Very Confused Valvular Leak Tricuspid Leak

[Blake777]

Hello. I am a member here, Blake777 but haven't posted here in a while, just been reading some posts. I have another crisis come up. I have a ONX mechanical heart valve, TEE shows I have a paravalvular leak. It shows moderate leak of mitral valve and moderate to severe tricuspid valve leak. Have any of you dealed with this? The hospital or medical center that did my surgery and has been there for me over the years is OU Medical Center in OK.

My last cardiologist put in a pace maker because she thought it would stop afib along with some cardioversions as well. Finally they stopped with more medication. Now this. And she is gone back to UK where she come from. Do you think the cardioversions may have caused the leaks? I also was very sick last year, I really think I had the coronavirus, just remember thinking I was going to die, then finally come out of it 3 months later felt better.

I am thinking about going to Heart Hospital here because they do the transcatheter leak closure procedure. I would rather go to an experienced hospital who does these. Would really love to go to Cleavland Clinic but with the coronavirus everywhere I am just scared out of my mind. Any suggestions and have anyone had the paravavular leak closure procedure done? Thanks!

Meant to say also I see surgeon tomorrow, don't know what their answer will be to my problem. But I will be sure to come back and let you know.

 

[Blake777]

Hello. I am a member here, Blake777 but haven't posted here in a while, just been reading some posts. I have another crisis come up. I have a ONX mechanical heart valve, TEE shows I have a paravalvular leak. It shows moderate leak of mitral valve and moderate to severe tricuspid valve leak. Have any of you dealed with this? The hospital or medical center that did my surgery and has been there for me over the years is OU Medical Center in OK.

My last cardiologist put in a pace maker because she thought it would stop afib along with some cardioversions as well. Finally they stopped with more medication. Now this. And she is gone back to UK where she come from. Do you think the cardioversions may have caused the leaks? I also was very sick last year, I really think I had the coronavirus, just remember thinking I was going to die, then finally come out of it 3 months later felt better.

I am thinking about going to Heart Hospital here because they do the transcatheter leak closure procedure. I would rather go to an experienced hospital who does these. Would really love to go to Cleavland Clinic but with the coronavirus everywhere I am just scared out of my mind. Any suggestions and have anyone had the paravavular leak closure procedure done? Thanks!

Meant to say also I see surgeon tomorrow, don't know what their answer will be to my problem. But I will be sure to come back and let you know.

 

[DachsieMom]

I’m sorry to hear this news. About six weeks after my surgery, they thought I had a leak after viewing my post- surgery echo. I recall posting here and looking for resources. There isn’t much available on these issues. My surgeon explained that in my case, it was simply how the valve worked - a type of backwash thst May look like a leak in the echo - and a leak was not possible in the places they described. I have a St Jude aortic mechanical valve conduit (valve connected to Dacron sleeve). Im
Sorry that I don’t have direct experience with what you describe, but I am hoping you find some answers soon.

 

[nobog]

ALL mechanical valves "leak". Manufacturers have specs as to the specific volume measured as leakage rates per pulse or as a % of stroke volume. Parts need clearances to work, thus the leakage - tissue valves should not leak, as their leaflets seal positively every beat.

 

[Blake777]

Had my meeting with the surgeon today. Found out I have a leak on top of ONX valve, where it shouldn't be. He thinks it may have something to do with the pacemaker I had put in last year and one of the leads. Also said they will keep an eye on it and if it gets worse they will consider replacing the lead to somewhere else and considering a perileak closure for mitral valve leak, well he would recommend me to someone who can do it. Also thinks that might slow the tricuspid valve leak. If I have to have surgery to replace tricuspid valve they can do it through catheter too. Said I am a candidate for minimally invasive through side of chest if for any reason I have to have a big surgery because I had a lot of problems my last heart surgery with blood infection and had to stay in hospital for 3 months. They also checked my blood for endocarditis and I think to see if my red blood cells were being destroyed. Turned out not so bad after all, I was sweating bullets thinking I would have to have open heart surgery right away.

 

[pellicle]

Turned out not so bad after all, I was sweating bullets thinking I would have to have open heart surgery right away.

which is why I advocate just waiting till you get more information.

Glad it all turned out not so bad

 

[sylviayasgur]

Hi, My husband, Joey, had his first surgery (RP) in 2001. Shortly thereafter they discovered a moderate leak near his av (from echos). Eventually, they discovered that it was not the valve at all, but it was a fistula. We were told that during surgery there is cutting of tissue, which may have caused it. They watched it for years, no change.
I've also heard that when valves in need of repair/replacement are corrected, often other valves that were previously working fine, can show leakage. I imagine this happens when all parts are now strong and working well, so weaker parts become more noticeable.
Stay well!
Please keep us posted on how things go.

