Mitral Valve Stuff
Mitral Valve Stuff
Hi everyone. Thanks for all the replies.
We're back from Cleveland; and it was a fruitful trip!
I was very worried that Jill's heart may have moved into the "intervention" range suggested by the article I linked to above and three others published recently (I have links and copies, if anyone wants to read them). It had been two years since she was seen at Cleveland, and I was on the edge of my seat.
Fortunately, I was able to spend about an hour with Jill's Cleveland Clinic cardiologist, both before and after her stress echo. I can't tell you how grateful I was for that opportunity.
Here's what I learned, for those of you who are tracking mitral problems. Maybe this post will help you ask the right questions...
1. That article represents the most aggressive school of thought when it comes to intervention for mitral valve problems. On a scale of 1 to 10, with a 0 being "We will NOT perform surgery on you," and a 11 being "You MUST have surgery NOW," the article is a "1." Jill's valve specialist in Cleveland (and the Cleveland Clinic generally) is probably a 3. He explained that the studies mentioned (he's familiar with all of them, and knows the author of the article I linked to personally) relate to patients with an average age in their 70's. Younger patients have more resilient hearts. He also stated that the science of treating valves has improved, improving the potential outcome for people having surgery now.
2. If we would elect to move forward with Jill's numbers, we'd be adopting a very "aggressive" approach (a "1" on the scale of "1" to "10,") but not a ridiculously aggressive approach. So what are her numbers? I had a chance to go over her entire chart today, back seven years. Since 1995, her mitral regurgitation has been, at best, moderate to severe, and, at worst, severe (as it is now). Her LVIDd has been stable at ~ 5.2 and her LVIDs has been stable at ~ 3.0. A LVIDd ~ 4.0 is considered worrisome under the very "aggressive" school of thought. She's nowhere near that. Her EF has hovered around 60. Today it was "60-65." An EF below 60 is considered worrisome under the very "aggressive" school of thought. Jill did 15 METS today on the treadmill! Last time, she had done 10. Anything less than 10 is worrisome under the very "aggressive" approach.
3. The odds of a successful valve repair in Jill's case have *risen* since our last two visits (1999-2000)! She has anterior leaflet prolapse, which is (was) tough to fix. We were originally given a 70-80% chance of repair. We were told that estimate is now too low, in light of recent advances in valve repair. The odds are now, *conservatively*, 80-90%, and may be higher depending on what Dr. Cosgrove says in the next few weeks. We were told we can basically make our decision about intervention assuming we'll get a repair. (Gary, this was somewhat vindicating, since the medhelp.org physician provided that low statistic regarding anterior leaflet repair).
4. If repair is impossible, the CCF, Jill would likely receive a Carpentier- Edwards Perimount Mitral Valve, not a mechanical valve. (
http://www.fda.gov/cdrh/pdf/p860057s011.html). We were told that valve (made of bovine tissue) has been an amazing success in the aortic position and has had similar success in Europe in the mitral position. It is now an option (maybe the preferred option at CCF) for young women of *childbearing* age. It would not otherwise be CCF's preferred choice for a 30-year-old.
5. We were told we could have children pre-or post surgery. Our cardiologist has taken twelve women with hearts like Jill's through pregnancies without complications. He said the main risk was an A-Fib episode. He did not believe there was a significant risk of heart failure. He believed the risk of heart-related complications was very low (in the low single digits).
6. He fully supported our choice of Dr. Cosgrove as the surgeon (that's not a surprise). He said Dr. Cosgrove is one of the best 4 options worldwide for mitral valve anterior-leaflet repair. Since it's the closest of the 4 to our home, it's a no-brainer.
7. Jill would have a minimally invasive surgery, with a conversion to the full-monte only if necessary.
In the end, he told us this: The decision to more forward or not was Jill's to make. We are at a "1" on that "1-10" scale, and there was no reason at all to rush forward -- indeed, he probably would recommend waiting if we hadn't told him we were considering "getting it over with." That said, he placed the ball squarely in Jill's lap, and said he'd support whatever decision she'd make. According to him, with her current numbers, she should go in for surgery "when she feels like it," whether that's now, or any time in the coming years before her numbers markedly change for the worse.
We're going to relax for a little bit, go vacation in London, and then have a long talk about babies, sureries, etc. Right now, I believe we've done everything right up to this point. I'm relieved, and pretty proud of us. Five years ago, I didn't even know what a "mitral valve" was.
Again, if any of you want copies of the little "packet" of articles I took to Cleveland, I'd be happy to oblige. Message me here or e-mail me at
[email protected]. Dr. Stewart has read all of them. He considers them valuable, but not dispositive.
