Different strokes...

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Seaton

VR.org Supporter
Supporting Member
Joined
May 12, 2015
Messages
583
Location
London, UK
In August last year, I had a 45 second or so episode of double vision (diplopia) while driving in the fast lane. It momentarily made driving safely extremely difficult. The double vision eventually resolved, and I hogged the slow lane back to London without a recurrence of the issue.

I thought the diplopia may have been tiredness/eye strain from driving or low blood sugar. But I erred on the side of caution and got it checked out.

At the A&E they did a thorough work up… full blood count, MRI head scan, carotid artery echo, bloods for endocarditis. All came back clear. Was referred to ophthalmology for eye tests. Those tests all proved clear.

In early December, I was out and about and suddenly felt unwell and lightheaded and headed for home. Once home, I still felt queasy and dizzy, but then suddenly my left arm and hand felt a tad heavy and disconnected.

I’m having a stroke, I thought.

I sat myself down considering what to do, and things appeared to resolve themselves just as quickly as they had begun. I headed for A&E.

Had a variety of tests at A&E and initially treated as trans ischaemic attack and loaded with Aspirin 300 mg to be taken daily (up from my usual 75mg daily) and discharged with TIA clinic follow-up.

An MRI of my head a few days later showed tiny cerebellar infarcts, which the consultant said might explain my symptoms. It thankfully wasn’t a bigger and more debilitating cerebellar infarction. These tiny infarcts were new and not showing on my previous August MRI following the double vision episode. I’ve noticed distinct short-term memory issues since this “minor stroke”.

The stroke consultant wanted to rule out cardio-embolic source of the ischaemic stroke, considering my background history of bioprosthetic valve.

Told to stop aspirin and switch to Clopidogel 75mg daily until further notice. There was to be no driving for one month.

New blood cultures for endocarditis came back negative. Full bloods taken all looked fine. Wore an ECG monitor for 7 days. Lots of stuff in that, but I wasn’t sure how to read it. They were mainly testing for atrial fibrillation, which didn’t seem to be an issue. There was another clear scan of the carotid artery.

A recent related (29 February) echocardiogram result came back, and it states:


On comparison to previous echo April 2023 at GSST, there is an increase in gradients across the aortic valve replacement.

Tissue aortic valve in situ appears well seated.

Peak v max 3.8 m/s,

gradient 58 mmHg,

mean 28 mmHg,

functional AVA 1.1cm²

DVI 0.31.

No obvious regurgitation.

Dilated LA (Left Atrium).



This shows my gradients are up from April 2023 and considerably up from a 4 month post August 2019 replacement reading of peak gradient 22mmHg and mean gradient 12mmHg.

For context, my final gradients pre AVR op were mean 60mmHg, peak 33mmHg

My aortic valve area is now moderate at 1.1cm². 4 month post replacement aortic valve area was 1.8cm². So edging towards severe.

Left Atrium dilated. Not sure of the significance of that.

I had an annual cardiac review booked for late May but had an urgent cardiology consultation a few days ago.

The cardiologist did a review and now wants me on warfarin, probably indefinitely, because of the cerebellar infarcts. She also suggested a low dose beta blocker (Bisoprolol) for the higher ventricular ectopic beats percentage that she noted reviewing the 7 day Holter monitor data.

She’s arranging an urgent cardiac angio CT scan of my 4 ½ year-old Inspiris Resilia bioprosthetic valve to look for any issues (BPVT – bioprosthetic valve thrombosis being one of them, I believe). The cardiologist confirmed my aortic valve area is now moderate and will monitor it again in six months with an echo. She will liaise with the stroke clinic.

She said my readings were not suggesting another surgery at this stage. But let’s see where things are in a year or two and what happens to my gradients and aortic valve area with warfarin treatment. Perhaps they will stabilise? Or better, I’m hoping the warfarin will reduce the current gradients. I read something about the possibility of that effect in a number of research papers. Let’s see.

