Wrong size tissue valve replaced

[iren_999]

I had my tissue valve replaced more than a year ago and I am having symptoms like sweating tired after walking and minor chest pains.

I went in for another echo (different doctor) and it has been revealed that my other surgeon put in a wrong size (21mm) tissue valve.

I am flying back to Europe where I had this done in about 2 weeks from now.

How life threatening this is?

They said that my valve is even more steno tickets than before.

Have anyone had a wrong size valve put in?

They may perform a TAVR on me this time.

 

[honeybunny]

Look up recent posts by Paleowoman who is dealing with this issue.

 

[Paleowoman]

Hi Iren - I would have replied sooner but looking back at your posts and the location where you live I am very confused. You live in the US but you had your surgery in Europe ? You saw a doctor before in the US who was going to do a TEE at the hospital where you had surgery ? How is that possible ? Please give more information. I was given a 19mm valve and that is too small for me as I am not petite - the valve is selected by the surgeon when the heart is open when they can measure the annulus - the size of the annulus is not always an appropriate size for a replacement valve which is always smaller than a native valve in which case a root enlargment should have been done at the time. I'm definitley not seeing the surgeon who did my aortic valve replacement - I have been referred to another one who I am advised will do a lot of other tests including transoesophageal echo to work out how much the aortic root can be enlarged to put in new larger valve. Of course they may find something instrinsically wrong with the replacement valve too.

 

[iren_999]

All I need to know if this life threatening or not until I get another procedure done.
That's all.

Thank you

 

[pellicle]

All I need to know if this life threatening or not until I get another procedure done.
That's all.

No, I don't believe so ... as I understand it you just need another OHS (which is a #1 downer if you ask me) to get you the right size valve. Of course you can't go on without the OHS as as it is it will shorten your life. But in the mean time I don't feel its life threatening (based on what you've written)

I would be discussing these points with your team.

also (I was going to reply earlier but didn't) I would be cautious of any TAVI because it results in making the valve even smaller. So that would mean that your already undersized valve will be marginally smaller after the TAVI. Again, discuss this with your team. But I'm pretty sure that's the way it is.

Take care and I hope they get it sorted soon.

Best Wishes

 

[Paleowoman]

also (I was going to reply earlier but didn't) I would be cautious of any TAVI because it results in making the valve even smaller. So that would mean that your already undersized valve will be marginally smaller after the TAVI. Again, discuss this with your team. But I'm pretty sure that's the way it is.

Absolutley right, that is the way it is. TAVI within prosthetic valves, that is "valve in valve" cannot work at all with a prosthetic valve that is too small to begin with. In fact, from what I understand, TAVI cannot be done with a prothestic valve less than 23mm. And how many TAVI valve in valves have been done already anyway ? The whole technique of TAVI is really quite new, and the idea of it inserted within prosthetic valves is even newer !

My understanding from both a top cardiac surgeon I have been in touch with and from my cardiologist, is that in the situation where a prosthetic valve turns out to be too small for the patient, that is "patient prosthesis mismatch", then in re-operation, the prosthetic valve has to be exised (taken out) and a root enlargement has to be done so that a larger valve can be implanted. Sounds easy ? Not !

 

[Paleowoman]

All I need to know if this life threatening or not until I get another procedure done.
That's all.

Thank you

What is your current peak and mean pressure gradients, and how much has it risen since you had surgery ? And what is the current valve size area ?

 

[iren_999]

Update. Sorry for the delay in my response.

So, I went back to the US for a second opinion, and there, the doctors said that my surgeon who got my valve replaced with, in Europe, that he did put in a smaller valve...So I am back in Europe now. So, finally, I went to all other cardio doctors here and they can hear a significant murmur, in addition, to my ongoing mild chest pains especially when walking and I feel dizzy at times. So this one cardiologist (who supposedly) is one the best in the country, told me that I needed another surgery... He also said that I do indeed have a murmur and the reason for this is the smaller valve that was put in place. This cardiologist referred me to one of his best surgeon, and now I am waiting for him to call me. Surgeon is different from my original surgery. I showed all the paper work results from my last echo that I had in the States, and he automatically told me that I need to have a second operation soon.

My little background here. I am from the US, but I needed to do my procedure here in my home country because I am retired, and I cannot afford to have my surgery here in the USA...I don't get that much a month from my Social Security benefits...And all my money from my savings would be GONE!!!

There is no set date yet, and I am afraid. Really scared.

I can do shopping and a bit of chores around the house most of the time without any of these issues.
But there is something wrong that I even know that its there. I feel like that I am more tired and just want to lay down earlier in the evening.

How many of you here has had another procedure?

Just because I really need some reassurance.

Thank you

 

[Paleowoman]

Hi Iren - since you were last here I have seen a cardiac surgeon at the Royal Brompton Hospital, London, and have had various tests to see exactly what is going on with my 19mm aortic valve - pressure gradient increasing rapidly to 59 mmHg peak only three years after aortic valve replacement, valve area size 1cm2, and also an element of left ventricular hypertrophy (very loud murmur too). The upshot at consultation two weeks ago with the cardiac surgeon is that the valve I got three years ago is "small" and that the only solution would be an aortic root replacement so that a bigger valve can be implanted, but that "the risks involved are not justified at this stage". I have to find out more but it would seem that I wait until the risks of not doing surgery outweigh the risks of doing it. Root replacement is complicated, and more so when it's part of a 'redo' surgery. I'm relieved I'm not having to have this kind of redo surgery right now - I know I'll have to have it done at some point though, haven't found out the prognosis of when that might be.

I'm actually pretty annoyed that the surgeon who did my AVR three years ago didn't do a root enlargement or replacement then as I think it might have been obvious that the replacement valve she chose was small !

 

[jwinter]

Hello and welcome back. I had a porcine valve originally and after 4 1/2 years it was stenosed. The tests showed my first valve was too small also.. Ugg Last November I had second surgery and got an On-x mechanical. It was no picnic either time but am glad I got the second one put in as quickly as possible. That waiting room is NOT for me. I am doing well now and so will you.

Stay in close touch with your cardio and surgeon and keep asking those questions. Knowledge builds confidence.

My first surgery was in Las Vegas and second at Mayo, Rochester, MN. I am 61 so not on Medicare or SS yet. I have insurance that we pay 2,000.00 per month with a 6,500 deductible. Stinks but you wouldn't even believe the bills if I told you. Won't Medicare pay or pay part for yours? Regardless........you can't put a price on life.

Best of luck and will continue to follow your posts.