Stenosis AFTER AVR?

[Queen TJ]

I had a St Jude Mechanical Valve installed in AUgust 2008 to repair an aortic aneurysm and replace aortic valve (44 y/o female) Overall it was a wonderful experience - and i was thrilled with the noticeable difference in heart function. However, just this past September I was admitted to the hospital after a very minor ob/gyn procedure. I had DC'd the coumadin and did a lovenox bridge exactly as instructed. I was to go home by noon but spent the next 6 days in intensive care. BP dropped to 47/33, Hemoglobin to 5 and i had 4 blood transfusions. CT could identify no source of bleeding except "Fluid in abdominal cavity". within 4 days it was obvious in the bruising that it was all settling in the abdominal tissue. The Echo in the hospital showed aortic stenosis but they said "the valve is working fine". They seemed to imply it was just coincidental because of the low volume of blood at the time. I had a followup Echo last week and the echo again confirmed the stenosis of the aoritic valve with a gradient of 55. My regular cardio doc was out of town during my admission and last week as well. I have been frustrated to not get any answers or explanations regarding this and finally forced an appointment for next week. BUT my mind is spinning with questions. How does Stenosis happen after a valve has been replaced? Does it mean the valve will have to be replaced again? How serious is this condition (with a 55 gradient)? etc. I feel like I'm waiting for another shoe to drop.

 

[Mentu]

Queen, you will have to wait for answers until you can speak with your cardiologist who can look at your test results. Stenosis just means narrowing and does not indicate what the problem may be. Also, keep in mind that test results can be misinterpreted. If there really is a significant pressure gradient across your valve, then your cardiologist will set up the kinds of follow on test that will characterize the problem so you both can determine the best way to deal with it. One possibility is that tissue growth around the valve can restrict blood flow but there may be other causes. The other thing to consider is that even though there may be a pressure gradient it may not be serious. We all like to think that with the replacement of our damaged valves all our problems are fixed. Sadly that is not always the case because our bodies are dynamic - they are always changing. One practical thing you can do is to write down the questions as they come to you so that you are prepared for your visit with your cardiologist. For now, take care.

Larry

 

[ShezaGirlie]

Hi Queen and welcome. Please know that there are folks on here so willing to help and you'll get suggestions soon. They may come a bit slow since it's the weekend, but isn't it insuring to know that somebody will be around for you.

Personally, I don't have any suggestions for you at this time about a mechanical valve developing stenosis -- but hang in here because we even have a doc onboard now.

Again, welcome..:thumbup:

 

[nngbwh]

Hi Queen and welcome. Please know that there are folks on here so willing to help and you'll get suggestions soon. They may come a bit slow since it's the weekend, but isn't it insuring to know that somebody will be around for you.

Personally, I don't have any suggestions for you at this time about a mechanical valve developing stenosis -- but hang in here because we even have a doc onboard now.

Again, welcome..:thumbup:

Janie is right. It does get slow here during the weekend and we do have a doc aboard name heartdoc.
Hopefully someone should come around and help you out soon. I just want to say hi and welcome you aboard.

 

[RobThatsMe]

Hi,

I just had that issue with my aortic valve. Pannus tissue developed unter the valve. So to say this correctly, " The valve was fine, but the body was rejecting the valve by building up scar or pannus tissue under the valve, and thus narrowing the opening." the growth of the scar tissue narrowed my opening from 1.8 cm down to 0.4. My cardiologist, said that it needed to be fixed, and that if I did not, I would most likely experience a "major cardiac event" in 12 months, and that it could be a deadly event. He said that I should get it fixed within the next 4 to 6 months. He said I had severe stenosis caused by the growth of pannus tissue.

So, about 6 weeks ago I went through a major re-surgery. This time instead of the St Judes aortic valve, my surgeon relaced it with the ON-X valve. These valves have a sleeve which surpresses, or even prevents pannus from building up. It also has a larger internal diameter, which allows more blood to flow through the valve. Since my St Judes only lasted 10 years due to the pannus tissue, I figured that this new valve is worth a shot. From what I have read, if you are suspectable to pannus, then it will keep coming back, so perhaps this latest valve design may be what I need. For those folks that don't have pannus issues, their mechanical valves can last for decades.

