Size of replacement valve

[Paleowoman]

How does a surgeon know in advance what size of valve to bring to the operating theatre ? Do they bring a whole selection of sizes ? I am of a very small build, smaller than 'normal' I think - at least when I had my son they had to do an emergency caesarean because my pelvis is too small despite the fact that I'm of average height, so they had no inkling until the very end.

 

[tom in MO]

My surgeon said he has a selection on hand all the time. There are emergency valve replacements done every week. The size needed can be estimated based upon what your pre-op images indicate. They won't know the exact size until he is there at your heart.

 

[Guyswell]

There's a sizing tool that the surgeon uses to measure the size of your aortic root after the old valve has been removed. There are a whole range of valves and sizes on hand in the operating room. The final decision on valve selection and size is made during surgery.

 

[Tom C]

They do have a good idea of the size needed and they do have every size on hand. Each manufacturer also provides a "sizing kit" that is used during the operation for measurement and size selection.

 

[Paleowoman]

What happens if I'm extra small ? I'm not saying I will be, but in my fantasy they are having to get one sent from somewhere else and me being left on heart lung machine for too long while it's getting sent from wherever to the hospital by emergency vehicle :confused2:

 

[Midpack]

What happens if I'm extra small ? I'm not saying I will be, but in my fantasy they are having to get one sent from somewhere else and me being left on heart lung machine for too long while it's getting sent from wherever to the hospital by emergency vehicle :confused2:

It can be worse than that. May be the provider has to manufacture it, and you are left a week (or more) on the heart lung machine until it is ready!

Just relax. Valve size will NOT be a problem. They will have one that perfectly fits you!!

 

[Paleowoman]

It can be worse than that. May be the provider has to manufacture it, and you are left a week (or more) on the heart lung machine until it is ready!

Just relax. Valve size will NOT be a problem. They will have one that perfectly fits you!!

I'll try and relax ! Thanks for making me laugh ! I'm not used to giving over control to others to such an extent as I'll have to with this !

 

[Bina]

I'm 5'2" with a small frame and my very experienced surgeon chose a 21mm St. Jude Regent for me, even with my dilated aorta root.
Kids receive valves too, so sizing isn't a problem.

 

[clay_from_nj]

Researchers have been thinking about small valve sizes for a long time: Aortic valve replacement with a small prosthesis and Long-term results of aortic valve replacement with a small St. Jude medical valve in Japanese patients. More important than the size itself is getting the right size for the patient: Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement.

 

[Paleowoman]

More important than the size itself is getting the right size for the patient: Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement.

You mean they make mistakes :eek2:

 

[Rachel]

I'm pretty small as well but I've got a 25MM - the bigger the better I say!!!

 

[clay_from_nj]

Linked document includes graphic images of open heart surgery.

Linked document includes graphic images of open heart surgery.

They just have to get the math right and not be to lazy to do any necessary extra work to make it right. Don't worry too much Anne, I think that thoracic surgeons are probably less likely to make mistakes than people in most other professions.

Everything you wanted (or didn't want) to know about Patient-Prosthesis Mismatch.

(You know, now that I think of it, I'm going to ask my surgeon why he chose a supra-annular valve placement for me.)

 

[Paleowoman]

They just have to get the math right and not be to lazy to do any necessary extra work to make it right. Don't worry too much Anne, I think that thoracic surgeons are probably less likely to make mistakes than people in most other professions.

Everything you wanted (or didn't want) to know about Patient-Prosthesis Mismatch.

I don't know, looking at that pdf - I have severe pressure gradient (68 mm/Hg) but very good ejection fraction (79%) - I'm not sure my surgeon has realised that because she said my heart could just go into left ventricular failure any time - no it couldn't as my ejection fraction is excellent and my heart muscle is strong (commented on by cardiologist and technician). My valve area size is 0.9 but I'm a woman with a small frame ! There are men on here with valve area size 0.8 which is probably much worse becasue they're men with bigger hearts to begin with than my heart which will be smaller, so 0.9 isn't so bad with me. So I guess my stenosis is severe due to the calcification making the cusps stiffer rather than smaller gap ? I wish I knew more about this. I hope the surgeon is as good as her reputation…...

