Zipper2 Update #2

[Freddie]

Just got off the phone with Zipper. Here's what she told me:

- Not coming home until Monday, had angiogram yesterday (Friday), cordinary arteries are clear.
- Surgery towards the the of October.
- Staff and Doctor's "are supper"
- Had a TEE done, but doesn't know the results yet.

Zipper has some concerns and asked me to post them to you to get feed back. As she is really not sure what she she do.

from Zipper
Doctor McAuther (supper Doctor) said that her aortic valve that was replaced 16 years ago with a 21mm carbomedics valve looks really good, that "the surgeon who did it, did a very good job and it should last you another 35 years. Planning on replacing the mitral valve with a
St. Judes that would be 29 or 30mm."

Question:
Is it smart or safe to have one small and one large valve, or is it better to have both valves the same size?

Of course no one wants to go through OHS again 2 or 5 years later and Zipper feels that both valves should be replaced since he's in there and doesn't want to take the chance on having a re-op. She asking for everyone's opinion on this.

The doc also warned her that doing both would be very hard on her - long surgery.
Also; can a St. Judes be placed in the mitral position?

I'll be phoning her with your responses. She'll be seeing the doc throughout the weekend and on Monday.

She's in good spirits, but is stressing out a bit about the two valve sizes. Hope someone could help her out.

Thanks

 

[Bina]

Good, coronary arteries are clear, and she likes her super doctors. Great start.
St. Judes makes aortic and mitral valves. Your mitral is bigger than your aortic valve.
The surgeon will decide once she is open which one fits better.

I know someone who has a double valve replacement, when he went in for a minor mitral valve sewing repair, they left the aortic alone as it "was working perfectly".
They won't risk messing with a good valve job.
All sounds good for Zipper.

 

[Freddie]

I'm refreshing this post as Zipper would like to hear more opinions if she should have 16 year old valve replaced or not.
I'll be phoning her later today.

Thanks Bina for response.

 

[Ross]

If there is nothing wrong with the valve, heck no. Why buy into possible extra trouble if there is no need too? The less cutting on the heart that has to be done is all the more in her favor. The rest is as Bina has said.

 

[Jkm7]

I have no expertise to advise about valve decisions such as this but please send Zipper my best wishes. She has been on my mind.

 

[marie]

Gosh I didn't answer but I really don't know but if it was me I'm not sure I'd replace something that's working. I haven't any knowledge on this however only a gut feeling.

 

[Leah]

Importance of getting medical advice from medical folks

Importance of getting medical advice from medical folks

First of all, I wish her the best. By this note, I'm sending her warm good wishes. I know, from my own experience, how important it is to feel comfortable that you're getting the best possible care and making the best possible decisions.

But/and - please, please, please convey to her that the people on this site, all of us (with one or two exceptions) are lay people who are "qualified" to provide support, swap experiences, and help formulate questions that she can ask her doctors. We're not qualified to provide medical advice. She needs to feel she can get the necessary information from her doctors. If she has concerns, she needs to ask the docs more questions. For example, if she's worried that leaving the old St. Jude in place creates a greater risk of another surgery, she needs to ask the docs whether that is or is not the case and what the trade-offs are. But the bottom line is that the docs went to medical school and spent years in surgical residencies, and we did not.

I'm sorry to get on a soap box about this - it's the one thing I worry about concerning this site: As people here come to trust one another for emotional support and feedback on the personal and practical aspects of going through valve replacement, some of us sometimes end up asking one another for medical opinions when we really, really need to be talking to the medical folks.

In the spirit of support, here's the question for Zipper2 to ask her docs: I want to make sure that I don't go through another surgery in the future if I can avoid it. Would replacing my old mechanical valve right now help me avoid future surgery? Why or why not? What are the added risks of replacing the valve now? What are the added risks of needing another valve replacement later if we don't replace it now?

Leah

 

[pamela]

I think the major concern was the diameter of the valve annuli and not whether the AV prosthesis will really fail. I think Deb needs to be assured by the surgeons that her measurements will be in the normal range.

Ask the docs what the average valve diameters are in both the aortic and the mitral positions, Deb. Don't beat around the bush, simply state the question and let them know you're worried about that ratio. We hear that bigger is badder so often with our heart problems that hearing a difference of nearly 1/3 of an inch can be a little scary. So, ask.

 

[Bina]

First of all, I wish her the best. By this note, I'm sending her warm good wishes. I know, from my own experience, how important it is to feel comfortable that you're getting the best possible care and making the best possible decisions.

But/and - please, please, please convey to her that the people on this site, all of us (with one or two exceptions) are lay people who are "qualified" to provide support, swap experiences, and help formulate questions that she can ask her doctors. We're not qualified to provide medical advice. She needs to feel she can get the necessary information from her doctors. If she has concerns, she needs to ask the docs more questions. For example, if she's worried that leaving the old St. Jude in place creates a greater risk of another surgery, she needs to ask the docs whether that is or is not the case and what the trade-offs are. But the bottom line is that the docs went to medical school and spent years in surgical residencies, and we did not.

