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View Full Version : When did you have your aortic valve replacement?



Braveheart
February 14th, 2009, 06:47 AM
As I have mentioned in the past, I have been diagnosed with aortic stenosis. the area is .96 and the gradient is 31. I don't have any frank symptoms, but I am beginning to realize that I am tiring more than usual, although I am able to walk 4 1/2 miles (but then I have to lie around the rest of the day).

Six months ago, my cardio told me that I had at least three years before I would need an AVR. This did not satisfy me, and when I found that the area went from .99 to .96 in 6 months on the echo, I decided that I wanted to get the whole thing over with.

This week, at my insistance, I am going in for a heart cath., and will have more information.

My question is: Just how stenotic was your valve, before you had it replaced?
Am I "jumping the gun" or am I right in wanting the surgery now, before my heart is damaged? (It is fine, now). If you have had the surgery, were their any neurological complications?

I am 69. The doctor claims that if I wait a few years, chances are that a valve will last for the rest of my life. If I have the operation earlier, I might need another surgery when I am elderly.

As people who have followed my posts can see, I am vaccillating. I want to make sure that I make the right decision.

ChouDoufu
February 14th, 2009, 06:59 AM
how bad do you want it to get, and how much damage are you
willing to accept?

a healthy human valve should have an effective area of 3.0-4.0
(this is square centimeters, not square inches!)

you're down to 0.96, about 1/4 of what you should have.

someone here has a link to treatment standards, i think it was 0.8
that was considered "critical" for aortic valves.

i thought mine was 1.7-2.0 and was ready to replace. but that was
based on erroneous test results! when i got my valve job 5 weeks
ago, they found it was down to 0.6



I am 69. The doctor claims that if I wait a few years, chances are that a valve will last for the rest of my life.

chances? mechanical will outlive you. at 69 a bovine 'could' last
25 years (maybe longer, who knows?).

Braveheart
February 14th, 2009, 07:10 AM
how bad do you want it to get, and how much damage are you
willing to accept?



I am not willing to accept ANY damage. That's the point. I just want to have the procedure, with reasonable certainty, that the "cure won't be worse than the disease".

I think that I am getting a bit nervous now. If the cath shows problems, I am going full speed ahead. I just wanted some feedback from people, to firm up my position.

ChouDoufu
February 14th, 2009, 07:33 AM
echos are not all that accurate, so a change from 0.99 to 0.96 is insignificant.
the same operator using the same equipment on the same day can easily get
numbers with a much wider range. however the fact that your numbers are
consistently that low is significant.

if it were my decision to make all over again? if i were in good health, with a
eva of 0.96, and asymptomatic, i'd opt for replacement asap.

have you had a chance yet for a second opinion on waiting, either from another
cardiologist or preferably from a surgeon?

Braveheart
February 14th, 2009, 07:38 AM
have you had a chance yet for a second opinion on waiting, either from another
cardiologist or preferably from a surgeon?

That is why I am waiting for the cath. At that point, when I have more information, I will be getting a second opinion from another cardio, and scouting out surgeons.

olefin
February 14th, 2009, 09:01 AM
My question is: Just how stenotic was your valve, before you had it replaced?
Am I "jumping the gun" or am I right in wanting the surgery now, before my heart is damaged? (It is fine, now). If you have had the surgery, were their any neurological complications?
I am 69.


Hi Braveheart,

You see my signature but I'll add that I'm now 74. I was diagnosed with aortic stenosis at age 45. I was excellent health. My cardiologist started running yearly echoes. My lifestyle never changed, I jogged 3 miles daily until a year before AVR he recommended I switch to walking.

Three months before AVR he ran an echo and said I was good for another year. Two months later while walking I sped up and started speed walking, really stressing myself. I soon felt faint and unstable so I slowed down. That feeling went away. I wondered then if what I felt was caused from the valve. The next day I tried the same thing but didn't have time to slow down before I blacked out and fell. I came to as soon as I hit the ground. That was a stupid thing and could very well had suffered a heart attack or heart damage.

