On-X Aortic Heart Valves: Safer with Less Warfarin On-X Aortic Heart Valves: Safer with Less Warfarin

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Should I still see the surgeon?

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  • Should I still see the surgeon?

    Hello,

    I've had my bovine aortic heart valve for 11 years this past March. A couple weeks ago, I had an echocardiogram that my cardiologist said showed moderate to severe stenosis of the aortic valve. When I asked him how long I had until it needed replacement, his answer was vague. I'm scheduled for cochlear implant surgery August 30 so when I heard the diagnosis, I called to make an appointment with the surgeon who did my first valve replacement to get better clarification concerning the time frame I had to work with. After making an appointment with my surgeon, my cardiologist called me and said he had looked at the echocardiogram again with several colleagues and feels the valve has moderate stenosis rather than severe. I asked about my cochlear implant surgery and he felt it would be fine to have that. He also said he didn't need to see me for 5 or 6 months. Now I'm wondering if I should still keep my appointment with my surgeon to get his input. In my experience, cardiologists are conservative and surgeons are proactive. I thought I would put some of the numbers from the echocardiogram here as a help and ask for your opinions as to whether to keep the appointment with my surgeon or not. I've copied below just the stats related to the aortic valve primarily. Everything else looked good. Thanks all.

    Summary:

    1. The left ventricular chamber size is normal.

    2. The EF is estimated at 60-65%.

    3. The bio-prosthetic aortic valve appears stenotic.

    4. This is a 23mm aortic prosthesis.

    5. There is moderate aortic stenosis. dimensionless index is 0.31

    6. Mild aortic regurgitation is present.

    Aortic Valve:
    Mild aortic regurgitation is present. The peak gradient across the
    aortic valve is 58mmHg. The mean gradient across the aortic valve is
    31mmHg. The aortic valve area by VTI is calculated at 1.06cm2. There is
    moderate aortic stenosis.dimensionless index is 0.31 This is a 23mm
    aortic prosthesis. A bio-prosthetic pericardial aortic valve is present.
    The bio-prosthetic aortic valve appears stenotic.

    Aortic Valve

    Name Value Normal Range

    AV Vmax 3.8 m/sec -

    AV peak gradient 58 mmHg -

    AV mean gradient 31 mmHg -

    AV VTI 81.7 cm -

    LVOT Vmax 1.29 m/sec -

    LVOT peak gradient 7 mmHg -

    LVOT VTI 30.5 cm -

    LVOT diameter 1.9 cm (1.7 - 2.5)

    AVA (continuity Vmax) 0.96 cm2 -

    AVA (continuity VTI) 1.06 cm2 -





    Aortic Valve Replacement And
    Aortic Root Repair
    Edwards Bovine Pericardial 23mm
    March 7, 2006

  • #2
    Hi Tigerlily - The gradients across your valve are roughly what my three year old one is at the moment (59mmHG peak, 32mmHg mean) and my absolute AVA is 1cm2 (by continuity 0.77 Vmax, 0.9 VTI). I was referred to a cardiac surgeon by my cardiologist after those last echo readings. Surgeon did a transoesophageal echo to see if the valve was degenerating - which it wasn't. He doesn't want to do surgery to replace my valve right now (in my case he'd have to do a root replacement as the valve is too small and he says the risks involved aren't justified at this stage). Surgeon wants me to continue with echos via my cardiologist every six months - cardiologist and surgeon are in close contact.

    Why don't you ask your cardiologist about you seeing the surgeon ? Or have a TEE (TOE in UK) to check the state of the valve in case it is degenerating ?

    Do keep us posted.
    Anne - Congenital bicuspid aortic valve. AVR 6th January 2014 CE Perimount bovine Magna Ease Aortic valve - 19 mm. St Anthony's Hospital London, UK, anaesthetist Dr JP van Besouw, surgeon Prof Jahangiri. Also atypical Type 2 diabetes, osteoporosis, small airways disease.

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    • #3
      Other than time spent I can't see the harm in another set of eyes on it.

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      • #4
        As above. I'd keep the appointment with the surgeon.
        Bicuspid Aortic Valve. Moderate Aortic Valve Stenosis. Ascending Aorta: 4.1cm
        In the waiting room.

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        • #5
          Originally posted by Paleowoman View Post
          Hi Tigerlily - The gradients across your valve are roughly what my three year old one is at the moment (59mmHG peak, 32mmHg mean) and my absolute AVA is 1cm2 (by continuity 0.77 Vmax, 0.9 VTI). I was referred to a cardiac surgeon by my cardiologist after those last echo readings. Surgeon did a transoesophageal echo to see if the valve was degenerating - which it wasn't. He doesn't want to do surgery to replace my valve right now (in my case he'd have to do a root replacement as the valve is too small and he says the risks involved aren't justified at this stage). Surgeon wants me to continue with echos via my cardiologist every six months - cardiologist and surgeon are in close contact.

          Why don't you ask your cardiologist about you seeing the surgeon ? Or have a TEE (TOE in UK) to check the state of the valve in case it is degenerating ?

          Do keep us posted.
          Hi Paleowoman, I did see the surgeon who seemed to be OK with allowing my cardiologist to monitor the valve every 3 months but I'm not sure how. How can they tell from a TEE if the valve is degenerating or not? Is that a different process from the valve becoming more and more calcified?
          Aortic Valve Replacement And
          Aortic Root Repair
          Edwards Bovine Pericardial 23mm
          March 7, 2006

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          • #6
            Originally posted by tigerlily View Post
            How can they tell from a TEE if the valve is degenerating or not? Is that a different process from the valve becoming more and more calcified?
            They can get a very good view of the valve from a TEE. If it's calcified they can see that too from a regular transthoracic echocardiogram, but I think the TEE is more definitive.

            Anne - Congenital bicuspid aortic valve. AVR 6th January 2014 CE Perimount bovine Magna Ease Aortic valve - 19 mm. St Anthony's Hospital London, UK, anaesthetist Dr JP van Besouw, surgeon Prof Jahangiri. Also atypical Type 2 diabetes, osteoporosis, small airways disease.

            Comment


            • #7
              Hi Tigerlily; I would want to know if there was LVH or Left Ventricular Hypertrophy and if you are having any symptoms?
              Plus, I always believe a second opinion is called for. good luck and hope you get answers soon. Bonbet

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