Valve size

[windsurfer]

Is there any relationship between any echo or cath data that would indicate aortic valve size? e.g. aortic root size,... I just had my valve replaced and was surprised that I got only a 21mm valve CE magna 3000 TFX. Could it be that there are different methods of mounting valves and that impacts what size is used? I hope the smaller size won't limit my athletic output ability.
Bob

 

[Mary]

Is there any relationship between any echo or cath data that would indicate aortic valve size? e.g. aortic root size,... I just had my valve replaced and was surprised that I got only a 21mm valve CE magna 3000 TFX. Could it be that there are different methods of mounting valves and that impacts what size is used? I hope the smaller size won't limit my athletic output ability.
Bob

Yep,
There's a relationship between special people and 21 mm CE magna 3000's. I have a 21 and you have a 21, so that proves my point!

Seriously, my surgery report says "we could pass a 21-mmsizer, but the aorta above the area of the annulus was small and it was not possible to close the aorta directly over the valve." I don't know if this has anything to with the size selected or not. Maybe someone else will wander through with more information.

 

[BAV Pt's daughter]

My mom got a 23 CE aortic valve. Her surgeon says that 25 is the most ideal, as it maximizes blood flow through it, but that the 25 is usually too large for most people. He especially wants to use the 25's for athletes, though. He was very happy to have gotten the 23 in for mom. But I also remember looking at and holding a 21mm sample at the pre-op visit, and he commented that he didnt know at that time "what size she would get" but I assume thats just because he needed to see how big of a valve he could fit for her. I gathered that he tries to use the biggest size that would still be appropriate for each individual heart. "the bigger the better"?

 

[JohnnyV_46]

I am 6'4" tall and way about 230...I got a 29mm 3000 TFX. Man, I feel like I got a super charger under the hood....my BAV had restricted flow for quite some time.

 

[Phyllis]

I am 6'4" tall and way about 230...I got a 29mm 3000 TFX. Man, I feel like I got a super charger under the hood....my BAV had restricted flow for quite some time.

Oh, you beat, Dick- he is 6'2" and got a 25 magna 3000 and I was just going to brag because he is so "athletic"!

 

[windsurfer]

longevity and size

longevity and size

I was expecting a 25mm or larger since in the bell curve of people sizes I thought I would be in the middle and not at the smallest end. I'm 5' 10", and 150 - 155lbs when active athletically. Edwards makes sizes 19, 21, 23, 25, 27, 29. I'm wondering if where it is mounted makes the differences e.g. supra-annular or not. See Edwards web sites at: http://www.edwards.com/Products/HeartValves/MagnaBrochurePDF.htm and http://www.edwards.com/Products/HeartValves/MagnaHolderBrochurePDF.htm

Also, what is the impact on longevity all else being equal in terms of calcification rate and stenosis. If next surgery is due at 7mm then perhaps longevity is proportional, so smaller sizes last less e.g. 25 versus 21 lasts 28% longer and 27 versus 21 lasts 43% longer. Formula (25-7)/(21-7) = 1.28, (27-7)/(21-7) = 1.43

Bob

 

[Phyllis]

Bob,
My understanding is that the way the magna valve is mounted, supra-annular, is what makes for the better blood flow. I think the size is totally dependent on your anatomy and has no bearing on recalcification or blood flow. The treatment they give the valve to keep it from calcifying is what hopefully will provide the longevity. Be happy with your 21 mm valve and I hope you and Dick are both here 20-25 years from now with the same valve to prove Edwards right!

 

[Phyllis]

P.S.
I should also state that Dick was quite adamant that he wanted the magna valve which was fairly new at the time he got his. When Dr. Cohn called me in the waiting room, he told me that he got the valve he wanted, but he could have done as well with the regular valve as his opening was quite large.

 

[tobagotwo]

The valve is sized to fit the root and to work within the aorta, which differs for each of us. A 21 is within the normal range.

You were not born an athelete, you became one. Your heart adapted to the workload, but didn't grow a bigger valve for it.

If the valve installed is too large, it will begin to leak (regurgitate or have insufficiency), because it won't have enough room to open and close freely. It will deform as it functions, continue to stress your heart with leakage, and its life span will decrease. We have had people get valves too large, and they have to go back early for resurgery and deal with the leakage until they do.

