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ilapreynolds

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Hi! I am new to this forum and wanted to introduce myself.

I was just diagnosed with 3 heart valve inefficiencies...aortic, mitral, and tricuspid. All three valves are leaking and regurgitating. None of them have stenosis. My heart chambers are not enlarged. My right ventricle systolic pressure is at the upper limits of normal. My left ventricle ejection fraction is 60-65%. I have trace tricuspid regurgitation, mild mitral regurgitation, and moderate aortic regurgitation. The aortic valve is trileaflet. The aortic root is normal. This was a limited echocardiogram with bubble study.

Last year I had a regular echocardiogram. It only showed Rheumatic Disease of the mitral and aortic valves.

I have also been diagnosed with ventricular premature depolarization and atrial premature depolarization, as well as palpitations. My blood pressure monitor has flagged atrial fibrillation, but it was not caught on my holter monitor and I am not diagnosed with it.

I do have shortness of breath, extreme fatigue, and sometimes a dry cough. I deal with swelling and edema.

I also have hypermobile Elhers Danlos Syndrom (hEDS), a connective tissue disorder. I have Rheumatoid Arthritis.

I have been diagnosed from a Pulmonary Function Studies test with mild restrictive lung disease. However, my pulmonologist does not think I have it, since it is so close to border for the cut off of diagnosing it. But, my cardiologist and ENT do think I have mild restrictive lung disease, most likely interstitial lung disease, and do not agree with the pulmonologist. They think it is just in the early stages of the disease.

My blood oxygen levels (SPO2) drop as low as 70, but usually when it drops it is in the low 90s or upper 80s, and often hits 80. But, it's only gone down, as far as I know, to 70 a few times. I am not on oxygen. They have run several tests and do not know why it is doing this. Could this be from the heart valve insufficiencies?

My resting heart rate is in the 70s usually, or the 60s. But, it drops as low as 30 quite often. My heart rate also goes up very high, especially when standing. I have it recorded at home as high as 162, but it has been recorded in the high 180s on a sleep study test. Usually it goes over 100 when standing, or over 116, or over 132 or something like that. It often hits over 130.

I did have a tilt table test and was diagnosed with orthostatic hypotension. I have also been diagnosed with dysautonomia. My cardiologist won't diagnosis me with POTS, even though I meet the criteria, because my blood pressure goes up when standing also. I have talked to him about it being hyperandrenergic POTS (I meet all the symptoms of that) and he thinks that might apply, and could be it, but he hasn't officially diagnosed me with it. He is treating me for my hyperangrenergic state, though.

As far as other diagnoses go, I have 7 pages single spaced of those, but probably over 20 major diagnoses. So, I do have a lot going on in my body.

I have not had my follow up with my cardiologist yet, so I do not know what he will say. I have just seen my medical report and the diagnoses in my patient portal. I am assuming that he will just watch my heart valves.

Have any of you had 3 leaky heart valves? It is concerning that it went from none last year to 3 this year? Or is that normal? Also, I know they usually wait until a heart valve is severely leaking before they do anything, but I read something from a heart doctor that said with multiple valves leaking that they sometimes do surgery before each valve can qualify. Has anyone had any experience with that?

I know everyone is different, but I do wonder how long I might have until this progresses and I have to have valve replacement surgery. If anyone has any advice on typical time frames or how long it takes things to advance, I would appreciate it. I realize that you might not be able to answer that, also. From what I understand from looking things up, it can stay mild, but once it progresses to moderate (like my aortic valve is) then it typically does progresss and eventually advances to needing surgery. Does that sound right with what you have learned? I know that looking things up on the internet is not always accurate.

Any stories or advice is welcome. I am very concerned.
 

MdaPA

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Welcome!

I have trace tricuspid regurgitation, mild mitral regurgitation, and moderate aortic regurgitation.
"Trace" TV regurgitation should not be causing any of your symptoms and usually does not require intervention. Certainly mild mitral regurgitation along with moderate aortic regurgitation could.