So, Guess I will see how long I get out of my new valve. I had to have a TEE, CT, and Cath done for the surgeons to evaluate. They also gave me a Stress Echo test to see just how bad my heart was being effected. I lasted 13 min 20 seconds on the treadmill.. My doctor was surprised. But, I have been working out for years, and even then would jog for 2miles every day.

Keep us posted on how things look after you meet with your doctor. In the meantime, just fire me an e-mail if you would like to discuss this further.

Wishing you good health,

Rob

 

[Lynlw]

Hi, Sorry to meet you because you're having problems. I know how scarey and frightning this must be, but until you have more information, try not to think the worse. I don't know what your blood volume was during the echo in the hospital, but I could imagine if there wasn't as much blood going (since 4 units means you lost about 1/2 of your blood volumn) thru your aorta it MIGHT be a little narrower. but I don't recall of anyone every having that happen.

AS for the follow up showing the stnosis. It is hard to say what could be going on, with out a little more details. Do you have any numbers beside the gradient? That would help.
My son has a pulmonary valve and conduit (kind of like the aorta graft you have) that has had a few problems over the years with new stenosis. Could you ask exactly where the stenosis is? since the valve works fine, it could be there is a probably above or below the valve. You also should ask what it looks like the stenosis is. some time Justin's was blocked w/ scar tissue right at the seam, other times he's had calcification sometimes as long as the valve was fine they were able to help him in the lab lab. other times, he needed either a new valve or they replaced a section of conduit because the valve was fine.
Since this happened right after you bridged, I would also ask if there is any possibity it could be a clot. (altho IF they suspected a clot, I doubt very much they would send you home)

Who gave you the results for the echo you had as an out patients? Its tough now, because it is a weekend. but if your regular cardiologist won't be in town monday I would put a call into who ever gave you the echo report and ask for a little more details and to they know what the plan is. Usually when Justin's stenosis comes back , or looks like it during the echo, they do an MRI and if they still can't get the best picture they do a cath..and hope it is something they can fix in the cath lab.
FWIW

 

[tobagotwo]

The only valve I am aware of that has a way of stopping pannus growth is the On-X. If the worst is suggested in the future (reoperation), I would seriously consider this option.

Best wishes,

 

[Greg a]

WELOME TO OUR FAMILY OF OHS BROTHERS AND SISTERS there is always someone nearby who has faced the same siuation and until that happens read all you can and ask all you can ...our family has been through the process many times and that makes for a group with about as much empathy as you can ever find...the important thing is to keep us all posted as you travel this road

I had a St Jude Mechanical Valve installed in AUgust 2008 to repair an aortic aneurysm and replace aortic valve (44 y/o female) Overall it was a wonderful experience - and i was thrilled with the noticeable difference in heart function. However, just this past September I was admitted to the hospital after a very minor ob/gyn procedure. I had DC'd the coumadin and did a lovenox bridge exactly as instructed. I was to go home by noon but spent the next 6 days in intensive care. BP dropped to 47/33, Hemoglobin to 5 and i had 4 blood transfusions. CT could identify no source of bleeding except "Fluid in abdominal cavity". within 4 days it was obvious in the bruising that it was all settling in the abdominal tissue. The Echo in the hospital showed aortic stenosis but they said "the valve is working fine". They seemed to imply it was just coincidental because of the low volume of blood at the time. I had a followup Echo last week and the echo again confirmed the stenosis of the aoritic valve with a gradient of 55. My regular cardio doc was out of town during my admission and last week as well. I have been frustrated to not get any answers or explanations regarding this and finally forced an appointment for next week. BUT my mind is spinning with questions. How does Stenosis happen after a valve has been replaced? Does it mean the valve will have to be replaced again? How serious is this condition (with a 55 gradient)? etc. I feel like I'm waiting for another shoe to drop.