I went to my cardiologist the next day, he ate me out good for doing what I did and for not calling him immediately after I came to. The echo confirmed valve replacement was needed. He did a heart cath and confirmed I had no other problems other than the valve.

I felt like I was in excellent health, other than a few months before had a severe bleeding duodenal ulcer. I though the valve surgery would be a snap and I wasn't worried about a little valve surgery.

I had AVR a month later. I had major complications. I was in the hospital fro 20 days and needed 21 pints of blood. Very sick for the first two weeks after getting home. Had I not been 55 and in excellent health before surgery I probably wouldn't have made it. That month I was the sickest I had been in my lifetime.

After 6 months I was almost back to normal. No neurological problems. Never been depressed other than while in the hospital. One thing that did change from the surgery, I became more sentimental or emotional.

Any surgery can be dangerous but the most are quite routine as you can read on this forum. I was one of the few that wasn't so lucky. Some are much worse, they are in the cemetery.

If I was you and tired after walking 4.5 miles a day, I would cut back to 3 miles. Get another opinion if your not satisfied with your cardiologist.

Best of luck to you.

Nupur
February 14th, 2009, 09:57 AM
Wait, Dayton, here is a question. You can't actually have a heart attack due to the valve, can you? I have been told by the cardio that unless my arteries are clogged, I am at no risk for heart attack from my mitral regurgitation. Is this different for stenosis? I feel extremely scared to exert myself (do nothing except short brisk walks of 20 mins) because when I do, I sometimes feel bad. Like I have to slow down, or...

Braveheart, I think taking control of your treatment, or at least exploring everything until you are satisfied, is not jumping the gun. Well, if it is, I am doing the same. My cardiologist has said that she needs more data points (more echos, i.e.) to see how my heart is coping with the leak, and would rather wait before seeing a surgeon. Especially since my valve cannot be repaired and at age 42, I would definitely get a mechanical and be on Coumadin for the rest of my life. But she was wonderful and supportive and understood my wish to see a surgeon and get more answers. I appreciated that. I think you have to do everything you need to and you are doing the right thing!

skeptic49
February 14th, 2009, 10:16 AM
I went for a consultation with a surgeon to get an answer to this question of timing. Not now was the answer, based on his review of my echo and CT scan.. Come back in a year. I figure that if you get this from a surgeon then that's that. Why not see a surgeon?

Jim

Braveheart
February 14th, 2009, 03:49 PM
Why not see a surgeon?



As soon as I get the results of my cath. I will start making surgical appointments.

olefin
February 14th, 2009, 04:23 PM
Wait, Dayton, here is a question. You can't actually have a heart attack due to the valve, can you? I have been told by the cardio that unless my arteries are clogged, I am at no risk for heart attack from my mitral regurgitation. Is this different for stenosis? I feel extremely scared to exert myself (do nothing except short brisk walks of 20 mins) because when I do, I sometimes feel bad. Like I have to slow down, or...


Nupur, I thought my cardiologist said it but can't be dead sure. I asked my wife, she says she can't remember for sure what he said? But that he was pretty upset at me. Maybe he was trying to scare some sense in me to not try that again. He did say I should have called him immediately and went to the ER. He was very concerned that I didn't act immediately. Even my wife wanted to go to a fire station that was close to the jogging track for help. I was too hard headed for that.
I'll ask my cardiologist the next time I see him.

Sorry, but I wouldn't know how mitral regurgitation effects a person in comparison to aortic stenosis.

tobagotwo
February 14th, 2009, 04:42 PM
There are a lot of numbers going around medical circles, defining what this one or that one thinks is severe, and what they think the heart may be able to get away with. Of course, these are the cardiologists, who frequently want to keep you away from surrery as if it were a life-saving, or even a humanly attainable strategy.