I have been diagnosed from a Pulmonary Function Studies test with mild restrictive lung disease. However, my pulmonologist does not think I have it, since it is so close to border for the cut off of diagnosing it. But, my cardiologist and ENT do think I have mild restrictive lung disease, most likely interstitial lung disease, and do not agree with the pulmonologist.
Some of you symptoms sound like they could be from pulmonary hypertension caused by your AV and MV regurgitation. My wife's Dr.'s thought that her pulmonary hypertension and associated symptoms were due to lung issues but they resolved after her diseased MV and AV were replaced. Ask your Cardio re: pulmonary hypertension due to left heart disease.

Last year I had a regular echocardiogram. It only showed Rheumatic Disease of the mitral and aortic valves.
Did you have rheumatic fever?

Have any of you had 3 leaky heart valves? It is concerning that it went from none last year to 3 this year? Or is that normal?

If your echo from 1 year ago was a truly a good study which definitively showed no regurgitation and your latest echo now shows moderate aortic regurgitation (much less so for mild MV regurgitation I would think), then no, this does not sound normal. However, you obviously have a lot going on, heart wise along with other stuff, so you need to find an answer for this with your Cardio and other specialists.

I also have hypermobile Elhers Danlos Syndrom (hEDS), a connective tissue disorder.
Have you been checked if you also have the cardiac form of EDS called cvEDS which can affect your heart valves?
 
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pellicle

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Hi @ilapreynolds , and welcome

I saw this earlier and didn't know what to say, but I see that @MdaPA has done a pretty good job of addressing some points (better than I could) and so as this is way out of my depth I just wanted to wish you well and hope it gets sorted out.

I would call this one of the more complex situations I have seen (and like, wow 3 valves) but I trust that the medical system will be able to re-plumb your system and you'll be better (at least).

Best Wishes
 

ValveAdmin

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Welcome to the forum. I hope that you find good answers here and that everything is okay. Best wishes.
 

Chuck C

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Welcome to the forum.

I can't speak to most of your questions, but I will say that to have an echo with "trace" regurgitation is very common in normally functioning valves and usually not cause for alarm. Your shortness of breath and extreme fatigue are a concern and could possibly be caused by your moderate aortic regurgitation. On the other hand, you have many other things going on, so it could also be something else which is the cause of this.


Have any of you had 3 leaky heart valves? It is concerning that it went from none last year to 3 this year?

Yes, and you should continue to be monitored. I expect that you will by your medical team. Although, it is common for a valve to show no regurgitation then trace then none again. This was the case for my aortic valve. It would sometimes show trace regurgitation and sometimes none. My issue was stenosis not regurgitation. In my view, your aortic valve with moderate regurgitation is more the issue, and also if the mitral progresses from mild to moderate. I suspect that you may have a one valve issue, rather than a three valve issue. Hopefully your cardiologist can shed some light on this after his interpretation of your echo.

Please let us know what your cardiologist says. With the complexity of your issues, I would suggest that a second and even third opinion might be a good idea.
 

vitdoc

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Of all of the things you mentioned the low oxygen saturation stands out significantly. With an ejection fraction of 60-65% you are not in major heart failure.
So I think the issue is why do you have such low oxygen saturation levels? Between the cardiologist and the pulmonary doctor hopefully you will get some answers. I doubt the orthostatic hypotension would cause the low O2 levels also.
Have this figured out.
 

ilapreynolds

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Location
Southeast Idaho
"Trace" TV regurgitation should not be causing any of your symptoms and usually does not require intervention. Certainly mild mitral regurgitation along with moderate aortic regurgitation could."

Thank you for this explanation.

"Some of you symptoms sound like they could be from pulmonary hypertension caused by your AV and MV regurgitation. My wife's Dr.'s thought that her pulmonary hypertension and associated symptoms were due to lung issues but they resolved after her diseased MV and AV were replaced. Ask your Cardio re: pulmonary hypertension due to left heart disease."

Thank you. I will ask my doctor about this. I am glad to know that your wife's lung issues resolved after replacing her diseased valves. I hope mine will do the same.

