Tear after Aortic Valve Replacement

[dan777]

I had my operation in Jan 2008 and it went very well. 6 months after surgery my cardio informed me that there was a slight tear in the valve however it was nothing to worry about at that point. Last October, he felt it would last me another 10 years without a problem and put me on an annual exam cycle. I asked what symptoms I needed to look out for and was told it would be the same as my aortic stenosis, shortness of breath, light-headedness, etc.

A few days ago I started experiencing these symptoms (so much for the ten year projection). It started to be noticeable after an exercise session which I have been pretty religious with averaging 2x-4x weekly.

Will be headed to the cardio in a few days. Needless to say, I'm not looking forward to this but after living in denial for a couple of days it finally hit me that ignoring it wasn't the best solution. I'm without insurance (have been for 10 years) so round two so soon was not in my immediate financial plans.

If you or others you know have experienced this, I have a few questions.

Has anyone experienced minimally invasive repair of such a condition?

If minimally invasive is not an option, I am considering replacing the valve (porcine) with an on-x. I went the porcine originally to avoid the hassle of warfarin but now that my second surgery is more likely to be sooner than later, I do not want to have to go through #3.

 

[skeptic49]

Sorry to read about the probems with your replacement valve, Dan. I hope they have some solutions for you short of a full replacement procedure.

Best wishes,

Jim

 

[Ross]

I don't know what's available to you over there. Perhaps Tobagotwo knows something.

 

[tobagotwo]

Umfortunately, I'm completely ignorant of your options in Singapore. However, most surgeons prefer not to do a second surgery as a minimally invasive one, just in case they need to get at something. Also, minimally invasive surgery is apt to be more expensive, which may not be what you're looking for, being without insurance.

Likley the tear was there from the inception, but was very small and went unnoticed by the surgeon. Or it may have been inadvertently damaged during the surgery. Even with a fully open chest, there's not much room inside a heart to work in.

I would also consider the On-X. With it, you may be able to use aspirin as your anticoagulant, which would be much less expensive than the monitoring that goes with warfarin.

Best wishes,

 

[Johan]

Dan, I am so sorry to hear about your valve. This sort of thing is devastating as one always hopes for the maximum time quoted for these valves. The On-X was on my short list but was persuaded by my surgeon that because of my age and other factors I go for a tissue valve. ..

 

[Lynlw]

Umfortunately, I'm completely ignorant of your options in Singapore. However, most surgeons prefer not to do a second surgery as a minimally invasive one, just in case they need to get at something. Also, minimally invasive surgery is apt to be more expensive, which may not be what you're looking for, being without insurance.

Likley the tear was there from the inception, but was very small and went unnoticed by the surgeon. Or it may have been inadvertently damaged during the surgery. Even with a fully open chest, there's not much room inside a heart to work in.

I would also consider the On-X. With it, you may be able to use aspirin as your anticoagulant, which would be much less expensive than the monitoring that goes with warfarin.

Best wishes,

I'm sorry to hear you are having problems so soon. I hope your appt goes well. If you don't mind my asking, what kind of prcine vale did you get.
I didn't think there were any chances of just aspirin as the anticoagulant in the near futre at least. The only trial I know of that had a just aspirin leg was closed. there IS an aspirin and plavix leg in the current trials, but I don't know if that would save much cost, since Plavix is much more expensive than coumadin, I don't know how it compares to coumadin plus the cost of testing tho.

 

[Lily]

I had my operation in Jan 2008 and it went very well. 6 months after surgery my cardio informed me that there was a slight tear in the valve however it was nothing to worry about at that point. Last October, he felt it would last me another 10 years without a problem and put me on an annual exam cycle. I asked what symptoms I needed to look out for and was told it would be the same as my aortic stenosis, shortness of breath, light-headedness, etc.

A few days ago I started experiencing these symptoms (so much for the ten year projection). It started to be noticeable after an exercise session which I have been pretty religious with averaging 2x-4x weekly.