The things to look for are good remodelling of the heart in the first six months, good aortic pressures in the echoes, and proper movement of the valve cusps. If those fall within the normal range, you have received the right size valve for you.

It ain't the meat: it's the motion.

Best wishes,

 

[windsurfer]

If the valve installed is too large, it will begin to leak

Hi tobagotwo, thank you. I was quite worried last night and had trouble sleeping.
The surgeon said that there was zero gradient across the valve. However, I'm still wondering if it was mounted in the supra-annular position which is what its flow characteristics are designed for. Also I believe you gain one size up in that position. If however it was mounted over the old valve position then, assuming all the old calcium was removed, it is probably one size smaller. Do you know what the consequences are if too small, will there be more turbulence around the edges?
My family tells me that in recovery while still on the breathing tube I needed two units of blood. Don't know if that has anything to do with this but thought I would mention it.
Bob

 

[savysmommy]

Very interesting..
So, if the new valve is too big, it could leak..?? scary.
I have a 22mm edwards ..whatever.. To me, it was noticably larger in the echo. It looked huge! But, I think its probably an ok size for me. Time will tell I guess.

 

[windsurfer]

Magna AVR video

Magna AVR video

Here is a link to a video of a 2005 AVR using the CE Magna 3000 TFX by Dr. Corso at the Washington Heart Center. It discusses how to get the larger size, the importance of calcium debridement in order to use the larger size valve and avoid perivalvular leaks, how to size for supra-annular position while avoiding too large a size from protruding struts.
See http://www.or-live.com/whcenter/1299/

Bob

 

[Phyllis]

Thanks for a great video, Bob. You should place this post in the References section too as I am sure many people will want it as a reference.

 

[windsurfer]

Thanks for a great video, Bob. You should place this post in the References section too as I am sure many people will want it as a reference.

I would be happy to do that but not sure how to do it.
Bob

 

[JohnnyV_46]

Yeah, seems like some of us just have that "Small Valve Syndrome".....lol
I got to see mine a couple weeks ago on the echo....everything was great...Looked so natural the Tech was not sure I had a replacement. She said she was used to seeing mechanical and had never seen a replacement that looked so natural. No leakage....all is well..

 

[Phyllis]

I would be happy to do that but not sure how to do it.
Bob

I did it for you- unfortunately, I didn't know how to do it under your name, but your post is there.

 

[JohnnyV_46]

That is a great video...I love OR-live......Thanks for finding and posting it. I was amazed at what Dr.Corso said their numbers for the choices of Bio over Mechanical even given the patients ages...only 16% choose Mechanical and the doctor seemed to agree with their decisions.

 

[windsurfer]

update on valve size

update on valve size

I learned that a 21mm Magna has an EOA of 1.8 cm2. My body mass I believe is around 1.82m2 (5' 10", 150lbs) so the ratio of the two or EOAI (index) is close to 1.0 so there is no mismatch - need to be above 0.85 I believe. However, I suspect that athletes have better EOAIs. Would love to hear from those athletes on this site - what their EOAIs are.
Bob

 

[bvdr]

The way I understand it is that the EOA (effective orifice area) only applies to non-native valves and it is basically the measurement as it comes out of the box before it is implanted. How it is seated in the heart may affect it by lowering it a little but can not make it larger.

I have a St. Jude mitral valve and my gradients still measure what would correspond to moderate stenosis which doesn't make a lot of sense to me but I think al (or at least most)l implanted valves have some degree of gradient present.

 

[Debrinha GT]

What about mitral valves!??

What about mitral valves!??

I've already had three mitral valve replacements and after having read this thread, I couldn't help wondering where I stand. I've had a "pericardium bovine bioprosthetic cardioprothesis valve umber 29. What's the normal opening for this valve? My last echo result done just over a month ago showed the following:
Biological prothesis with slightly thickened cusps. Sufficient and competent opening. Maximum GRAD=14mmhg, Medium GRAD=06mmhg, valvular area(doppler)=2.00cm2. Increased left atrium. The internal dimensions of my left ventricle are normal.
There's no regurgitation or PH at all either.
Thank you!
Débora
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