"there is really no good solution" :confused: help!

[Beha]

well the solution presented it. my surgeon has decided after reviewing all of my test results that he will only be replacing the pulmonary valve- not the aortic valve (unless things look a lot worse than he is expecting when he gets in there- which is unlikely)

 

[Ross]

No to distract from Beha's original thread, but wanted to answer sparklette77 about her question:
"one thing i didn't understand in this thread is why an employer would have an issue with someone's personal use of coumadin for their heart? why would any employer have any kind of say in this issue? I think i am missing something. "

Alcapshaw hit on it, I'm in law enforcement, and you really can not be a police officer while on coumadin. It's not so much the employer, as the profession. Almost (and I say almost, because I'm sure there is a few out there) all doctors would not give a person the ok to go back on active duty.

Nick

Dear Nick, while this may be your departments policy, it is NOT THE POLICY in general. There is no reason on earth that you cannot go back on active duty while on Coumadin. The all star policy makers are not living in the here and now. They suspect that should you cut yourself crossing a fence, you'll bleed to death, which is utter nonsense. Lets say you get stabbed while trying to disarm someone with a knife. Well guess what, Coumadin or not, your in serious trouble. People have to get over this thing that Coumadin makes your blood run like water. It is not the truth. You bleed a tiny bit longer and I'm taking seconds, not minutes. A normal persons blood starts to clot in 10 to 12 seconds. Someone on Coumadin 20 to 30 seconds. Stopping the bleeding is the same regardless of which person you are. Direct pressure. Now if your stabbed, your going to need surgical intervention, possbily blood, which is automatically going to knock your INR down to nothing or they'll give you plasma or they'll do what they have to do to save your life at that time, Coumadin or not.

Just so you know, I'm not attacking you or your post. It's just plain BS that some departments choose to enact this policy on otherwise great officers.

 

[Dina]

well the solution presented it. my surgeon has decided after reviewing all of my test results that he will only be replacing the pulmonary valve- not the aortic valve (unless things look a lot worse than he is expecting when he gets in there- which is unlikely)

This is good news,as long as you aren't having symptoms from the aortic
valve(not sure if you are symptomatic at all?).If you are It could be that
once the pulmonary is replaced the problems in the aorta may be lessened
as any abnormality can effect any weaker areas in the heart-I'm sure.
I wish you the best-Dina

 

[Bryan B]

Beha,

If I were in your shoes and decided to go with a mechanical valve for my aortic valve I would still get a tissue valve for my pulmonary valve. First of all you said your surgeon gave you an estimated valve life of 15-30 years for a tissue valve in the pulmonary position. There is no guarantee that you will not need to have the mechanical valve replaced in that 15-30 year time frame. I have a lot of confidence that pulmonary valves will be the first valves to be routinely replaced via catheter in the not so distant future since the pulmonary valve is positioned on the outside of the heart and much more accessible. If you do get a mechanical valve in the pulmonary position, more than likely they would not be able to replace it via catheter if you needed it replaced. Lastly...with a mechanical valve in the pulmonary position you will need to maintain a higher INR to prevent clots forming since it is a valve in which blood is flowing through it under low pressure. If reducing the amount of OHS is more important to you than having children I would go with a mechanical aortic valve and a tissue pulmonary valve. If you get a tissue pulmonary valve and it lasts you 15 years or more I am pretty confident that if/when it's time to replace it the standard method of replacing it will be via catheter. BUT...I'm just giving you my opinion on what I would do, but it is something you can bring up with your surgeon and get his opinion on whether or not he thinks that the technology of replacing pulmonary valves via catheter will be the standard procedure by the time you may need yours replaced.

I don't see it as a "I'll be on Coumadin anyway" scenario. I see it as a "I'll have to maintain a higher INR level and probably won't be a candidate for catheter replacement of the pulmonary valve in the future if the pulmonary valve is mechanical.

I had a Ross Procedure and I have a homograft valve in the pulmonary position. From all the data I have been able to research the homograft valve should last 20-25 years if there are no unexpected complications. I've gone nearly 5 years on it already and so far so good.

 

[Bryan B]

well the solution presented it. my surgeon has decided after reviewing all of my test results that he will only be replacing the pulmonary valve- not the aortic valve (unless things look a lot worse than he is expecting when he gets in there- which is unlikely)

I guess I should have read this post before I just made that long post.

But if he gets in there and decides he DOES have to replace the aortic valve you still need to decide before the surgery what type of aortic valve and pulmonary valve you want him to use. I say this because there have been several members here who came out of surgery with a different valve than expected because the surgeon discovered the "unlikely scenario". So I hope my thoughts on the matter will give you food for thought and questions to ask your surgeon. My surgeon said I was a perfect candidate for the Ross Procedure but I still had to let him know what kind of aortic valve I wanted him to use if he got in there and decided that the Ross Procedure was not a viable option.

 

[lbecker]

Have you looked at the Ross procedure? Where they use your pulmonary
valve in the Aortic place and use homograft in the pulmonary position?

 

[Lynlw]

Have you looked at the Ross procedure? Where they use your pulmonary
valve in the Aortic place and use homograft in the pulmonary position?

She needs a Pulm valve

 

[Beha]

yea= I don't have a pulmonary valve to put in the aortic position! So we (me + surgeon) have decided to go with the tissue pulmonary valve (he did say if i really wanted mechanical he would do it but advised against it (and I dont want it)) and if he needs to replace the aortic I will go mechanical for that- I just might end up a Hybrid!