Test valve during surgery?

[aniper]

Can anyone tell me how the doctors can tell, during surgery, about the condition of the valves? My dad's surgeon mentioned that if the valve showed only mild regurgitation, then he would not replace it. This concerns us because the heart valve is the problem we've been watching over the last 10 years. In December, the aortic aneurysm was diagnosed and at that point took priority in my research. Probably the valve (and high bp) caused the aneurysm (although they don't think it's bicuspid). The current MRI done at Cedars Sinai showed only mild regurg., but the December echo showed moderate to severe. Dr. said that final decision would be made during surgery. We just want everything done at once. I think the doc was referring to the TEE test, but is there another test they do that is even more conclusive during surgery? Dad's fatigue has been just awful the last 1 1/2 years. My mom is distressing about this so much! She wants an absolute commitment from the doctor that he will change the valve during this one and only surgery.

Thanks for your input!

Anita

 

[Nancy]

I believe it's pretty standard procedure to do TEEs throughout surgery not only to determine the condition of the native valves, but to assess the function of the heart itself and any work that is done during surgery. It's important to gauge the pressures of the working heart to make sure all is well before closing. The TEE is an excellent measure of all of these things. They will take a careful look around during surgery for other conditions that need immediate fixing. It is also possible to find another valve not completely up to par, but not in need of surgery at that time. It all depends what they find when they get in there.

It is also possible for a valve to be not functioning well because there are other things wrong with the heart, and once those things are repaired, the valve improves.

You will have to trust that your surgeon with all of his training and experience and intelligence will do whatever is prudent to do at this time. Heart surgeons are extremely careful individuals. I'm not sure that you would be able to dictate to the surgeon to do something that he shouldn't be doing. There are protocols for replacing or repairing valves and other things. I'm also sure the surgeon will assess your dad's medical conditions very carefully before he goes on to other areas of the heart and will take care of what is safe to fix and needs to be taken care of right now.

All of the testing that is done ahead of time cannot show everything that's going on, that's why there is some leeway for what has to be done during surgery.

 

[Tom F.]

Your dad's situation sounds like mine before my surgery. I had an aneurysm of the ascending aorta. As the aorta increased in size the valve itself expanded. As that happend the valve no longer functions and regurgitation is the result. With me they went in and replaced the aortic tissue with dacron. The valve tissue itself was normal. With the dacron in place and sized to fit the aortic valve, the aortic valve would now function properly. So in my case they were able to spar the aortic valve. Go on Google and do a search for "valve sparing" and you will get a lot of hits about this type of surgery.

The aneurysm was likely caused by the high BP, possibly combined with a simple weakness of the tissue itself. It is possible that this was the problem all along, and a growing aneurysm over the years was the cause of the regurgitation. Its is unlikely that anything having to do with the valve would be the root cause of the aneurysm.

I was told that keeping my native aortic valve was much better than having a replacement, of any type. I know at Cedars they have a very active value repair surgical practice. I would suggest that your mom reconsider the idea of requiring that the valve be replaced if the docs can save it.

 

[aniper]

Thank you for your thought filled advise. You both make sense to me. I know that this situation has my logical mind doing flip-flops. It's good to hear advise from people who have been here b4.

Anita

 

[suz]

Hi Anita,

Just popped in and noticed your thread. I just wanted to add that when your Dad has his work up the day prior to the day of the surgery, they do get alot of good info which seems to be more exact. In the blur of surgery and now recovery, I frankly don't recall exactly what they had suspected during his last work up but on the day before, they found that his valve did have significant obstruction. While the doc had thought that a pig valve would be the way to go, he had said that he would have to wait until the surgery itself to decide whether to go that way or bovine. He thought that since my Dad seemed smaller, he's 5'10, that pig would be best but during surgery it was decided to go bovine. It seems that when it comes to heart surgery, many decisions are made once the doc sees what he is actually working with. Cedar Sinai has some fine docs, and at some point, it seems you just have to put your faith in their experience and knowledge. I hope that your mom can come to this conclusion.

best,
suz