The fact is that they only have estimates of the valve opening from a standard echo, A TEE (TOE, if your from GB), or even from a cardiac catheterization. The proponents of each argue their merits continuously. They tend to come up with different results. For you, that means your .96cm² may actually be a .79cm² or a 1.03cm².

To the best of my knowledge, whatever number they're selling on any given day, it's generally accepted that anything below 1cm² is considered operable without recrimination. While they do check your arteries via catheterization for atherosclerosis, unles there is a large disparity, they will still operate on the numbers provided by the standard echo. As they normally perform a cardiac cath just days before the already-scheduled is set to happen, I am personally appalled by seeing doctors sneak in a TEE (TOE) at the last minute, too. I see nothing to be gained from that but an hellacious extra testing fee.

At any rate, valve opening aside, the biggest determining factor in the surgery decision is the presence of symptoms. Unfortunately, the doctors usually get most of them by asking their patient. Patients most often fall into one of two buckets: they have an exaggerated sense of their symptoms, or they are in denial/don't recognize their symptoms.

You sound like you're from the second group. You are judging your heart by your legs. The fact that you can walk doesn't make you not have excessive fatigue, which your posting idicates you do. You may be having palpitations (arrhythmias) that you aren't feeling or are subconsciously ignoring. You may be experiencing angina, but thinking it's just cold air at the top of your lungs or a toothache, or muscle ache. I felt it most as a slight to tight knot at the top of my throat.

Look to yourself for your symptoms, and thell them to your doctor. Now is not the time to be macho, or to downplay those symptom-like feelings that you're not quite sure enough to tell him about.

There is also nothing against seeking out a surgeon's opinion, or a second opinion from a different cardiologist.

By the way, at 69, a tissue valve should already last you the rest of your life (20+ years). By that time, percutaneous replacements will be common. If you wait, you may develop permanent heart damage. Worse, you may encounter some other health problem that would make the surgery more dangerous or cause surgeons not to want to do it.

Just my thoughts.

Be well,

marilyn
February 14th, 2009, 08:29 PM
You wrote that the tissue valve would last 20+years. The Cleveland Clinic indicated that they could last from 8-10 years. I know that they can last that long but is that the usual lasting time? Are certain valves lasting longer?

Braveheart
February 15th, 2009, 03:37 AM
You wrote that the tissue valve would last 20+years. The Cleveland Clinic indicated that they could last from 8-10 years. I know that they can last that long but is that the usual lasting time? Are certain valves lasting longer?

That question is exactly what is on my mind. I have heard that tissue valves last about 10 years, which would not be acceptable to me.

On the other hand, I am nearing 70.(although I certainly don't feel or act anywhere near THAT old). I have read that surgeons usually won't consider mechanical valves after 70. My cardio spoke of using a mechanical valve until age 75.

I would not be averse to using coumadin, if I knew that I had a valve that had the potential to last me for the rest of my life.

Does anyone have any information on the use of mechanical valves in a person over 70?

Eva
February 15th, 2009, 09:39 AM
Braveheart,

My girlf friend's mom is a strong energetic and very healthy 80 years young! She had a mechanical valve! In 2002, I had a very smart caring cardio who told me I had five years before the surgery time...I had mild aortic regurgitation and stenosis and calcification; and mild mitral stenosis and regurgitation and mild calcification...I asked him if I could have the surgery then...the answer was NO. I was like you...walked four-five miles a day, went three times to gym, did aerobics, but I felt tired somehow the rest of the day I did these. In March 2007, my fatigue increased ... yet I walked sometimes 4 miles a day but no aerobics. My newer cardio told me in 2008 I needed surgery within 6-12 months, another cardio said I could start thinking surgery, but my surgeon insisted on surgery as he goes by symptoms more than numbers in echos ... I was by then SOB and no walking...in pajamas all day...light cooking sometimes, etc. He was right and I am glad I did it in September as both valves were worn out completely!!
So, seek another opinion (in my opinion) about the timing of the surgery and what valve is better for you, based on your health. And meanwhile, do the other stuff which will have to be postponed for six months after surgery; such as teeth cleaning or fillings, etc.