 

[Blake777]

Well now looking at my blood tests online looks like I may have hemolytic anemia (blood cells being destroyed), but still waiting on doctor to call with results. Been so cold lately in this 100 degree heat, anemia may be the cause.

 

[Protimenow]

Sylviayasgur -- your speculation that a good valve can make other parts fail is a solid one.

In plumbing, fixing a leak can cause another leak in a pipe or fitting that can't handle the improved pressure. The adage that 'a chain is only as strong as its weakest link' fits here -- but, for most of us, fortunately, the rest of our cardiac plumbing is usually pretty strong, and able to handle the improved efficiency (and higher internal pressures and improved blood flow) that come with surgical intervention.

 

[Dana]

Hello. I am a member here, Blake777 but haven't posted here in a while, just been reading some posts. I have another crisis come up. I have a ONX mechanical heart valve, TEE shows I have a paravalvular leak. It shows moderate leak of mitral valve and moderate to severe tricuspid valve leak. Have any of you dealed with this? The hospital or medical center that did my surgery and has been there for me over the years is OU Medical Center in OK.

My last cardiologist put in a pace maker because she thought it would stop afib along with some cardioversions as well. Finally they stopped with more medication. Now this. And she is gone back to UK where she come from. Do you think the cardioversions may have caused the leaks? I also was very sick last year, I really think I had the coronavirus, just remember thinking I was going to die, then finally come out of it 3 months later felt better.

I am thinking about going to Heart Hospital here because they do the transcatheter leak closure procedure. I would rather go to an experienced hospital who does these. Would really love to go to Cleavland Clinic but with the coronavirus everywhere I am just scared out of my mind. Any suggestions and have anyone had the paravavular leak closure procedure done? Thanks!

Meant to say also I see surgeon tomorrow, don't know what their answer will be to my problem. But I will be sure to come back and let you know.

Blake777,
This question may not apply because I’m assuming some things – that your pacemaker is pacing your ventricle and because the ventricle can be paced either extrinsically or intrinsically, I’m also assuming intrinsic pacing (where the lead connects to the inside wall of the ventricle as opposed to outside. The question is: How does your pacemaker lead get into your ventricle? My intrinsic lead used to go right through my tricuspid valve and when I questioned my EP about why he would do that since the lead would interfere with the closing of the tricuspid and cause leaks, he said the tricuspid is a low pressure valve and any leak induced by the lead would not be significant and maybe temporary as the lead typically scars over and the leaflets operate around it. That was in 2011. In 2017 I scheduled OHS to replace a stenotic mitral valve and while they’re at it, a new aortic valve and tricuspid valve.

Knowing that he was going to have to disconnect that lead to get a new tricuspid valve in, during the OHS pre-surgery meeting I asked the surgeon about that lead and found he planned to route it the same way, right through my soon-to-be brand new tricuspid. I suggested the following to him: since the valve comes with a circumferential Dacron skirt through which the surgeon stitches the valve in place, before you install it why not punch a small hole in the skirt and run the pacemaker lead through the skirt hole where it won’t interfere with the opening and closing of the leaflets. He couldn’t commit but he agreed to see it if it was feasible during the surgery. Well he told me after that he was able to do it. It seems sensible to me that that procedure would be standard when replacing a tricuspid with a lead running through it.

I don’t know if a surgeon could accomplish this percutaneously after a valve has been placed but it might be possible, if it turns out you do have a lead running through your tricuspid and it’s causing leakage. Worth asking anyway.

 

[Blake777]

Thanks for all the info Dana, sounds like you were smarter than the surgeon and you have been through it all so soon. I don't think the surgeon was saying the tricuspid valve leak was because of the pacer lead location, but rather the other leak that's on top of the mitral valve. I may be looking at tricuspid valve minimally invasive surgery though, I wouldn't think they could re route the the lead doing surgery that way.

 

[Blake777]

Well just got the call that I am hemolytic anemia like I thought. I will have to go to Texas I think is where they will send me. I am so scared because all of this covid-19 stuff and also I might have to do this by myself without my husband, sure they are not letting spouses in the hospitals like here where we live. Also might have to have blood transfusion, I noticed my blood pressure is dropping and forgot to tell my doctor. Having an anxiety attack right about now and I know that is not good. I just hope I can get through this.

 

[tom in MO]

Well just got the call that I am hemolytic anemia like I thought. I will have to go to Texas I think is where they will send me. I am so scared because all of this covid-19 stuff and also I might have to do this by myself without my husband, sure they are not letting spouses in the hospitals like here where we live. Also might have to have blood transfusion, I noticed my blood pressure is dropping and forgot to tell my doctor. Having an anxiety attack right about now and I know that is not good. I just hope I can get through this.

Don't worry, you will get through it. You've been through open heart surgery.

In KC about 10 days ago, the hospital where my future son-in-law was just started letting one visitor/patient/day in the chemo ward filled with immune compromised patients. Ask, you may be surprised, they could let your husband in.