Doing the reading in answering the above post I was struck (yet again) by the apparent contradictions in readings. To me the obvious answer is that we (as a collective of humans and shared knowledge) just don't know with certainty. Some authors prefer to write in ways which suggest they are sure (perhaps for the reasons of showmanship needed to be perceived as a top surgeon in your field by your clients) ... maybe they are ... or maybe its just the science trained that choose to accept that we don't know everything. Once upon a time the idea of "egoless" writing was pervasive in science ... once upon a time.
My first link was
this one (from the European Society of Cardiology:
Paravalvular leak (PVL) is a relatively rare complication related to the surgical replacement of mitral and aortic valves. Most PVLs are hemodynamically non-significant, however large leaks lead to heart failure and increased risk of infectious endocarditis. Intravascular hemolysis causing anemia is also common in small PVLs. In many patients reoperation is associated with very high risk and alternative methods using transcatheter closure have been designed. Such techniques are less invasive and can be used in most of high-risk patients.
Seems encouraging ... over the atlantic it seems debate is more divided ...
And
this source suggests:
Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves.
which means not common but not "unheard of" .
This source goes on to clarify who:
Paravalvular leak (PVL) occurs when there is backflow around a prosthetic valve. This can occur through a variety of causes. Paravalvular Leak is accompanied by regurgitation and is often a significant problem for patients with bioprosthetic or mechanical heart valves.
{underline mine}
so both prosthetic types (and they have a reference to support their claim
Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med 1996;335:407–16.)
so its not just something they pulled wriggling out of a hole
Yet curiously
this source has a different view:
Paravalvular leaks are a common issue with mechanical valve implantation.
common ... sounds "
worrying" .. yet they single out mechanical and fail to clarify what common means; is 5% common?
They clarify their view point perhaps by inference:
In 15-50 percent of cases, small paravalvular leaks are detected, but these are typically of minimal clinical significance.[1] However, in 1-5 percent of these cases, the leaks are associated with hemolysis, arrhythmias or congestive heart failure.
so of the "common" occurrences only 1 ~5% of these are associated with problems ... as many as half are of "minimal clinical significance" (which is good news for Ryan) ....
Clearly its not like a proper science (like engineering or physics) where you can go and pick a bolt from a shop and we'll know everything about that bolt, what forces it can take, how it will last in the environment and measurements down to its most tiny details. [IMG2=JSON]{"data-align":"none","data-size":"full","src":"http:\/\/atmedia.imgix.net\/af1f489c39c1de5ecb388a47c723df5f3c0d57c6?auto=compress&w=640.0&fit=max"}[/IMG2]
Of course material science has been acting like a science since at least the 16th Century (not a "Theatre" as Medicine remained until recently). [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/elbrecht.files.wordpress.com\/2014\/01\/surgicaltheater.jpg"}[/IMG2]
So onto treatment, the guys at Radcliff have this to say:
The mechanism of leaks is not well understood....
How can PVL be treated? Unfortunately, repeat surgery portends a worse prognosis, with mortality rates for the first redo, second redo or third redo surgery of 13 %, 15 %, and 35 %, respectively2. Each repeat operation is less likely to be successful. Therefore there is ample room for percutaneous approaches.
so that's (to me) encouraging. They recognise that:
- repeat OHS surgery brings worse outcomes for the patient (something surgeons like to play down when selling you a tissue valve)
- each repeat is less likely to be successfull
- no mention of needing to be "frail" to benefit from a percutaneous patch solution.
which is encouraging I'd say, unlike the view expressed by dicardiology:
Transcatheter repair of these leaks represents a new treatment option for these patients, who are often too frail for repeat surgery.
what's my point?
my point is that medical opinion is just that ... OPINION.
Unlike the hard sciences (stuff that can put sattelites in orbit or send Cassini to Saturn with incredibly fine margins for error) people in Medicine often argue about the most obtuse issues, making clear that there is ambiguity and uncertainty in their community.
This is why the medical people only offer "OPINIONS" (imagine if NASA offered an Opinion "oh yes, we think we can do that"), science instead offers evidence and calculations. This is something which ***** me off and is compounded by the "Stockholm Syndrome" relationship many have evolved into with their practitioners ....
So to
Ryanvs I say that the outlook for you looks promising with many good alternatives that seem to have a good likelihood of success. I recall that you are in Sydney, and I am of the view that there are many good "catheter" drivers down that end of the sticks.
So keep in mind some of the above points (how likely it is that its trivial) and they they are just doing proper diligence on investigating it at this stage. IF they find there is a significant leak (were you symptomatic or was it just identified in a routine checkup?) there is "ample room" for a good treatment that does not require OHS
Best Wishes mate
