Echo shows low EF after mitral valve replacement-need more advice please!

[jhusker2]

Well, I am officially 5 weeks post op and have had several concerns that hopefully can be addressed via this forum.

1) Whenever I lay on my left side or back at night, my heart rate drops significantly (from 70’s to high 40’s) and it feels like I can’t breath until I sit up or lay on my right side (The cardiologist didn’t have any suggestions on what this might be).

2) I had an echo last week and the same thing happened when lying on my left side. I met with the cardiologist today and he said my Ejection Fraction was 35-40% post-op and was 60% pre-op. He suggested that I start taking an ACE inhibitor to bring it back up to normal.

I really don’t want to take any more meds, but will if necessary. Being that I just had mitral valve replacement surgery, wouldn’t my EF go back up on its own? Especially if I am in cardiac rehab? Could problem #1 be causing this?

Thanks in advance for all that wish to respond!

Jason

1/10/2011 MV replacement – Bovine valve

 

[malibu82]

hey there.

i had a similar problem. i had my surgery of my aortic valve replacement with a bovine valve like yours in may of 2010. (9 months ago). i had an echo at 6 months post op done, and was devastated by my results. my pre op ejection fraction rate was 60%. my post op ejection fraction was 55%. and then my mean gradient numbers were way off as well. so i grilled multiple doctors about it, they all didn't really give me an answer or have any concern about it.

i recently had a cardiac mri, and it shows my ejection fraction rate is back up to 64%!! so i think it takes time.....i dont know. its weird and just something i will never understand!

 

[ALCapshaw2]

It might be a good idea to get a Second Opinion, starting with your Surgeon.

A resting heartrate below 40 bpm is a serious concern to many physicians.

'Small' Variations in EF can be attributed to measurement error.

Dropping from 60% to 35% is something should be explained.
Was it a measurement error or is it somemore more significant?
Good Questions to ask when getting second opinions.

'AL Capshaw'

 

[UnderDog]

Hi J, after my mitral valve repair my ejection fraction dropped from 65% to 45%. My cardiologist and electrophysiologist think the drop in ejection fraction happened because my valve was so leaky before the surgery. They said that because of the significant mitral valve regurgitation before the repair, my left ventricle could push blood out two ways- through the aortic valve and also backwards through the mitral valve (it was almost as if the mitral valve wasn't there). After surgery, blood could only be pushed out one way- through the aortic valve. Because there is only one exit now, the left ventricle needs to squeeze harder than it did before the surgery to move the same volume of blood out of the chamber. The heart needs to get used to the remodeling and adjust the level of its "squeeze." I'm not on medication for this, yet. They are going to check my ejection fraction at 6 months out and expect (hope) that it will improve on its own now that I am physically active again.

 

[Greg a]

hey there.

i had a similar problem. i had my surgery of my aortic valve replacement with a bovine valve like yours in may of 2010. (9 months ago). i had an echo at 6 months post op done, and was devastated by my results. my pre op ejection fraction rate was 60%. my post op ejection fraction was 55%. and then my mean gradient numbers were way off as well. so i grilled multiple doctors about it, they all didn't really give me an answer or have any concern about it.

i recently had a cardiac mri, and it shows my ejection fraction rate is back up to 64%!! so i think it takes time.....i dont know. its weird and just something i will never understand!

Nail on the head time ...I agree with Jackie

 

[hook]

1) Whenever I lay on my left side or back at night, my heart rate drops significantly (from 70’s to high 40’s) and it feels like I can’t breath until I sit up or lay on my right side (The cardiologist didn’t have any suggestions on what this might be).

I wish I could find the study, but I know it exist. The study concluded people who regulary sleep on their left side have a higher risk of heart disease. The logic was that sleeping on the left side adds extra pressure to the left ventricle. Who knows

2) I had an echo last week and the same thing happened when lying on my left side. I met with the cardiologist today and he said my Ejection Fraction was 35-40% post-op and was 60% pre-op. He suggested that I start taking an ACE inhibitor to bring it back up to normal.

My doc told me after my mitral valve was replaced my EF would go down. He explained that the pre-op EF was a false reading since much of that blood was pumping backwards, where there was little presure. Once the blood has to pump in the right direction where the presure is much greater, there may be a lower EF. If did not say that right, please don't hold my feet to the fire, my memory is not perfect.

My Ef is the same or lower when I got my MV replaced; I am at 25%. Now that I am 10 months post op, I feel better that i have felt in 5 years. It will take you anywhere from 6 to 9 months to get to a point where you feel better that you did before the surgery. Hang with it and live well