"Did you have rheumatic fever?"

No. I haven't. Not as far as I know. But my cardiologist said that this can be caused by Strep Throat. And, from what I read about it, it also says that it can be caused by Strep Throat. I have had a LOT of Strep Throat in my life. They even took my tonsils and adnoids out when I was very young because of it. It seemed to help when I was younger. But, I have had it a lot as an adult.

My cardiologist said that if I ever have a sore throat or ear, nose, throat infection that I would need to be on antibiotics.... and I have been since he told me for those reasons.

My dad did have rheumatic fever when growing up... as a teenager, I think. But, my parents tell me that I never had it.

"If your echo from 1 year ago was a truly a good study which definitively showed no regurgitation and your latest echo now shows moderate aortic regurgitation (much less so for mild MV regurgitation I would think), then no, this does not sound normal. However, you obviously have a lot going on, heart wise along with other stuff, so you need to find an answer for this with your Cardio and other specialists."

I have wondered if they missed it the first time. I really don't know. I would like to get a copy of my report on this and see exactly what it said. I only know what I was diagnosed with after it was done. Perhaps it was listed in the report and not in the diagnoses. But, I do know that my cardiologist only talked with me about the other heart issues and not any heart valve insufficiencies, so I am thinking it was not found. Maybe it was to mild/trace enough not to mention.

Thank you for the answer. I will look into this.

"Have you been checked if you also have the cardiac form of EDS called cvEDS which can affect your heart valves?"

I have been checked (genetic testing) and I do not have cvEDS. I do know that there is a lot of overlap between the different types of EDS.

Thank you for replying.
 

ilapreynolds

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Southeast Idaho
Hi @ilapreynolds , and welcome

I saw this earlier and didn't know what to say, but I see that @MdaPA has done a pretty good job of addressing some points (better than I could) and so as this is way out of my depth I just wanted to wish you well and hope it gets sorted out.

I would call this one of the more complex situations I have seen (and like, wow 3 valves) but I trust that the medical system will be able to re-plumb your system and you'll be better (at least).

Best Wishes

I appreciate you responding to me. Thank you. And, thank you for the well wishes. I appreciate that.

Thank you also, for the perspective on this being a more complex heart situation. I didn't know that it was. Have you seen a lot of different situations?

I do hope that they can help me to get feeling better.

I have a lot of medical issues, I am told by my doctors, due to being in a very abusive marriage for 23 years. I am just recently divorced and working with the Family Crisis Center and am in their Domestic Violence and Sexual Assault support groups. I have C-PTSD (Complex PTSD). I am working with the prosecutor's office, as well, although that was put on hold through the divorce. I did have surgery to fix the damage done by all the years of marital rapes and sexual abuse. My OB-GYN is the one who got me connected with help in getting out and was willing to testify for me and wrote a witness statement for me.

So, from my understanding, living with severe abuse for so long, and living with so much stress from it all, has a way to do a lot of damage to the body and can cause autoimmune and other diseases. I am hoping that as this situation resolves completely, that my body will be able to heal as much as possible.

That is the only reason I can think of for having so many medical issues. And, my many, many doctors and specialists have told me that they think this is the reason.
 

ilapreynolds

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Messages
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Location
Southeast Idaho
Welcome!


"Trace" TV regurgitation should not be causing any of your symptoms and usually does not require intervention. Certainly mild mitral regurgitation along with moderate aortic regurgitation could.


Some of you symptoms sound like they could be from pulmonary hypertension caused by your AV and MV regurgitation. My wife's Dr.'s thought that her pulmonary hypertension and associated symptoms were due to lung issues but they resolved after her diseased MV and AV were replaced. Ask your Cardio re: pulmonary hypertension due to left heart disease.


Did you have rheumatic fever?



If your echo from 1 year ago was a truly a good study which definitively showed no regurgitation and your latest echo now shows moderate aortic regurgitation (much less so for mild MV regurgitation I would think), then no, this does not sound normal. However, you obviously have a lot going on, heart wise along with other stuff, so you need to find an answer for this with your Cardio and other specialists.


