another small bump or hiccup, and one that doesn't seem to manifest itself in the way I feel. I'm not on any medication apart from Coumadin, and that's set to stop in three weeks. My next echo/cardiologist appointment is in six months, and I'm sure that will be a better time to evaluate things.

Andy

 

[abbanabba]

Hi Andy - can't really comment about post-op EF, but prior to my OHS I had an MRI which showed my RVEF had dropped from the mid-high 40's it had been sitting at for the last couple of years to 36%. Even though MRIs are supposed to be more accurate than echos, my cardio still thought it was probably a misinterpretation or tech-error rather than a dramatic drop and an echo I had a few months later showed my numbers back up where they had normally been. I hope this is also the case for you.

Meanwhile I always thought EF should be between 50-70%, so it seems you were still within "normal" limits.

And hey - at 5 weeks it's still early days. I was chatting to another heart patient the other day and his doctor had told him: "If you cut your finger, it will take 6 days to heal, if you break a bone, it will take 6 weeks, but because your heart is ALWAYS moving it will take up to 6 months for it to heal."

Anyway, hope your next appointment shows an improvement in things for you.


A : )

 

[AndyChas]

Hi Anna
You're right: it's only early days, and it's also clear that the heart has quite a bit of this 'remodelling' to do over the next six months.
By the way, has it rained yet?
Andy

 

[abbanabba]

YES!! We didn't get as much in Strathalbyn as they did in Adelaide, but we still got some which is a great start! Good to see they've had some in VIC too - hopefully it hit some of the fire affected areas to give the CFA guys a break.


A : )