Will be headed to the cardio in a few days. Needless to say, I'm not looking forward to this but after living in denial for a couple of days it finally hit me that ignoring it wasn't the best solution. I'm without insurance (have been for 10 years) so round two so soon was not in my immediate financial plans.

If you or others you know have experienced this, I have a few questions.

Has anyone experienced minimally invasive repair of such a condition?

If minimally invasive is not an option, I am considering replacing the valve (porcine) with an on-x. I went the porcine originally to avoid the hassle of warfarin but now that my second surgery is more likely to be sooner than later, I do not want to have to go through #3.

I'm very sorry to hear this. What test did he administer that he could see the tear? Or how did he discover it? What clued him in? Do you mind saying what type of valve you received? I recall hearing about another porcine tissue valve that had a tear. My Mosaic valve is now considered "abnormal," as per an echo, though I don't know in what way it is abnormal. I guess I'm going to have to be more proactive and ask my cardio more questions about it. Dan, I hope things go well for you. I don't look forward to another surgery either, nor would anyone, not even a first surgery, except it has to be done for survival. Best wishes

 

[dan777]

Thanks everyone. The valve was an Edwards Life Sciences porcine valve. The cardio was aware of the tear a few days after surgery detected either by the xrays or echos they performed. I did not ask how he knew. The only monitoring I have had done since was regular echos.

Maybe I don't understand the plumbing involved by I'm trying to figure out why my pulse isn't elevated. You would think it would be higher than normal to compensate for the reduced blood flow due to the leakage but its still consistently around 64.

Will let you all know what the cardio has to say in a few days.

Thanks again for all your support !

 

[nngbwh]

Sorry to hear this. Hopes everything works out. Keep up posted

 

[dan777]

I did my usual put things off act but today I nearly fainted standing in a grocery store. Really weird sensation which I had only experienced once before, when a well meaning but poorly informed GP prescribed atenolol for me.

That was enough to push me to see my cardio. Did a blood test, xray and echo and will get the results tomorrow since he had to leave before the test results were back.

 

[Lily]

Good that you went. Keep us posted?

 

[Eva]

So sorry to hear this, Dan. Keep us posted and I wish you a much better luck and full scuccess.

 

[dan777]

Got the test results back from the Cardio and all were OK, meaning no negative progression on the tear or the valve's performance since the last echo in October 2009, and no infections...

He told me I should slowly resume exercise and see how things go. They will run more tests if anything does develop.

Have never been one to imagine a problem, but in this case I am MORE than happy to assume that after a bit of over exercise and "normal" chest tightness, my fears took over. That's my story and I'm sticking to it !

Thanks again to everyone for your support !!!

 

[dtread]

I would just like to clarify the (mis)statement made by Tobagoto:

"I would also consider the On-X. With it, you may be able to use aspirin as your anticoagulant, which would be much less expensive than the monitoring that goes with warfarin."

On-X has an ongoing Clinical Trial for reduced anticoagulation, that if successful, would allow for the use of Plavix versus Warfarin. The trial does not have as one of its arms an "aspirin only" regimen. The Clinical Trial is expected to be complete around 2015. Regarding the cost of monitoring, my health plan (Kaiser Permanente) allows for blood tests for INR level at no charge. Or get a home monitoring kit and do it yourself, which in my opinion is an even better option. There is not any mechanical valve on the market today that allows for "aspirin only" for anticoagulant.

 

[Guest]

Got the test results back from the Cardio and all were OK, meaning no negative progression on the tear or the valve's performance since the last echo in October 2009, and no infections...

That's wonderful news.

He told me I should slowly resume exercise and see how things go. They will run more tests if anything does develop.

Have never been one to imagine a problem, but in this case I am MORE than happy to assume that after a bit of over exercise and "normal" chest tightness, my fears took over. That's my story and I'm sticking to it !

Thanks again to everyone for your support !!!

Start back slow, if anything comes up call your cardio. Good luck!