Have you been checked if you also have the cardiac form of EDS called cvEDS which can affect your heart valves?

I don't think my reply was done correctly, so I am trying this again.

Here are my answers that I already posted listed below:


"Trace" TV regurgitation should not be causing any of your symptoms and usually does not require intervention. Certainly mild mitral regurgitation along with moderate aortic regurgitation could."

Thank you for this explanation.

"Some of you symptoms sound like they could be from pulmonary hypertension caused by your AV and MV regurgitation. My wife's Dr.'s thought that her pulmonary hypertension and associated symptoms were due to lung issues but they resolved after her diseased MV and AV were replaced. Ask your Cardio re: pulmonary hypertension due to left heart disease."

Thank you. I will ask my doctor about this. I am glad to know that your wife's lung issues resolved after replacing her diseased valves. I hope mine will do the same.

"Did you have rheumatic fever?"

No. I haven't. Not as far as I know. But my cardiologist said that this can be caused by Strep Throat. And, from what I read about it, it also says that it can be caused by Strep Throat. I have had a LOT of Strep Throat in my life. They even took my tonsils and adnoids out when I was very young because of it. It seemed to help when I was younger. But, I have had it a lot as an adult.

My cardiologist said that if I ever have a sore throat or ear, nose, throat infection that I would need to be on antibiotics.... and I have been since he told me for those reasons.

My dad did have rheumatic fever when growing up... as a teenager, I think. But, my parents tell me that I never had it.

"If your echo from 1 year ago was a truly a good study which definitively showed no regurgitation and your latest echo now shows moderate aortic regurgitation (much less so for mild MV regurgitation I would think), then no, this does not sound normal. However, you obviously have a lot going on, heart wise along with other stuff, so you need to find an answer for this with your Cardio and other specialists."

I have wondered if they missed it the first time. I really don't know. I would like to get a copy of my report on this and see exactly what it said. I only know what I was diagnosed with after it was done. Perhaps it was listed in the report and not in the diagnoses. But, I do know that my cardiologist only talked with me about the other heart issues and not any heart valve insufficiencies, so I am thinking it was not found. Maybe it was to mild/trace enough not to mention.

Thank you for the answer. I will look into this.

"Have you been checked if you also have the cardiac form of EDS called cvEDS which can affect your heart valves?"

I have been checked (genetic testing) and I do not have cvEDS. I do know that there is a lot of overlap between the different types of EDS.

Thank you for replying.
 

ilapreynolds

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Joined
Jun 6, 2022
Messages
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Location
Southeast Idaho
Welcome to the forum.

I can't speak to most of your questions, but I will say that to have an echo with "trace" regurgitation is very common in normally functioning valves and usually not cause for alarm. Your shortness of breath and extreme fatigue are a concern and could possibly be caused by your moderate aortic regurgitation. On the other hand, you have many other things going on, so it could also be something else which is the cause of this.




Yes, and you should continue to be monitored. I expect that you will by your medical team. Although, it is common for a valve to show no regurgitation then trace then none again. This was the case for my aortic valve. It would sometimes show trace regurgitation and sometimes none. My issue was stenosis not regurgitation. In my view, your aortic valve with moderate regurgitation is more the issue, and also if the mitral progresses from mild to moderate. I suspect that you may have a one valve issue, rather than a three valve issue. Hopefully your cardiologist can shed some light on this after his interpretation of your echo.

Please let us know what your cardiologist says. With the complexity of your issues, I would suggest that a second and even third opinion might be a good idea.

Thank you for the reassurance about the "trace" regurgitation. And, thank you for helping me understand that the shortness of breath and extreme fatigue could possibly be caused by my moderate regurgitation. I wondered if it could. I do know that I have too many other things that could cause these things as well. That's what makes it difficult.

I didn't know that regurgitation could disappear. Is this only for trace reguritation? Can mild regurgitation go back to trace, and moderate to mild?