Valve in valve (TAVI/TAVR) does not appeal to me for various reasons and is an unlikely option anyway I imagine, considering I have first degree heart block and left bundle branch block from my previous AVR surgery, plus the infarcts.

Should the day for re-operation arrive anytime in the next few years, I’m currently inclined to go mechanical. At least I will be warfarin savvy and well practiced by then… he said hopefully!

Onwards.
 
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Hey there ... well that's annoying isn't it!

glad to hear everyone is "on top of it"

Everything seems prudent ... I hope that it progresses back to normality soon.

Best Wishes

 
i am sorry to hear that. I would have thought the inspiria would last longer much longer. I think your gradients are quite high.

my onx is 5mg mean and between 8-10 mg peak depending on echo.

I am very happy to hear that despite being so overburdened at the moment, the NHS is taking such good care of you.

Unfortunately, if you read the studies closely, the stroke risk of a bio and mechanical valve is roughly the same. in my own bio valve experience i had two neurogical events, but they were not blamed on the valve. So neurological events with bio valves can happen. its kind of annoying but unfortunstely that seems to be the way it is.

Nevertheless, i will keep my fingers crossed that it is still a long time off
 
i am sorry to hear that. I would have thought the inspiria would last longer much longer. I think your gradients are quite high.

my onx is 5mg mean and between 8-10 mg peak depending on echo.

I am very happy to hear that despite being so overburdened at the moment, the NHS is taking such good care of you.

Unfortunately, if you read the studies closely, the stroke risk of a bio and mechanical valve is roughly the same. in my own bio valve experience i had two neurogical events, but they were not blamed on the valve. So neurological events with bio valves can happen. its kind of annoying but unfortunstely that seems to be the way it is.

Nevertheless, i will keep my fingers crossed that it is still a long time off
Thanks, Tommy.
Your valve gradient readings are impressive. Will be interesting to see if the warfarin brings mine down.
 
I'm also sorry to hear about your issues.

In 2011 (IIRC), I trusted my InRatio meter (since ordered removed by the FDA) to give me correct readings. The meter was telling me 2.6. I had a stroke (not just a TIA, apparently) and the hospital showed an INR of 1.6. Damned meter (and I'm holding back on my language, for obvious reasons). The event was clearly related to my low INR and reliance on an easy to use - but faulty monitoring device.

On 9/11 last year - with my INR in range according to my XS, I had a TIA. This wasn't related to my INR. I'm still not entirely sure what caused it. It resolved in a few days. When I got to the hospital, I was told (and not surprised) that the clot breaking medications that they use for most stroke victims wouldn't help in my case because I take warfarin.

I've had my mechanical valve since 1991. I've been self testing and self managing since 2009. In my case, even staying in range didn't completely insulate me from the possibility of a TIA, and, perhaps, maybe worse.

Warfarin might help reduce your risk of TIAs, or worse, strokes -- some experts consider these to be the same thing. Others don't.
 
I'm also sorry to hear about your issues.

In 2011 (IIRC), I trusted my InRatio meter (since ordered removed by the FDA) to give me correct readings. The meter was telling me 2.6. I had a stroke (not just a TIA, apparently) and the hospital showed an INR of 1.6. Damned meter (and I'm holding back on my language, for obvious reasons). The event was clearly related to my low INR and reliance on an easy to use - but faulty monitoring device.

On 9/11 last year - with my INR in range according to my XS, I had a TIA. This wasn't related to my INR. I'm still not entirely sure what caused it. It resolved in a few days. When I got to the hospital, I was told (and not surprised) that the clot breaking medications that they use for most stroke victims wouldn't help in my case because I take warfarin.

I've had my mechanical valve since 1991. I've been self testing and self managing since 2009. In my case, even staying in range didn't completely insulate me from the possibility of a TIA, and, perhaps, maybe worse.