Good luck and keep us posted.

Braveheart
February 15th, 2009, 10:04 AM
Eva- Life is so strange. I had not been to the dentist in years. All of a sudden, a tooth started to bother me. Apparently, w/o having to go into gory details, I have to have a tooth pulled. I have made appointments to have my teeth taken care of; cleaning, etc.


It is bizarre that this thing with the tooth just happened at this particular time.

Marguerite53
February 15th, 2009, 11:18 AM
Eva- Life is so strange. I had not been to the dentist in years. All of a sudden, a tooth started to bother me. Apparently, w/o having to go into gory details, I have to have a tooth pulled. I have made appointments to have my teeth taken care of; cleaning, etc.


It is bizarre that this thing with the tooth just happened at this particular time.

Please be sure that the oral surgeon knows exactly what is going on with your cardiac health. I would actually tell your cardio that this is happening. You will probably need to be on antibiotics for the procedure. Don't want endocarditis rearing its ugly head.

I was 52 when my surgeon told me that my bovine tissue valve "might actually" last me my lifetime since this particular version was having such great results. Of course, cancer could swipe down and kill me before the valve went again, or any number of things. My opinion is that we choose our valves to match our lifestyle. It really sounds like you like the mechanical because you want to maybe live to be 100. Don't waiver. Learn about the tissue, but go with your gut.

As far as timing goes, the angiogram will surely tell you a lot. Whether you have clogged arteries, and a very true and close measure of your valve opening area. My surgeon would not discuss surgery dates without the angiogram.

When I first got symptoms, the echo read 1.0 and the cardio said surgery for sure within 3 years. When I got impatient and asked the cardio when she calls in the surgeon she said .7. I gathered up old echos and noticed that I'd been hovering in at 1.2, 1.5 etc. for many years. Then, almost 3 years after the 1.0, I finally got the .7 I needed. But then I suddenly had 2 other minor but intrusive medical issues. So, I had to wait 4 months after the .7 reading. The measure for me at surgery was .53 Really narrow. Critical. As happens with some of us, the valve started closing up faster toward the end. However, my surgery was simple, boring, everything is working perfectly (knock on wood) now, no damage to the heart.

Everyone is different.

Good luck.

Marguerite

Eva
February 15th, 2009, 11:24 AM
Eva- Life is so strange. I had not been to the dentist in years. All of a sudden, a tooth started to bother me. Apparently, w/o having to go into gory details, I have to have a tooth pulled. I have made appointments to have my teeth taken care of; cleaning, etc....

It is bizarre that this thing with the tooth just happened at this particular time.


Braveheart, your angel is watching you...I had my teeth cleaned in April and I completely forgot to go again after three months (I go 3 times a year) due to the tension and dilemma of the surgery....and now I am almost a year late!


Please be sure that the oral surgeon knows exactly what is going on with your cardiac health. I would actually tell your cardio that this is happening. You will probably need to be on antibiotics for the procedure. Don't want endocarditis rearing its ugly head.....
Good luck.

Marguerite

Thanks, Marguerite. I should have added that to my reply...It is very important, Braveheart, to premedicate before any cleaning or any dental work or follow whatever your cardio recommends.

Keep us posted. Good luck and prayers:)

Cooker
February 15th, 2009, 11:32 AM
I had my AVR before ANY symptoms or damage .... My father had to retire early due to his not being replaced soon enough ... when they finally did it he went to Texas, his surgeon was Denton Cooley (sp?) .... At the time it was not being done in SC ... when I found out I needed it I said lets do it before I had symptoms .... I loved my Dad but I did not want to be in the shape he was in for the las 25 years of his life ... I feel better now than I have in years:)

Braveheart
February 15th, 2009, 03:07 PM
.It is very important, Braveheart, to premedicate before any cleaning or any dental work or follow whatever your cardio recommends.



