Debora - Mitral
Debora - Mitral
You're young, and that decreases the life of tissue valves, especially earlier generations of them. If you also had this valve when you were pregnant, that would further decrease its lifespan, as changes during pregnancy temporarily degrade even an original mitral valve's functioning.
The cheap tour on mitral stenosis, as I understand it:
Mitral stenosis occurs when the mitral valve thickens, due to illness-created injury or congenital issues, and the opening that the blood passes through becomes progressively smaller, and the valve progressively less flexible.
In some cases, balloon valvuloplasty can be used to widen the opening. While there is frequently a tradeoff with regurgitation when that method is used, about 90% of people who have successful BV have a fix that lasts at least ten years. On a replaced valve, BV is an unlikely option.
Replacements can be either tissue or mechanical. In appearance, they seem to be made more like an aortic valve than a native mitral valve. Issues regarding what type of valve to choose are similar to those involved in choosing an aortic valve. In your case, having had multiple surgeries and your desired number of children, you may well lean toward the mechanical option, in hopes of permanency.
The basic issue with mitral stenosis is that it makes the heart work harder to get enough blood through the heart for the body to use. This puts pressure on the heart muscle, usually causing enlargement, and on all of the other valves in the system, which can begin to cause calcification, stenosis, or regurgitation (leakage) in the rest of the otherwise healthy valves. It can even lead to failure of that side of the heart.
When mitral stenosis becomes severe enough, possible resultant issues like thrombosis (blood clots) or atrial fibrillation become considerations. At some point before it becomes this severe, some form of anticoagulant therapy is usually introduced, anything from aspirin to Coumadin.
The normal area of the mitral valve orifice is 4-6 cm. Yours is about 3 cm. The pressure gradient is how much pressure or force is required to push the proper amount of blood through the valve in a single heartbeat. Results for this include a max (peak) pressure and an average pressure.
When a mitral valve is to be replaced (as yours is), it is usually deemed critical at about 1.4 cm, or with a maximum pressure gradient greater than 60 mmHG (millimeters of mercury - a measurement based on how high a column of mercury the pressure would create). If you showed other symptoms, such as shortness of breath (SOB) or atrial fibrillation (Afib), the critical pressure point might be set at 50mmHG.
Usually, the pressure doesn't really start to rise until your valve opening is down to 2 cm. At 1 cm, the pressure is generally around 25 mmHG, and by the time you would hit .5 cm, surgery will likely have already been performed.
Of course, you know that I am neither a doctor nor an expert. This is only my understanding of what I have read, and it contains generalizations. Note: Anyone spotting errors or omissions please step in. I am always open to learning more about all valve issues, and would be very unhappy to have misinformed and not been corrected.
Debora, you realize that certainly, individual heart histories affect the point at which a cardiologist or surgeon will say, "enough!" You have a long, interesting, and somewhat terrifying heart history, so much said here about criticality may be thrown out the window, based on your cardiologist's experienced view of your particular situation.
I don't know how much time you have left on your valve, but generally, valve stenosis progresses more rapidly over time. In other words: the worse it gets, the faster it gets worse. Your cardiologist may be able to make a "time remaining" judgement call, based on the rate at which the valve opening has narrowed over your last few echoes.
I hope yours is moving very slowly.
Best wishes,