I guess I am worried that if three leaks sprouted up in a year and one progressed to moderate, then by the time it progresses to severe, would the other mild and trace ones have progressed too? So, do they only replace the most diseased heart valve during surgery and then wait until the others are severe enough before replacing them? So, if the others do progress to the point of needing surgery, then I am looking at multiple surgeries? Or, are they likely to just stay at trace, and mild, and won't be worrisome? I do agree that the most concerning part is the moderate aortic valve regurgitation.

I could try and see another cardiologist in the practice for a second or third opinion, but outside of this practice, it would be harder to find another cardiologist without going to Utah or Boise. Specialists here are all overbooked and there aren't enough to go around. Most people in the area aren't happy with most specialists and travel to Utah for specialists... a four hour drive. I try to work with the doctors locally, as I don't really want to make that drive. Most of my specialists are fine. I do think I might do better for a few of them to go to Utah or Boise, though. I can see why people recommend that.
 

ilapreynolds

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Of all of the things you mentioned the low oxygen saturation stands out significantly. With an ejection fraction of 60-65% you are not in major heart failure.
So I think the issue is why do you have such low oxygen saturation levels? Between the cardiologist and the pulmonary doctor hopefully you will get some answers. I doubt the orthostatic hypotension would cause the low O2 levels also.
Have this figured out.

Yeah.... I am worried about that.

That's good to know. Thank you.

My pulmonologist has run all the tests he wanted to and thinks it is a heart problem. My cardiologist could only think that I possibly had a stent in my heart.... a hole between chambers.... or something like that. He said if he didn't find it on this test, then it could be in my lungs. And, if he didn't find it there, then it could be in my liver. Other than that, he didn't know what would cause it, other than my Dysautonomia.

They didn't find a stent with this limited bubble study echo. But, they did find these three valve insufficiencies. So, I am interested to know if that will change what he is thinking.

My oxygen saturation levels don't drop for long periods of time... ususally only less than a minute or two... and up to ten minutes. My cardiologist told me if it drops below 85 for over an hour, then he will put me on oxygen at home. But, it hasn't done that.

Even though each episode doesn't last long, they come one right after another. It can be below 94 for 87% of the time that I am recording... or 50% of the time I am recording... or 30% or 10%. I have more drops when I am awake and active. I have less drops while sleeping but still have them. I did have more drops when sleeping before I got my CPAP machine.

If it is not the orthostatic hypotension causing the oxygen drops, do you have any suggestions that I could ask my cardiologist and pulmonologist about?

Thank you for your answers and insight.
 

pellicle

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Have you seen a lot of different situations?

I guess perhaps I have. I've been here on this forum for about 10 years now and for a younger man ...

40335848202_129ac8b3dc.jpg


I've had 3 OHSs (starting from 10 yo) and thus had a few direct experiences of my own.

Best Wishes
 

ilapreynolds

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I guess perhaps I have. I've been here on this forum for about 10 years now and for a younger man ...

40335848202_129ac8b3dc.jpg


I've had 3 OHSs (starting from 10 yo) and thus had a few direct experiences of my own.

Best Wishes

Thank you. I wondered if that was the case.

I appreciate your insights.

LOL.

Oh, wow! So many! That's so young! That must have been awful! And so many times! I am sorry!

Do you mind sharing why so many open heart surgeries? Is it related to tissue vs mechanical?

I have had a lot of surgeries and surgical procedures, but never anything with my heart. I have watched my mom go through open heart surgery, though. And, that was awful to watch her struggle.