Warfarin might help reduce your risk of TIAs, or worse, strokes -- some experts consider these to be the same thing. Others don't.

Sorry to hear about those TIA/stroke incidences... and your faulty monitor! Glad things eventually resolved.

The cardiologist was swift to want me on warfarin once I got to see her (I've yet to start the warfarin process). Will be good to know the results of the upcoming cardiac CT, to see if they can pinpoint a source.
I'll update when I know more.
Thanks for the info!
 
In August last year, I had a 45 second or so episode of double vision (diplopia) while driving in the fast lane. It momentarily made driving safely extremely difficult. The double vision eventually resolved, and I hogged the slow lane back to London without a recurrence of the issue.

I thought the diplopia may have been tiredness/eye strain from driving or low blood sugar. But I erred on the side of caution and got it checked out.

At the A&E they did a thorough work up… full blood count, MRI head scan, carotid artery echo, bloods for endocarditis. All came back clear. Was referred to ophthalmology for eye tests. Those tests all proved clear.

In early December, I was out and about and suddenly felt unwell and lightheaded and headed for home. Once home, I still felt queasy and dizzy, but then suddenly my left arm and hand felt a tad heavy and disconnected.

I’m having a stroke, I thought.

I sat myself down considering what to do, and things appeared to resolve themselves just as quickly as they had begun. I headed for A&E.

Had a variety of tests at A&E and initially treated as trans ischaemic attack and loaded with Aspirin 300 mg to be taken daily (up from my usual 75mg daily) and discharged with TIA clinic follow-up.

An MRI of my head a few days later showed tiny cerebellar infarcts, which the consultant said might explain my symptoms. It thankfully wasn’t a bigger and more debilitating cerebellar infarction. These tiny infarcts were new and not showing on my previous August MRI following the double vision episode. I’ve noticed distinct short-term memory issues since this “minor stroke”.

The stroke consultant wanted to rule out cardio-embolic source of the ischaemic stroke, considering my background history of bioprosthetic valve.

Told to stop aspirin and switch to Clopidogel 75mg daily until further notice. There was to be no driving for one month.

New blood cultures for endocarditis came back negative. Full bloods taken all looked fine. Wore an ECG monitor for 7 days. Lots of stuff in that, but I wasn’t sure how to read it. They were mainly testing for atrial fibrillation, which didn’t seem to be an issue. There was another clear scan of the carotid artery.

A recent related (29 February) echocardiogram result came back, and it states:


On comparison to previous echo 2022 at GSST, there is an increase in gradients across the aortic valve replacement.

Tissue aortic valve in situ appears well seated.

Peak v max 3.8 m/s,

gradient 58 mmHg,

mean 28 mmHg,

functional AVA 1.1cm²

DVI 0.31.

No obvious regurgitation.

Dilated LA (Left Atrium).



This shows my gradients are up from 2022 and considerably up from a 4 month post August 2019 replacement reading of peak gradient 22mmHg and mean gradient 12mmHg.

For context, my final gradients pre AVR op were mean 60mmHg, peak 33mmHg

My aortic valve area is now moderate at 1.1cm². 4 month post replacement aortic valve area was 1.8cm². So edging towards severe.

Left Atrium dilated. Not sure of the significance of that.

I had an annual cardiac review booked for late May but had an urgent cardiology consultation a few days ago.

The cardiologist did a review and now wants me on warfarin, probably indefinitely, because of the cerebellar infarcts. She also suggested a low dose beta blocker (Bisoprolol) for the higher ventricular ectopic beats percentage that she noted reviewing the 7 day Holter monitor data.

She’s arranging an urgent cardiac angio CT scan of my 4 ½ year-old Inspiris Resilia bioprosthetic valve to look for any issues (BPVT – bioprosthetic valve thrombosis being one of them, I believe). The cardiologist confirmed my aortic valve area is now moderate and will monitor it again in six months with an echo. She will liaise with the stroke clinic.