Strange thing about the premedication.Here is an article where the American Heart Association had changed its guidelines about premedication. Apparently, they feel that the risk of using antibiotics outweighs the risk of infection. My dentist knew about that.

After I have the AVR, I WILL need antibiotics before I have a dental procedure.


Until recently, the American Heart Association recommended giving antibiotics to prevent endocarditis to these patients before they had dental work. However, those guidelines have changed — the American Heart Association no longer recommends antibiotics before dental procedures, except for patients at the highest risk for bad outcomes from endocarditis, including:

those with prosthetic heart valves
patients who have had endocarditis in the past
patients with certain types of congenital heart defects, and
heart-transplant patients who develop a problem with a heart valve.
For all people with prosthetic heart valves, it’s very important to receive antibiotics before certain types of dental work involving the gum tissues, teeth or other soft tissues inside the mouth. This includes routine professional cleaning.

http://www.americanheart.org/presenter.jhtml?identifier=4592

Cameron
February 15th, 2009, 05:31 PM
I had few symptoms, but the few I did have prompted me to the doc and onward to internalist and angiogram and surgery late last year. My aortic valve was down to 0.6 sq cm but luckily I had no damage to the heart and all other bits were functioning normally. After surgery the surgeon said the valve was worse than expected with an area of only 0.4 sq cm. I am very fortunate that I paid attention and that my medical team did so too and pushed me along fairly quickly to the replacement with an On-X mechanical on 22nd January 2009. All my team said it is better to get the replacement done before you become overtly symptomatic and do damage to your heart.
Cameron

ticktock
February 17th, 2009, 09:04 PM
I'm not really a new member.... I haven't been on for about 2 years, and somehow got.. um.. misplaced. I'm an oldie actually.. Having had 4xOHS, I can say that my doctors were great every time about recommending I go in before I was even moderately symptomatic. The better shape/condition you are in before the surgery; the stronger you will be for your recovery. I truly believe this strategy served me in every case.

In response to your other question, I suffered NO neurological damage after the first 3OHS... but did with the 4th. I'm still up, around and having fun (almost) every day, so it wasn't too drastic.

Braveheart
February 18th, 2009, 01:58 AM
Having had 4xOHS, I can say that my doctors were great every time about recommending I go in before I was even moderately symptomatic. The better shape/condition you are in before the surgery; the stronger you will be for your recovery. I truly believe this strategy served me in every case.



ticktock- I am of the same mind. I am going in for my heart cath this morning, so then I feel that I will have more "ammunition" to give to the surgeons.

khawkk
February 18th, 2009, 04:43 AM
Hi there,
We are similar. Age, etc.
However, I went from a .98 to .7 something in one year.
I had a moo-cow valve replacement last march. Hmmmm almost time for
my 1 yr. anniv.
Everyone take a moment "HAPPY BIRTHDAY TO JACK! HAPPY BIR..."
OK that's enough. I am now very active and the only anti-coag. I take
is an 81 aspirin. If I am still around and need another valve operation in
say.........ahhhh 18 years, the new procedures will be so improved that
the operation will probably be a piece of cake. That is if we don't blow ourselves off this precious earth before then.
So, I recommend a bovine valve within the next year.
Whatever/whenever you choose, don't look back and wonder. Just look forward
and enjoy your new healthy life.

JdW

KristyW
February 18th, 2009, 10:02 AM
I'm not really a new member.... I haven't been on for about 2 years, and somehow got.. um.. misplaced. I'm an oldie actually.. Having had 4xOHS, I can say that my doctors were great every time about recommending I go in before I was even moderately symptomatic. The better shape/condition you are in before the surgery; the stronger you will be for your recovery. I truly believe this strategy served me in every case.

In response to your other question, I suffered NO neurological damage after the first 3OHS... but did with the 4th. I'm still up, around and having fun (almost) every day, so it wasn't too drastic.


Mindy! Nice to see your "type". Hope things are all going well :D