When to replace it?

[happyheart]

So, a surgeon says it would be good to do it now. One cardiologist agrees. Another one says: "Don't listen to the surgeon. He's a carpenter. Carpenters pound nails".

The contradictions have left me not feeling so good.

I'm a 55 y.o. otherwise healthy guy who loves long runs, loves the feeling of walking outta the gym after a nice workout (although getting myself to walk 'into" the gym isn't always easy) and generally has enjoyed good health all of his life. Cut off my head and I'd look much younger than my years.

After a lot of nagging by people with better habits, I learned long ago to eat a boring but healthy diet, I gave up my three smokes a day, and while I swore off the martinis I do enjoy Chardonnay now and again (and again).

Last year I finally had an echo to learn more about the murmur that's been fluttering in my chest since my early 20's--and probably before. Oh boy. "Severve regurgitation" in the aortic valve I was told. Leaking mitral too, sucker. You need to replace your two flap valve buddy, some docs said. You wanna do it now?

Ah. Will I drop dead if I wait? Well, it depends on who you talk to.

So far, I've waited. But frankly (and since this is anonymous and I don't have to show my face as a complainer), I ain't been feeling so hot. Maybe the idea of having my nicely defined pecs split by a scalpel is getting me down. Maybe the idea of hearing a tin ticker in my chest is making me blue. Maybe it's the thought of a lifetime downing that rat poison Coumadin.

I used to feel pretty energized. Now I don't feel like running no half-marathons. It's tough to get to the gym. A nap? That sounds good. Although when I wake up, I'll wish I had spent the time doing something that made me sweat. This is a downer.

Which brings me to me my question (and thanks for listening to me whine): Should I just slap myself and do what I can do even if I feel kinda lousy at times? Or, should I let the surgeon pound me?

I can still climb stairs without puffing. And my ticker hasn't enlarged to a dangerous point--yet.

Sooner? Or later?

Thanks for listening.

 

[Ross]

Listen to the surgeon. He wants to fix before damage is done. Cardio's always want to wait and some wait way too long, then the damage is done. If the regurg is severe, the left ventricle is enlarging and your showing symptoms, there is no reason to wait any longer. It would be the perfect time to have it handled.

 

[ALCapshaw2]

Hello Happy,

Click on "Members List" then go to "S",
then find Scott Vant and read his story.

He went for a fit bodybuilder to having significant heart muscle damage in SIX WEEKS which has greatly affected his post-op recovery. It is not yet known if this will be a lifetime limitation or something that will eventually return to normal. Does that sound like something you want to wait around for?

For the record, I am a proponent of early intervention, BEFORE the heart enlarges to the point of PERMANENT IRREVERSIBLE HEART MUSCLE DAMAGE.

Several of our members reported getting to surgery 'just in time'. One's surgeon told him his valve literally "crumbled in his hands". I vote with the SURGEON.

'AL'

 

[d and d]

My hubby?s in a similar situation. He is 46 and very fit, but has a mitral valve with severe regurgitation that has just started to enlarge his heart. No symptoms to speak of. We have been pondering the same question after 2 cardiologists and a surgeon all recommended surgery soon. It is very hard to think about going under the knife and facing a year of recovery when you feel pretty good. He decided to go ahead and do this now, before his heart is permanently enlarged and he has a lifetime of symptoms that cannot be fixed. I agree that none of the options seem very attractive -- it?s depressing. We're trying to focus on a sensible plan to get him back to his normal activities and workouts, and plan some fun things to do next spring and summer when he's healed.

D

 

[epstns]

I think a lot depends upon your individual case, and the medical/surgical opinions you're given. It sounds like you are beginning to have some "clinical" symptoms of the valve deterioration. If that is the case, and the surgeon and cardio agree that it is time, then it is time.

Some of us can wait, with little risk. You may be in the other group.

Just my $.02, though.

 

[tommy]

Happyheart,

The important thing is to get it fixed before permanent damage has been done. Next, decide when you want your quality of life to be improving rather than deteriorating.

