wlaldredge: I 'managed' my aortic and
wlaldredge: I 'managed' my aortic and
mitral valve disease for nearly 50 years after two bouts of rheumatic fever, one at age 6 and the other as a 13 year old.
I had a functionally bicuspid aortic valve for a long time; my mitral still has +2 leak.
Depending on the type of life you wish to live, its 'style', your weight, conditioning, general health otherwise, immune system and a variety of other factors such as your stress levels (or lack of them) , lipid panel, thyroid output, etc., you could go until a 'minor' symptom rears its ugly head, like I did.
For me it was one episode of Congestive heart failure which scared the hell out of me but was in reality no big deal to the medical community. I thought I was going to die because I could not 'catch my breath'.
To the cardiologists it was a signal for more invasive testing including the definitive one, the catheter, which revealed a far more damaged valve under load (exercise and strain) and therefore immediate replacement was recommended.
From onset of CHF to replacement was nine months. In the interim my LV got weaker and more stretched. (It can deteriorate real fast after CHF).
Provided your Ejection fraction is healthy +50%, preferably +55,
your LV is in good shape with little to any hypertrophy and NO other CV problems, you could manage till symptomatic depending on what, as John says, you are willing to relinquish in your activities.
AV will have to be done one day, and the technological advances may make it worthwhile. But the risk is that when you come off the pump and X-clamp you want the strongest LV action you can get on restart. I think if I had stuck to my routine exam each year I might have had my AV replaced WITHOUT symptoms such as CHF in my case and possiblly saved more of my LV output. It will likely never get much shrinkage from its 4.5 cm size now, two years and 4 months post-op.
Preserving LV function to its maximum should be a primary focus.
Postponing the Timing is a bit of a luxury in this somewhat 'elective' environment but it could work to a disadvantage if the fear of surgery overrides the benefits. Those benefits are admittedly hard (but not impossible) to calculate without symptoms. How can you know for certain what they will be since you won't 'feel' much better than you do now?
But an ounce of prevention, etc...... may be the operative motivator.
On the other hand, as one surgeon told me, the Very best surgery, is No surgery.
Trust the best cardiologist you can find to suggest to you when
is the optimum time to get it done.