She said my readings were not suggesting another surgery at this stage. But let’s see where things are in a year or two and what happens to my gradients and aortic valve area with warfarin treatment. Perhaps they will stabilise? Or better, I’m hoping the warfarin will reduce the current gradients. I read something about the possibility of that effect in a number of research papers. Let’s see.

Valve in valve (TAVI/TAVR) does not appeal to me for various reasons and is an unlikely option anyway I imagine, considering I have first degree heart block and left bundle branch block from my previous AVR surgery, plus the infarcts.

Should the day for re-operation arrive anytime in the next few years, I’m currently inclined to go mechanical. At least I will be warfarin savvy and well practiced by then… he said hopefully!

Onwards.
So sorry to hear but glad everyone seems on top of it!
 
Sorry to hear about those TIA/stroke incidences... and your faulty monitor! Glad things eventually resolved.

The cardiologist was swift to want me on warfarin once I got to see her (I've yet to start the warfarin process). Will be good to know the results of the upcoming cardiac CT, to see if they can pinpoint a source.
I'll update when I know more.
Thanks for the info!
Thanks. The second incident had nothing to do with INR or meter. I'm still unsure why the second TIA occurred. This was a day after I started electrolyte packets (mix the packet with some water) from VitaminShoppe - I haven't had any since - probably unrelated, but I'm not sure I want to take another chance with these. (Could they have loosened some kind of plaque or something?)
 
Hi Seaton.

Very sorry to hear about this. I hope things stabilize for you, but it sounds like your bio-valve is experiencing early SVD.

Have you had your Lp(a) level tested? I've linked a recent study below, published in Feb 2024, which found that elevated Lp(a) correlated with more rapid SVD in bioprosthetic valves. As of 2019, the EU guidelines now recommend that all people be tested at least once in their lifetime for Lp(a). Lp(a) levels are almost completely independent of diet and lifestyle, so one generally just needs to be tested once.

"high serum concentrations of Lp(a) were associated with a higher risk of SVD after aortic valve replacement at amedian follow-up of 4.4 years"

https://heart.bmj.com/content/heartjnl/110/4/299.full.pdf

Also, when have they scheduled your next echo? Hopefully they are not waiting longer than 6 months for the next follow up. When biovalves start SVD they sometimes degenerate rapidly, so please pay close attention to any symptoms you might have, such as shortness of breath, chest pains, or lightheadedness. If you experience any of these, I would strongly suggest advocating for another echo to see if things have advanced.
 
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Hello Chuck

Thanks for that link. Good information to have. I don't recall ever having had my Lp(a) level tested. I might bring it up at my next cardiology consult and see what they say. Would be really interesting to know my level.
Cheers and best to you.
 
I will add to @Chuck C point on SVD above. Mine started to leak a bit one year. Then 8 months later my heart started aching during exercise. Turns out that my valve had gone from small AR to very severe in 8 months. My LV was already in moderate dilation. The surgeon and the cardiologist were debating if it would go to back to normal after intervention.

Granted I had a stentless valve, where that is a lot more likely to happen. Nevertheless, Chuck is right that regular monitoring is the right thing to do at this stage. You really want to catch early rather than when you get to my phase. (Believe me, surgeon and cardio saying something different about long-term prognosis is quite anxiety inducing - I got incredibly lucky and my cardio was right. my LV went back to normal right after surgery.)
 
Good morning
Now I know I'm preaching to the choir, but it seems an ideal set up for me to not smash over the net...
Unfortunately, if you read the studies closely, the stroke risk of a bio and mechanical valve is roughly the same.
The only difference is that "the user" can make a huge difference by managing INR better with a mechanical valve and ACT and with the bioprosthetic valve too, it's just that the only attraction if the bio is that you (cab pretend) don't need to be on ACT. The attraction if the mech is it never wears out...

https://www.medscape.com/viewarticle/838221

For anyone who hasn't listened to that yet this is a textbook case of that discussion
 
Would be really interesting to know my level.
Cheers and best to you.
You know, I should have mentioned that in our discussion, but was too stunned by the news. But yes, it will be interesting because it will be one more data point in the growing body of evidence that Lp(a) levels are key to durability (of what isn't a durable option for a younger patient anyway) .