The better your fitness going into surgey, the smoother and faster your recovery will be.

I was an overweight, out of shape, sedentary type prior to AVR. I "woke up" to fitness two years after AVR and ran a marathon a year after that. I'll run another in December. For me life began anew after AVR. My story is posted, but not updated for the marathon. We have a bunch of VR runners in here. They have been a huge inspiration to me.

Fear of surgery is natural. Have courage knowing that we have all been through it.

 

[Nancy]

http://valvereplacement.com/forums/showthread.php?t=4618

Here is a post which takes you to guidelines which are used for replacing valves.

My husband has had 3 valve replacements, and there were a couple of times when I wished he had had his surgery sooner rather than later. he was certainly VERY debillitated when he had his third, to the point that I felt and so did he, that he wouldn't make it. His cardiologist wanted to wait until things got worse, his surgeon wanted to operate, Joe broke the tie and insisted that it be done asap. He won, thank God.

 

[Ross]

My hubby?s in a similar situation. He is 46 and very fit, but has a mitral valve with severe regurgitation that has just started to enlarge his heart. No symptoms to speak of. We have been pondering the same question after 2 cardiologists and a surgeon all recommended surgery soon. It is very hard to think about going under the knife and facing a year of recovery when you feel pretty good. He decided to go ahead and do this now, before his heart is permanently enlarged and he has a lifetime of symptoms that cannot be fixed. I agree that none of the options seem very attractive -- it?s depressing. We're trying to focus on a sensible plan to get him back to his normal activities and workouts, and plan some fun things to do next spring and summer when he's healed.

D

None of the options are attractive, but thank God we live in an age where he can be fixed. Not all that long ago, this would have been the end and there wouldn't be any fun next spring and summer, in fact, there may not be any at all.

 

[Karlynn]

3 words - Do it now.

If it's diagnosed as "severe" - it is doing damage. After you get it fixed and have recovered you may find that you were feeling symptoms much before your brain actually realized it. If the deterioration is slow, our bodies fool us by accomodating.

As far as what you replace the valve/valves(?) with, you should have a choice of tissue or mechanical. At 55, you are at a tough age to decided because chances are that with a tissue, you'll live long enough to have to have it replaced at some point. We have avid supporters of both tissue and mechanical in our "little" family here.

I have a St. Jude mechanical and it's been a part of me going on 13 years. Coumadin hasn't been a big issue for me. It's a serious medication that has to be managed, but as far as what you eat, drink and do - it's all about staying consistant.

Are they thinking that your mitral valve needs replacing, repairing, or that it will repair itself once the aortic valve is replaced?

 

[jenny]

I am going with the machanical valve when i have the Maze proceedure done. I am scheduled for this August 18th, the surgeon told me that the mechanical valve lasts forever and the pig valve last about 10 to 12 years. I am on coumadin now, for a fib . This is my second open heart surgery, the last one was in 97. I am scared right now, but if I do not do it I cannot stand the constant feeling of mice running wild in my chest. The sad thing is that I will be on coumadin forever and that is not great for me. Good luck to all that are going through this.. Jenny

 

[Raverlaw]

Recovery from valve surgery usually doesn't take a year. I'm about 51/2 months out and can say that I am fully recovered.

When to have surgery is always open to discussion. If a cardio and surgeon both agree it's needed, I'd tend to go with surgery soon. Once you decide to have the surgery, you can move on to decisions about type of valve, etc. and you will find lots of helpful information here.

Welcome to VR - it's OK to whine here (although we may slap you once in a while to help you get over it ) The important thing is to get yourself informed- and you've found the best site to do that.

 

[d and d]

None of the options are attractive, but thank God we live in an age where he can be fixed. Not all that long ago, this would have been the end and there wouldn't be any fun next spring and summer, in fact, there may not be any at all.

Well said, Ross. Thanks for putting it in perspective.

