Pulmonary Hypertension secondary to Mitral Regurg

[jds]

I have an MVR and will have surgery on May 23. If a replacement, it will be a bovine valve (Carpentier-Edwards) so I will not need long-term coumadin.

Before the MVR, and what led to the detection of the murmur then all the testing, was a serious case of pneumonia. The time-line is (a) 1/1/07 - hospitalized with pneumonia (organism never identified) (b) detect murmur and do echo on 1/4/07 to identify MVR (c) Leave hospital for home 1/5/07 (d) roughly 1/5/07 to 2/28/07 focus on pneumonia and lung function - pulmonary function seemed good on testing 3/1/07 (e) 3/1/07 and on - heart testing with TEE and catheterization and finding a surgeon (f) Surgery scheduled for 5/23/07 - originally for 4/19/07 but scheduling problems caused a delay.

One puzzling symptom is that the pressure in my right ventricle is quite high - 80mmHg vs normal of about 30. We (me and doctors) cannot see any reason other than the back pressure from the MVR and our hope/expectation is that it will resolve itself when the MV is fixed.

Anyone have experience with this or something like it?

 

[tobagotwo]

Secondary pulmonary hypertension is a frequent companion of valve problems. Echoes are notoriously poor for judging pulmonary pressure, and are often ignored. Exercise stress echoes can detect it sometimes, TEEs are better that transthoracic echoes at it, but the gold standard is a right-heart cath (most often, just a left-heart cath is done for valve problems).

The PH tends to remain for a while after surgery. If it stays long enough, it can develop into primary pulmonary hypertension, which is a lifelong condition. I'm not aware of anything you can do to prevent that from happening, but walking-type exercise is known to reduce the symptoms, as is reduction of salt intake. Major identifiable symptoms include SOB and fluid retention (edema) in the legs and hands, as well as in the abdomen (ascites). I do hope it goes away for you after surgery.

Best wishes,

 

[jds]

Thanks for your thoughtful reply.

I do have significant SOB but no edema. Had some peripheral (shin) edema at the beginning of the pneumonia but it went away and never returned. I had a significant left-side pulmonary effusion during pneumonia that was drained - no infection or pus. I have had some left-side pulmonary effusion showing up in in x-rays up through 3/1/07.

I do moderate walking 2-4 times a week. My diet is moderately low-salt but not obsessively so.

The major diagnosis of the PHT was via a right-side cath during my cardio-catheterization.

I guess we will have to monitor it with echos afterward and do another cath only if it turns into a significant problem.

 

[susieq14]

Hello JDS!
Welcome to VR.com! I missed your earlier posts but see we have a lot in common - MVR and a fellow "Bay Stater". I'm still in the waiting room (2 1/ 2 years) so I have not investigated surgeons and hospitals yet. I live in MetroWest and see a cardiologist at MetroWest Medical Center. Where are you having your surgery? If I read your post correctly, it doesn't sound like you have been in the "waiting room" very long. I wish you all the best as you prepare for your big day later this month. Take Care! Susie

 

[jds]

Hello -

I see a cardiologist - Tom LaMattina - at Emerson Hospital in Concord. I had my "minor" diagnostics - echo and TEE - there then had a catheterization with Dr. LaMattina at Mass General. I will have surgery at Mass General with Dr. Gus Vlahakes. He came with high recommendations from many people and my wife and I were impressed with him when we met.

I've only known about the MVR since early January of this year. The symptoms - shortness of breath and eercise intolerance - have been pretty significant. Test results - pulmonary hypertension and the size of the regurgitation - have been pretty significant as well. I was awake for much of the catheterization and, to me, it looked like as big a jet was going the wrong way (back through the valve) as the right way (out the aorta).

Really looking to get this resolved.

Good luck to you. There are a lot of good hospitals and surgeons in the Boston area. The hospitals I hear the most about are Mass General, Brigham and Women's, Leahy Clinic (Burlington), and Mt. Auburn. I'm sure tere are others as well. Call all the medical folks you know (doctors, nurses, ...) to collect the names of surgeons. Dr. Vlahakes seems very good and I got his name from a physician friend of mine.

John

 

[Nancy]

This is an excellent website for those with PH. It has a forums section too.

http://www.phassociation.org/