Best Wishes
 
In August last year, I had a 45 second or so episode of double vision (diplopia) while driving in the fast lane. It momentarily made driving safely extremely difficult. The double vision eventually resolved, and I hogged the slow lane back to London without a recurrence of the issue.

I thought the diplopia may have been tiredness/eye strain from driving or low blood sugar. But I erred on the side of caution and got it checked out.

At the A&E they did a thorough work up… full blood count, MRI head scan, carotid artery echo, bloods for endocarditis. All came back clear. Was referred to ophthalmology for eye tests. Those tests all proved clear.

In early December, I was out and about and suddenly felt unwell and lightheaded and headed for home. Once home, I still felt queasy and dizzy, but then suddenly my left arm and hand felt a tad heavy and disconnected.

I’m having a stroke, I thought.

I sat myself down considering what to do, and things appeared to resolve themselves just as quickly as they had begun. I headed for A&E.

Had a variety of tests at A&E and initially treated as trans ischaemic attack and loaded with Aspirin 300 mg to be taken daily (up from my usual 75mg daily) and discharged with TIA clinic follow-up.

An MRI of my head a few days later showed tiny cerebellar infarcts, which the consultant said might explain my symptoms. It thankfully wasn’t a bigger and more debilitating cerebellar infarction. These tiny infarcts were new and not showing on my previous August MRI following the double vision episode. I’ve noticed distinct short-term memory issues since this “minor stroke”.

The stroke consultant wanted to rule out cardio-embolic source of the ischaemic stroke, considering my background history of bioprosthetic valve.

Told to stop aspirin and switch to Clopidogel 75mg daily until further notice. There was to be no driving for one month.

New blood cultures for endocarditis came back negative. Full bloods taken all looked fine. Wore an ECG monitor for 7 days. Lots of stuff in that, but I wasn’t sure how to read it. They were mainly testing for atrial fibrillation, which didn’t seem to be an issue. There was another clear scan of the carotid artery.

A recent related (29 February) echocardiogram result came back, and it states:


On comparison to previous echo 2022 at GSST, there is an increase in gradients across the aortic valve replacement.

Tissue aortic valve in situ appears well seated.

Peak v max 3.8 m/s,

gradient 58 mmHg,

mean 28 mmHg,

functional AVA 1.1cm²

DVI 0.31.

No obvious regurgitation.

Dilated LA (Left Atrium).



This shows my gradients are up from 2022 and considerably up from a 4 month post August 2019 replacement reading of peak gradient 22mmHg and mean gradient 12mmHg.

For context, my final gradients pre AVR op were mean 60mmHg, peak 33mmHg

My aortic valve area is now moderate at 1.1cm². 4 month post replacement aortic valve area was 1.8cm². So edging towards severe.

Left Atrium dilated. Not sure of the significance of that.

I had an annual cardiac review booked for late May but had an urgent cardiology consultation a few days ago.

The cardiologist did a review and now wants me on warfarin, probably indefinitely, because of the cerebellar infarcts. She also suggested a low dose beta blocker (Bisoprolol) for the higher ventricular ectopic beats percentage that she noted reviewing the 7 day Holter monitor data.

She’s arranging an urgent cardiac angio CT scan of my 4 ½ year-old Inspiris Resilia bioprosthetic valve to look for any issues (BPVT – bioprosthetic valve thrombosis being one of them, I believe). The cardiologist confirmed my aortic valve area is now moderate and will monitor it again in six months with an echo. She will liaise with the stroke clinic.