 

[Babydoll]

I vote for sooner

I vote for sooner

Hey happyheart,
The best thing to do is get it fixed before permanent damage has been done.
If not fix now over time it will only get worse and recovery will take longer. Look at it this way if you have to replace your valve it's better to get it done and over with instead of always wondering how your heart is doing today!
Stacey

 

[ALCapshaw2]

Jenny,

What are your Doctors doing to TREAT your A-Fib?

Coumadin only helps to prevent clots from forming.
It does NOTHING to PREVENT A-FIB.

There are LOTS of options, starting with easily tolerated Beta Blockers (Toprol, Atenalol?) which limit your heart rate to Beta Blockers targeted as anti-arrhythmia medications (Betapace/Sotalol) to some really heavy duty drugs (Amiodarone) with NASTY side effects.

Invasive procedures to cure A-fib include Ablation (RF and Cryogenic) or surgical (Maze Procedure).

Have you seen a cardiologist who specializes in Electro-Physiology? That would be a good place to start.

'AL'

 

[chilihead]

Happy,

I'm 40 and had mine done about 8 months ago. I'm back in the gym but still getting a mental image of my chest opening op like a zip lock bag every time I do much weight ont he bench press! I'd say get it fixed and move on. The longer you wait the more anxiety you will develop.

Good luck,

Jim
Ross procedure 11/18/03

 

[happyheart]

Thanks from Happy Heart

Thanks from Happy Heart

Thank you all for taking the time to share your recommendations. Boy, I've got a lot more homework to do. You've pointed me to a number of resources to check out--and I will--and you've helped me be a much more intelligent patient. It really is fun to ask these docs questions they don't expect from lay persons.

Happily, I'm under care at a VA hospital with a team of doctors with no constraints about ordering costly tests. I also see a cardiologist privately. In the last year I've had like five echos, plus the delightful one with the tube down the throat. I've had numerous EKGs and chest exrays and I've burned up the treadmill test twice so far. So, quite a large group of heart docs (this is a teaching hospital) have checked me out and the consensus is: keep testing and wait to replace the valve until it enlarges to the magic number.

However, based on the terrific stuff I've learned on this site, I'm going to be real critical of the judgements I learn from the docs and I'm getting ready to debate them in Latin.

Thank you all very much.

--Jim

 

[gary48]

Fitness and Heart Problems

Fitness and Heart Problems

I opted for a valve sparing techinique-my running partner chose a mechanical valve-he can still out run me....whatever works...but get it fixed!!!

 

[Rush20]

Just chiming in with the rest of the gang. If you have severe regurgitation, now is the time to fix it. I'm approaching my 1-year "second birthday" on August 29th and I have a lot less anxiety now than I did the 4 weeks prior to the testing and surgery. You'll be happy to get it over with.

Regarding the workouts, I understand as I have been pretty fit my entire life. In fact, my PCP told me that fit people tend to not display the normal symptoms, simply because our hearts have been conditioned for extra stress. (Maybe he was just trying to make me feel better).

Anyway, if it's an option, confirm whether or not you are a candidate for the minimally invasive procedure. I was fortunate to have a surgeon skilled for this type of procedure and now that the chest hair has grown back, you can't even see the 2-inch razor scar.

 

[Susan BAV]

Hey Happy -

My (now former) cardiologist gave me some (pitifully poor) advice regarding my bicuspid valve, which didn't fit with the things my husband and I had researched. I eventually found a well-respected and highly recommended surgeon, who recommended surgery. My husband and I felt like it would be prudent to get another well-respected and highly recommended surgeon's opinion. "Surgery." We felt like a third well-respected and highly recommended opinion wouldn't hurt. "Surgery."

Those opinions, and the angiogram that the third surgeon did, made us realize that surgery was definitely the right thing to do and it was the right time to do it. My (former) cardio's opinion was just dangerous nonsense.

 

[gary48]

Hey

Hey

For what it is worth-Michael Deeb at the University of Michigan performed my surgery (valve sparing) we had it agreed upon to go with the porcine valve (I was 48 at the time) if things didn't work out-he was great-strait forward-by most accounts he is one of the most skilled surgeons in the mid-west. A great listener-