valve selection for 'fragile' tissue and damaged heart

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K

kia

My daughter will be undergoing tricuspid and mitral valve repair and/or replacment in the near future. We've just started researching it all and found this great site.

She is 34 now. At 33 she had an aortic dissection, type B descending. Two weeks later her coronary artery dissected and she had an MI. In the following OHS the dissected coronary artery was by-passed and the medical team at George Washington University Hospital saved her life.

The MI did a lot of damage. She went into CHF. Three months after the OHS she was implanted with a bi-ventricular defibrillator which really helped. 7 months after that tests showed that the tip of her heart is ischemic and that the tricuspid and mitral valves are leaking, one of them moderately to severe and the other severely. Only 1 valve had been leaking, moderately, 5 months before that.

One complicating factor is this one: her father's family has an unknown type of connective-tissue disorder that expresses itself in aortic dissections and aneurysms. My daughter's father passed away at 47 from a dissected aorta and a burst aortic aneurysm. His mother and HER brother died of the same thing at 67 and 53 years old, and their father at 55 from the same thing. At least 2 from each generation are currently being affected by this connective-tissue disorder.

The doctors classify her as "fragile", tissue-wise. When valve surgery came up last October the doctor said he did not yet know what type of valve he would use.

The other complication is that, while she is a young person, her now-damaged heart may not last her the rest of her natural life. She could be a cardiac replacement candidate in a few years, if the valve repair-replacement doesn't help. We won't know that for while.

What do you all think are the important qualifying attributes for the different types of valves, given my kidlet's situation? I know this is very generalized, but no fear! I'm just gathering knowledge!

Her next echo will be done in about 3 weeks and should give an indication of the time-frame we need to work within regarding the valve surgery.

Appreciate your feedback, Kia
 
WOW, Iam not sure what to say. I am sure there will be others along to respond to this that might know more. But my gut feeling is that if she is having tissue problems now, they may opt for a tissue valve. Plus with the potential for another surgery only a few years from now they may not want to add anyore medication like blood thinners that are required for mechanical valves, to her allready existing condition. I am no doctor so I cant say. Boy I am nearly speechless!

COME ON GUYS someone here has to know something on this.

Be patient Kia, everyone will here the call for help. We are here for you.

God Bless, my prayers are with you
Jeff
 
Your daughter certainly has a very complicated medical situation. We have at least one member who has posted regarding fragile tissues. I hope your post is read by that member.
 
Very difficult situation

Very difficult situation

The best thing for you to do would be to get all your records together
and send them to the best heart centers for a second opinion. Cleveland Clinic will do this for around $600.00 and you can get the details at their
website.
Yours is a very sad case, but not hopeless. Get the best PROFESSIONAL
advise you can. Let us know how it goes and the best of luck to you and your familly :)
 
RCB hit the nail right on the head. You want the best professional opinion you can get. And the CCF review is one reasonable way to get another opinion.

The thoughts that occur to me (and I am not a medical professional) are that with tissue problems, which she certainly has, they don't want to have to do it twice. That really leans toward mechanical, as long as there is no other health contraindication for warfarin anticoagulation therapy (most times there isn't). And in choosing a model, one aspect that might be particularly useful to her is a "soft-landing" type of valve, which doesn't have as much of a percussive efffect as some of the older valves, and is more sparing of the tissue the valve is sewn into.

The ATS valve claims to have eliminated one of the two common contact points and to viscous-damp the other, which should cause less percussion:
http://www.atsmedical.com/atsmedicalinc.d.html

The On-X valve makes specific claims about its "soft landing closure," which is a different approach to the same objective:
http://www.mcritx.com/valvedesign.htm#stasis

Carbomedics (Sorin Group) is currently offline (some kind of server error), so I can't link anything there right now.

St. Jude valves, while the most widely used, do not mention this issue at all on their website, and describe their newer, top-of-the-line Masters Series valve as being the same basic design they have been using for many years, with only the addition of some suture marks, ability to rotate after sewing in, and greater reflectivity for xray equipment.

Just some thoughts, and some places to look, if you find them helpful. You've been through a frightening time. I hope things start to go better for you both now. It's terrible to have to worry so much for your child, when there's so little you can physically do to help her with this. Thank goodness you're there to support her.

Best wishes,
 
many thanks

many thanks

Thanks, Jeff, Nancy, RCB, and Bob H., for your replies. I will check out the Cleveland Clinic site. And we are getting second opinions. Many, many thanks for your good wishes.

Wishing good health to you all, Kia :)
 

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