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When did you have your aortic valve replacement?

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  • When did you have your aortic valve replacement?

    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.
    6/30/09-AVR and single bypass
    Edward Lifesciences Pericardial Tissue Heart valve- Model 2700/ 21mm

    Dr. Joseph Sabik- Cleveland Clinic

  • #2
    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


    Originally posted by Braveheart View Post
    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?).

    Comment


    • #3
      Originally posted by ChouDoufu View Post
      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.
      6/30/09-AVR and single bypass
      Edward Lifesciences Pericardial Tissue Heart valve- Model 2700/ 21mm

      Dr. Joseph Sabik- Cleveland Clinic

      Comment


      • #4
        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?

        Comment


        • #5
          Originally posted by ChouDoufu View Post
          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.
          6/30/09-AVR and single bypass
          Edward Lifesciences Pericardial Tissue Heart valve- Model 2700/ 21mm

          Dr. Joseph Sabik- Cleveland Clinic

          Comment


          • #6
            Originally posted by Braveheart View Post
            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.
            Dayton

            AVR, 6/91, 23 mm St Jude Mechanical, age 56, Texas Heart Institute.
            Home testing and dosing 2/09

            Comment


            • #7
              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!
              In the waiting room with moderate-severe Mitral Regurgitation w/ Bi-leaflet Prolapse

              Comment


              • #8
                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
                BAV/0.8cm2AS/4.2cmAA - In the waiting room. "Don't worry about your heart, it will last you as long as you live." - W. C. Fields

                Comment


                • #9
                  Originally posted by skeptic49 View Post
                  Why not see a surgeon?

                  As soon as I get the results of my cath. I will start making surgical appointments.
                  6/30/09-AVR and single bypass
                  Edward Lifesciences Pericardial Tissue Heart valve- Model 2700/ 21mm

                  Dr. Joseph Sabik- Cleveland Clinic

                  Comment


                  • #10
                    Originally posted by Nupur View Post
                    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.
                    Dayton

                    AVR, 6/91, 23 mm St Jude Mechanical, age 56, Texas Heart Institute.
                    Home testing and dosing 2/09

                    Comment


                    • #11
                      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,
                      Bob H

                      "No Eternal Reward will forgive us now for wasting the dawn..." Jim Morrison

                      [B] [URL="http://www.valvereplacement.org/forums/attachment.php?attachmentid=8494&d=1276042314"] Click here to View the Glossary of VR Terms and Acronyms[/URL] [/B]

                      [B]I am not a Medical Professional.[/B] Aortic Valve Replacement (Medtronic Mosaic) on 4/6/04, at Robert Wood Johnson UH in New Brunswick, NJ. AVR again (St. Jude Biocor) on 08/25/09 at St. Michael's MC in Newark, NJ. Both performed by Dr. Tyrone Krause, a true Zen Master Mechanic in the world of valve replacement surgery.

                      Comment


                      • #12
                        Tobagotwo

                        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?

                        Comment


                        • #13
                          Originally posted by marilyn View Post
                          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?
                          6/30/09-AVR and single bypass
                          Edward Lifesciences Pericardial Tissue Heart valve- Model 2700/ 21mm

                          Dr. Joseph Sabik- Cleveland Clinic

                          Comment


                          • #14
                            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.
                            Eva

                            Aortic & Mitral valves replaced with St. Jude Mechanical valves @ age 57 on 9/2/08

                            INR home tester/Coagucheck

                            Forum Rules: " .... medical opinions expressed in this forum are the personal opinions of individuals. No person should at any time
                            act on the information contained herein without the express consent of your own physician."

                            Comment


                            • #15
                              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.
                              6/30/09-AVR and single bypass
                              Edward Lifesciences Pericardial Tissue Heart valve- Model 2700/ 21mm

                              Dr. Joseph Sabik- Cleveland Clinic

                              Comment

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