She said my readings were not suggesting another surgery at this stage. But let’s see where things are in a year or two and what happens to my gradients and aortic valve area with warfarin treatment. Perhaps they will stabilise? Or better, I’m hoping the warfarin will reduce the current gradients. I read something about the possibility of that effect in a number of research papers. Let’s see.

Valve in valve (TAVI/TAVR) does not appeal to me for various reasons and is an unlikely option anyway I imagine, considering I have first degree heart block and left bundle branch block from my previous AVR surgery, plus the infarcts.

Should the day for re-operation arrive anytime in the next few years, I’m currently inclined to go mechanical. At least I will be warfarin savvy and well practiced by then… he said hopefully!

Onwards.
That's the valve I'm thinking about going with myself. How old were you when you got it implanted? I'm 61 myself and I found some studies that showed people like me with high LPA or lipoprotein will have increased SVD and a shorter life if I go down the bio prosthetic valve route. Of course in Thailand most of the doctors don't know anything about lipoprotein just like america. I did found however a surgeon here who will give me PC ks9 which will lower my lipoprotein number and should reduce calcification throughout my arterial and cardiac system going forward. It's an off-label treatment so I'll have to pay about $425 US dollars a month but it's worth it if I can extend the life of my cardiac system.. I had my Lipoprotein tested in the fall of 2019 very high. I just got it tested today ironically here in Thailand will be interesting to see if the numbers changed at all
 
Hello Chuck

Thanks for that link. Good information to have. I don't recall ever having had my Lp(a) level tested. I might bring it up at my next cardiology consult and see what they say. Would be really interesting to know my level.
Cheers and best to you.
Get it checked out. I'm not a bicuspid but I'm a normal tricuspid.. my valve started calcifying in my 40s but nobody said anything until I was in my fifties I had to go through old documentation. My calcification numbers are through the roof like in the thousands I got them checked out a week or two ago. It's an unknown risk factor that's just as much of a problem if not more so than cholesterol or ldl. Nobody seems to know about it anywhere in the world barely. There's no cure for but there's some off label treatments that work.
 
Hi Seaton.

Very sorry to hear about this. I hope things stabilize for you, but it sounds like your bio-valve is experiencing early SVD.

Have you had your Lp(a) level tested? I've linked a recent study below, published in Feb 2024, which found that elevated Lp(a) correlated with more rapid SVD in bioprosthetic valves. As of 2019, the EU guidelines now recommend that all people be tested at least once in their lifetime for Lp(a). Lp(a) levels are almost completely independent of diet and lifestyle, so one generally just needs to be tested once.

"high serum concentrations of Lp(a) were associated with a higher risk of SVD after aortic valve replacement at amedian follow-up of 4.4 years"

https://heart.bmj.com/content/heartjnl/110/4/299.full.pdf

Also, when have they scheduled your next echo? Hopefully they are not waiting longer than 6 months for the next follow up. When biovalves start SVD they sometimes degenerate rapidly, so please pay close attention to any symptoms you might have, such as shortness of breath, chest pains, or lightheadedness. If you experience any of these, I would strongly suggest advocating for another echo to see if things have advanced.
I didn't realize that bio valves could degrade quickly. Never heard that. Interesting. Even quicker than your native valve? Thanks Chuck
 
Hi Seaton.

Very sorry to hear about this. I hope things stabilize for you, but it sounds like your bio-valve is experiencing early SVD.

Have you had your Lp(a) level tested? I've linked a recent study below, published in Feb 2024, which found that elevated Lp(a) correlated with more rapid SVD in bioprosthetic valves. As of 2019, the EU guidelines now recommend that all people be tested at least once in their lifetime for Lp(a). Lp(a) levels are almost completely independent of diet and lifestyle, so one generally just needs to be tested once.