 

[heartdoc]

Queen,

I can imagine the anxiety these echo readings provoked. The best thing to do is to discuss these results in detail with your cardiologist as soon as possible. I suspect they would have not sent you home if there was anything that granted intervention but you need to get your answers. Do you have any new symptoms (i.e. shortness of breath, chest heaviness, fatigue) now? If you do, call your doctors now. Here are a few questions to ask:
1) Is 55 the PEAK gradient or the MEAN gradient? (A mean gradient of 55 would be more concerning than a peak gradient)
2) Is this gradient substantially different from the gradient you had right after your AVR? If the valve that was implanted has a small diameter, you might have had a residual pressure gradient since surgery. They would know this from previous echos.
3) If it is higher than before, what caused the increase? A good echocardiogram should shed some light on the reasons for an increase in gradient and allow your doctors to tell you what to do about it.

Stay strong and get your answers,

HeartDoc
www.bigappleheartsurgery.com

 

[vtbecca]

Hi,

My son has a pulmonary valve and conduit and had that issue with the first one he had put in. Within a few months of surgery the narrowing was much more than what is considered normal and he had it replaced 17 months later. It had lots of scar tissue and calcium built up. The cardiologist said they speculate that some people reject them. Not in the conventional sense but the body treats it as a foreign object and scar tissue builds up. Gabe's valve and artery are human tissue. His replacement has been in now for 8 years. He was 1 1/2 at the time of replacement and is now 9 and it's narrowed but that's to be expected. He's small but has grown a lot since that operation, and obviously the valve doesn't grow with him. So the good news is that with a different valve you may not have the same thing happen. Unfortunately the old one may need to be removed. However, it was put in 2 years ago and it's now at a 55, so you probably do have some time before they'll need to redo it. Talk to your doctor as soon as you can, he/she may be able to reassure you and you'll at least have more information about it. I hope you get some good answers.

 

[Queen TJ]

Little Update: Thank you all for the kind words and great info: I saw my regular cardio doc today. Today was a reminder and lesson of the importance of staying on top of your own care. It really is easy to "fall through the cracks". He had no idea that I had even been hospitalized. The "admitting" doctor was the ob/gyn and so on paper his partner was just a consult - so again, the paper trail can go all over the place.. .its important to be assertive~His office had scheduled me for a routine followup in January. . He was GLAD that I insisted on todays appt.

I really thought we might just have a discussion about all the questions that I have but He was very reassuring that the way things "are" are not what they "should be" and that there is a lot of things going on that need explored. So. . . I've come home wearing a monitor and go back tomorrow for a TEE and some angio pix - he'll be consulting with the surgeon that installed the st.Jude valve

I got a bit teary there in the office - Second guessing my decision for the Mech valve, not wanting to go through all of this again. He offered a GREAT pep talk. "remember how great you felt 2 years ago with that new valve" - "we're gonna get you there again - we are!"

I really have been a "lurker" on this site for more than 2 years and regret that I've never logged on just to say this site and community is absolutely awesome.

 

[deek]

I can certainly relate to your situation, as I am going through a similar one. I'm one year, six months post mitral valve repair for bi-leaflet prolapse and severe regurgitation and my PA presssures have been elevated and I have been progressively symptomatic since. Lung congestion, exercise intolerance, cough, sob and palpitations. Cardiologist referred me to PH specialist who ordered a right heart cath which indicated pulmonary hypertension, secondary to mitral stenosis and gave the impression that my annuplasty ring was too tight or too small resulting in symptoms. Recently had stress echo which indicated moderate to severe stenosis which prompted my cardiologist to call and tell me that it was her opinion that I needed intervention on mitral valve again. Contacted surgeon and he say's it is not mitral stenosis. Hmm? So cardiologist has referred me to surgeon at CC but I still don't know WTH is going on. All I know is that I am severely symptomatic and that something is wrong. Anyway, I certainly hope you get some answers soon and best of luck to you. Take good care, D