I'm sorry to get on a soap box about this - it's the one thing I worry about concerning this site: As people here come to trust one another for emotional support and feedback on the personal and practical aspects of going through valve replacement, some of us sometimes end up asking one another for medical opinions when we really, really need to be talking to the medical folks.

In the spirit of support, here's the question for Zipper2 to ask her docs: I want to make sure that I don't go through another surgery in the future if I can avoid it. Would replacing my old mechanical valve right now help me avoid future surgery? Why or why not? What are the added risks of replacing the valve now? What are the added risks of needing another valve replacement later if we don't replace it now?

Leah

Leah, nobody on this thread is "offering medical advice".
If you have a comment concerning the site, then you may wish to take it to a new thread or to the administrators.

 

[SHEEPDOG]

Good questions!

Good questions!

I wouldn't want another surg if I could avoid it. Just want to echo the above questions that NEED to be asked.

Bina, I don't think Leah was having a problem with the site. Just stating an opinion. That is what we do here and we all should know that that is ALL we are doing. An HYPOTHESIS is an EDUCATED OPINION.

Sorry, I know this isn't the place.

 

[Ross]

Zipper has some concerns and asked me to post them to you to get feed back. As she is really not sure what she she do.

Leah I agree to a point, but this is what zipper2 wanted. I'm sure if she wanted the Docs advice, which I'm sure she's gotten, she wouldn't want to hear it from us. You are correct though, none of us medical experts. All of our experiences combined make us the way we are. I think we can all agree that we've run across a physician at least once in our lives that shouldn't be practicing medicine, so the idea of getting opinions of other people is wise, or at least I think it is.

Bina be nice to your sister. Don't make me take the sandbox shovel away from you.

 

[Freddie]

I did talk to Zipper this afternoon. She is much more at peace of leaving the 16 year old valve alone after a long conversation with the surgeon today.

They are still trying to get her INR up. It was 2.1 this morning (Sunday) but won't let go home unless its 2.5 or better, so keep your fingers crossed.
She also appreciated members opinions/replies - I read them to her and she had already asked the questions Pamela and Leah asked.

As we talked, she sounded more confident than yesterday and feels more assured about everything.
Her spirits and attitude are Fantastic.

 

[Duff Man]

ok here's my opinion and the standard disclaimer applies "i'm not a doctor etc etc"

I've never read anything about a difference in annulus size between the mitral and aortic valves being an issue with replacement. It seems like logic would dictate that the annulus size of the mitral valve as determined by the surgeon is what size the new prosthetic mitral valve should be, is it not? Seems like it would be a bad idea to have the valve be too small for the mitral annulus.

 

[pamela]

True enouh Aaron, but is the mitral annulus "normally" larger than the aortic one?

 

[Lisa in Katy]

The mitral valve is normally larger that the aortic valve, so it would actually be abnormal for them to be the same size.

As to removing a functioning valve, I wouldn't do it. It seems to me that removal and replacement would cause more scar tissue to form, which is often what causes the valve to fail.

 

[pamela]

The mitral valve is normally larger that the aortic valve, so it would actually be abnormal for them to be the same size.

As to removing a functioning valve, I wouldn't do it. It seems to me that removal and replacement would cause more scar tissue to form, which is often what causes the valve to fail.

Thanks Lisa, I was wondering and had vaguely remembered something to that effect, I just couldn't find a reference to confirm it.

 

[CThrock]

Glad to hear Zipper2 is doing good. As we all know it takes a while to get the INR back in range.
She'll have alot to think about sure she has alot of questions. So keeping her in my prayers.

 

[Superbob]

Certainly adding my best thoughts and prayers for zipper2. Hope she continues to do well and to get the guidance and answers she needs.

 

[Leah]

Leah, nobody on this thread is "offering medical advice".
If you have a comment concerning the site, then you may wish to take it to a new thread or to the administrators.

Hello Bina. I very much agree with you and it sounds as if clarification of what I said may be in order. The concern I was trying to express is that sometimes we can slide into asking one another for advice that in reality only a medical person can provide. I do think this is a pitfall of participating on a site that draws knowledgeable, helpful lay people. That's all I was saying.

I wasn't in any way suggesting that folks here hold themselves out as providing medical advice. I was trying to provide support to Zipper2 by framing a question that I thought might be useful to ask the medical folks (sounds like she already has) and by emphasizing that I felt this was the best way of getting the info she needed. This was a direct response to Zipper2's question, not a criticism of, or commentary on, this site. I am unwilling to enter into any cross-fire and will "take my ball and bat elsewhere" if forced to do so. OK? ;>) (hee hee).

All the best to you, and thanks for all the information you provide, Bina.
Leah