Arlyss
Well-known member
Sixteen years ago my husband had a severely calcified stenotic bicuspid aortic valve replaced with a mechanical valve. He was extremely sick then, in full congestive heart failure with really no warning other than developing pneumonia. Removing that constricted valve was a great relief to his heart! He recovered from surgery without complications, was given no exercise restrictions, and adjusted to coumadin well. His left ventricle fully recovered... Life returned to normal, and it did seem this could be a life long solution for him.
Looking back now, I think of the complexity of getting that first new valve into a very calcified area. I don't believe it was an easy procedure. I was warned before he woke up that he might have had a stroke due to the heavy calcification - there was high risk of particles going to the brain. But he was fine then.... I think now about how important that very first procedure was - because it set the stage for what would happen later.
It was eleven years later, in 2001 that an ascending aortic aneurysm was "discovered".... A second time the sternum had to be opened to save his life. The mechanical valve appeared to be working well, and there had been no issues with coumadin. So there was no reason to expose him to the added risk of changing out the valve, and the mechanical valve stayed in place.
Then in 2004 a new murmur was heard in his chest. The mitral valve had developed a leak, and the mechanical valve had an increase in the pressure differential across it. Blood wasn't flowing through the mechanical as easily as it had before......why? It was opening and closing well. Possible scar tissue forming on the mechanical? So now we were watching two valves......
So we were living with the thought that perhaps both the mechanical and the mitral could mean another surgery at some point. Without warning, six months ago now my husband suffered an extensive stroke. His INR, checked just the day before, was perfect. It was also in range when checked in the ER. Locally they had no idea what caused the stroke - the mechanical valve still appeared to work well on echo. However, later testing in a major center showed strands of tissue attached to the "heart side" of his mechanical aortic valve. These fine hair-like strands of tissue have been associated with stroke, but they are difficult to detect and relatively little is known about them. Surgery to remove the mechanical valve needed to happen before he had another stroke. Now there was a greater risk if the mechanical valve stayed in place than in removing it.
So, four months ago, for the third time he had open heart surgery - the mechanical valve is gone and the problem with the mitral (calcification on a leaflet) resolved. It was very difficult to replace the mechanical aortic valve - the aortic root needed to be enlarged with a patch - bovine pericardial tissue was used to patch it. And calcification/debris had to come out to make room for the new tissue valve. Not an easy procedure at all, but it went very well in expert hands. The last look into his chest, a few weeks ago, showed the new tissue valve and the mitral valve working beautifully. And now there is a track record for his new tissue valve that gives hope that it may last as long as he needs it.
Today I want to tell others about these strands. What we did not know, and I would like others to know, is that if the pressure difference across a prosthetic valve increases, it is important to look for these strands - and the only way to "see" them is by TEE or transesophageal echo. I hope knowing about this will spare someone from having a stroke. I have heard that 2% of those with mechanical valves have unexplained strokes - I have not been able to confirm that statistic - but these strands likely explain some of them....
Here are some references
http://www.ncbi.nlm.nih.gov/entrez/...uids=12514645&query_hl=38&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/..._uids=9692533&query_hl=35&itool=pubmed_docsum
Best wishes,
Arlyss
Looking back now, I think of the complexity of getting that first new valve into a very calcified area. I don't believe it was an easy procedure. I was warned before he woke up that he might have had a stroke due to the heavy calcification - there was high risk of particles going to the brain. But he was fine then.... I think now about how important that very first procedure was - because it set the stage for what would happen later.
It was eleven years later, in 2001 that an ascending aortic aneurysm was "discovered".... A second time the sternum had to be opened to save his life. The mechanical valve appeared to be working well, and there had been no issues with coumadin. So there was no reason to expose him to the added risk of changing out the valve, and the mechanical valve stayed in place.
Then in 2004 a new murmur was heard in his chest. The mitral valve had developed a leak, and the mechanical valve had an increase in the pressure differential across it. Blood wasn't flowing through the mechanical as easily as it had before......why? It was opening and closing well. Possible scar tissue forming on the mechanical? So now we were watching two valves......
So we were living with the thought that perhaps both the mechanical and the mitral could mean another surgery at some point. Without warning, six months ago now my husband suffered an extensive stroke. His INR, checked just the day before, was perfect. It was also in range when checked in the ER. Locally they had no idea what caused the stroke - the mechanical valve still appeared to work well on echo. However, later testing in a major center showed strands of tissue attached to the "heart side" of his mechanical aortic valve. These fine hair-like strands of tissue have been associated with stroke, but they are difficult to detect and relatively little is known about them. Surgery to remove the mechanical valve needed to happen before he had another stroke. Now there was a greater risk if the mechanical valve stayed in place than in removing it.
So, four months ago, for the third time he had open heart surgery - the mechanical valve is gone and the problem with the mitral (calcification on a leaflet) resolved. It was very difficult to replace the mechanical aortic valve - the aortic root needed to be enlarged with a patch - bovine pericardial tissue was used to patch it. And calcification/debris had to come out to make room for the new tissue valve. Not an easy procedure at all, but it went very well in expert hands. The last look into his chest, a few weeks ago, showed the new tissue valve and the mitral valve working beautifully. And now there is a track record for his new tissue valve that gives hope that it may last as long as he needs it.
Today I want to tell others about these strands. What we did not know, and I would like others to know, is that if the pressure difference across a prosthetic valve increases, it is important to look for these strands - and the only way to "see" them is by TEE or transesophageal echo. I hope knowing about this will spare someone from having a stroke. I have heard that 2% of those with mechanical valves have unexplained strokes - I have not been able to confirm that statistic - but these strands likely explain some of them....
Here are some references
http://www.ncbi.nlm.nih.gov/entrez/...uids=12514645&query_hl=38&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/..._uids=9692533&query_hl=35&itool=pubmed_docsum
Best wishes,
Arlyss