 

[clay_from_nj]

Anne, I would think that your EF good because your heart is still strong, despite the bad valve. My ejection fraction went way down because I went so long with a worn-out BAV that was both stenotic and regurgitating, making my heart weaker and weaker. When my EF got below 40, I was pretty miserable. They probably want to get your surgery done now so as to spare you from a weakening heart and CHF in the future. Trust me, you don't want heart failure.

This is interesting: "About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions (EFs). These patients are diagnosed with 'diastolic heart failure' or 'heart failure with preserved EF.'" (from Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography)

 

[Paleowoman]

Hi Clay - yes I guess that's why they want to do surgery now, to avoid heart failure. I wouldn't want it no !

 

[OldManEmu]

I received a 29mm Medtronic Aortic valve the first time and it had a pressure gradient of 11mm hg when installed. With the redo I had a 27mm Carpentier Edwards valve and it has a gradient of 6mm hg. Smaller valve on the redo yet lower pressure gradient?
Regarding EF, 60's are normal more is usually the heart compensating which is not sustainable longer term.

 

[Paleowoman]

Regarding EF, 60's are normal more is usually the heart compensating which is not sustainable longer term.

Looking back over my previous echoes over the past seven years, my ejection fraction has always been 77 to 79%, whether my pressure gradient was a much more respectable 35 mm/Hg or now at 68 mm/Hg. The technician doing my last echo asked me if I do weight lifting, I thought he was seeing increased muscle tissue overlying my chest, but no he said it was my heart muscle which was extremely strong and looked like the heart muscle of a weight lifter ! My endo said that would be "althelete's heart" (well I wouldn't describe myself as an athelete by a long chalk, but I have got strong muscles), which would explain why the ejection fraction is so good I would think ?

 

[ottagal]

Hi Paleogirl,
I am very petite and received a 21mm Carpentier Edwards Bovine Valve. Try not to worry about Patient prosthesis mismatch. Surgeons know about this ahead of time and try and avoid it at all costs. I think the issue could be with a very large framed person who has to receive a smaller valve size because of the valve/ root anatomy.

Worry about what you can control and try and let the rest of the other stuff go.
BTW, I also had my aortic valve replaced closer .9 (although they thought it was .6 prior to surgery). Surgeon told my family that the valve was very calcified and that was one of the reasons he replaced it (along with other reasons!).

 

[chaconne]

My heart valve was actually too small. I could have had a 33mm aortic valve implanted (made only by St Jude) but I got a 29mm because I wanted the On-X. My surgeon had to stretch my tissue to make it work. I'm doing fine now after 2 years. My heart has probably shrunk to fit the size better and I am authorized to get my HR up to it's max when I exercise (180 bpm). I'm sure you do fine.

 

[Lynlw]

I received a 29mm Medtronic Aortic valve the first time and it had a pressure gradient of 11mm hg when installed. With the redo I had a 27mm Carpentier Edwards valve and it has a gradient of 6mm hg. Smaller valve on the redo yet lower pressure gradient?
Regarding EF, 60's are normal more is usually the heart compensating which is not sustainable longer term.

Hey EMU good to see you

One problem is that different manufacturers measure/lable their valves differently, meaning it isnt necessarily true that you got a smaller valve the 2nd surgery, I think per lable the Perimount valve of one number has a larger opening than that same "size' of a different manufacturer so it is almost comparing apples to oranges. If you went from a 29 to a 27 from the same manufacturer it would be a smaller valve but since they are different brand, they "MIGHT" actually be te same size...How is that for confusing/ which is one of the reasons all manufactureres have ther own sizing tools
here is one of the article discusing it
http://www.ncbi.nlm.nih.gov/pubmed/24151764

Paleo, As other said i wouldnt worry about it. Yes they take several different size valves to the OR and have a general idea of what size a persons valve is from all te preop testing, Also since the do replace valves on small children dont worry about needing a valve that would be too small to be available. I'm sure IF you needed a tiny valve from various preeop tests, especially the cath. they would make sure to have a couple valves around that size on hand,

Good Luck. BTW I was kind of surprised to see you in preop when I came back since last I knew the vitamins (maybe k2?)seemed to be helping so much.