"high serum concentrations of Lp(a) were associated with a higher risk of SVD after aortic valve replacement at amedian follow-up of 4.4 years"

https://heart.bmj.com/content/heartjnl/110/4/299.full.pdf

Also, when have they scheduled your next echo? Hopefully they are not waiting longer than 6 months for the next follow up. When biovalves start SVD they sometimes degenerate rapidly, so please pay close attention to any symptoms you might have, such as shortness of breath, chest pains, or lightheadedness. If you experience any of these, I would strongly suggest advocating for another echo to see if things have advanced.
I think Chuck might be referring to a link that I sent him or he found out on his own regardless I found a link also for 2024 that showed definitively that bio prosthetic valves where our quicker for people who have elevated levels of lipoprotein. Even though I don't want to go down the mechanical valve route myself I'm having second thoughts about it because of my very high lipoprotein score. It means you're going to burn through valves quicker and your heart and your arteries or else going to get calcified quicker there's some alternative off label treatments you probably heard about. I'm going to follow the path of Chuck and get on PC ks9 here in Bangkok it took me almost 5 years to find a doctor who understood lipoprotein and agreed to give me this off label treatment of course it doesn't cover I'm not covered by anything in Thailand for insurance I'm just going to pay for $500 a month immediately after I get my heart surgery even if I get a mechanical valve just to slow down and calcification of my cardiac system
 
That's the valve I'm thinking about going with myself. How old were you when you got it implanted? I'm 61 myself and I found some studies that showed people like me with high LPA or lipoprotein will have increased SVD and a shorter life if I go down the bio prosthetic valve route. Of course in Thailand most of the doctors don't know anything about lipoprotein just like america. I did found however a surgeon here who will give me PC ks9 which will lower my lipoprotein number and should reduce calcification throughout my arterial and cardiac system going forward. It's an off-label treatment so I'll have to pay about $425 US dollars a month but it's worth it if I can extend the life of my cardiac system.. I had my Lipoprotein tested in the fall of 2019 very high. I just got it tested today ironically here in Thailand will be interesting to see if the numbers changed at all
Greetings newarrior

You are the age I was when I had my valve implanted.

I'm booked for a CT angio in mid April, so I should have a better idea if there are any issues percolating behind the scenes once I get the results. Apparently, it is much clearer to see BPVT / HALT (hypoattenuated leaflet thickening) via a CT angio. Will be interesting to see the results.

I've never had my Lp(a) tested, but am hoping to get it checked soon. I believe such a test's not routinely done via the UK's National Health system.

Best of luck to you going forward towards your eventual surgery.
 
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Greetings newarrior

You are the age I was when I had my valve implanted.

I'm booked for a CT angio in mid April, so I should have a better idea if there are any issues percolating behind the scenes once I get the results. Apparently, it is much clearer to see BPVT / HALT (hypoattenuated leaflet thickening) via a CT angio. Will be interesting to see the results.

I've never had my Lp(a) tested, but am hoping to get it checked soon. I believe such a test's not routinely done via the UK's National Health system.

Best of luck to you going forward towards your eventual surgery.
Good evening and nice to meet you sir. I'm sorry to hear about your dilemma. I became aware of LPA through Chuck who's been a tremendous resource for me. I had it tested in late 2019 it was very high just had it checked again today. I did doubt the number has changed but I want to check it out anyways. I found a doctor here in Bangkok who will give me the same drug that chuck is taking PC ks9. It's going to cost about $425 a month but at least I found somebody who'll give it to me and my cost of living is so low where I live whatever I'll just do it. I'll probably wait until after I get the surgery since at this point my native valve is pretty much toast. Your thing has got me frightened because I'm supposed to get the resilia valve in the next month or two. I'm very freaked out about the mechanical valve the ticking that everybody jokes about would drive me nuts I have no problems taking Warfarin I'm just worried about managing my INR because my life and my lifestyle is so erratic I'm always traveling moving around all the time plus I'm hardcore vegan but my dietary intake of things that could affect INR is very variable anyway somebody be watching your case closely. I'm wishing the best for you.
 
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