Oh, I am 48 years old, by the way.
 

pellicle

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Do you mind sharing why so many open heart surgeries?
not at all. If you simply do the numbers (and indeed look at my bio) you can see that my first was when I was 10, back in the mid 1970's technology and surgical technique was not what it is today (the actual first human valve replacement was 1962, so pretty new stuff). Further working on one so young means valve choice (specifically durability and diameter) are very vexing. So I was fortunate to have that done as a repair which allowed the heart to grow naturally. #surgery1

This lasted until I was about 28 and in that time many developments and new ideas were burgeoning in cardiac surgery, so in 1992 I got someone elses valve (a homograft) which lasted me quite well. Because things are what they are in Australia this stuff was done in one hospital in my state and I formed part of this study. Stuff like the title of that (The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements.) just don't happen any more. #surgery2

I continued to lead a normal life (lived abroad and travelled a lot) and accordingly missed about the last 10 years of any follow-up. I felt in 2010 I felt that it was time another checkup (and we were going back to Australia) and found that as well as (I'd suspected based on my own evidence) the valve was becoming incompetent I had a rather large aneurysm which needed urgent attention (IIRC 5.6cm) and so after discussions (perhaps too brief for my wife) I saw that the logical course was to have a mechanical with a bental and begin my career on Ratsak. #surgery3

A get well postcard my Finnish friends sent me when I started my career on Warfarin
1655032903950.png


;-)

In combination with my prior educational and working career I've managed to make a pretty good fist of managing INR (indeed even help the odd person here and there) ... that we now have point of care machines is even better and indeed entirely makes it possible.

The world of the 1990's with labs and vein draws to manage INR seems rather stone age to me, and in reality managing INR is far less onerous than managing ones blood sugar levels and the administration of insulin.

Frankly I just won't know what all the fhukken fuss is about with a finger stick once a week and taking some pills.

If you search you'll find a ton of my posts on:
  • measuring INR,
  • self managing,
  • debunking bull5hit about the horrors of warfarin
1655032720146.png


take the mystery out of stuff >> self test and know thyself.

Best Wishes
 

MdaPA

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Messages
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I guess I am worried that if three leaks sprouted up in a year and one progressed to moderate, then by the time it progresses to severe, would the other mild and trace ones have progressed too?
Maybe, maybe not. Normal people without heart valve disease (like me) can and do develop "trace" valve or even "mild" regurgitation as they age and not require surgery or intervention.

So, do they only replace the most diseased heart valve during surgery and then wait until the others are severe enough before replacing them? So, if the others do progress to the point of needing surgery, then I am looking at multiple surgeries? Or, are they likely to just stay at trace, and mild, and won't be worrisome?
Therein lies the rub when someone has multi-valve disease or only has AV disease and has a ROSS procedure. The diseased valves replaced with tissue valves often don't deteriorate at the same rate and may require surgery/intervention at different times.

My wife had a ROSS procedure and a mitral valve repair in her 1st OHS. So she went from a 2 valve disease (AV and MV) to 3 (AV, MV and PV). It was a long, complex surgery and the surgeon was running out of time and tried to do a quick MV repair (commissurotomy) rather than replace it. 3 years later, her MV repair failed and she had her 2nd OHS to replace it with a bovine tissue valve. Her AV and PV valves were running fine at that time and did not require intervention.

17 years later, her bovine MV was now leaking moderately-severely and required intervention. Her surgeon recommended that her MV be replaced with a mechanical valve and during that same surgery, her AV also get replaced with a mechanical valve to reduce the likelihood of a 4th OHS (note she did get a 2nd opinion with another surgeon who said he would only replace her MV with a tissue valve, not mechanical valve, and would not replace her functioning, but slowly declining, AV and PV valves in that same OHS but she did not go with this surgeon). So in her 3 OHS, she got mechanical AV and MV's, porcine for her PV and a simple repair of her TV (so now she has 4 valve disease).

She lives echo-to-echo (annually) and as of her last report, everything is good but we know that there is good chance her porcine PV valve will need intervention hopefully in the far distant future (hopefully TPVR procedure but who knows) but much less of a chance with her AV, MV and TV's.

So you can see how multi-valve disease can get real complicated and opinions can be drastically different among surgeons as when or if to intervene.
 
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pellicle

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@ilapreynolds

Maybe, maybe not. Normal people without heart valve disease (like me) can and do develop "trace" valve or even "mild" regurgitation as they age and not require surgery or intervention.

I would second this point

So to me what is happening (observe and calculate while you go on with life as normal) is the best strategy to have. If there is progression then it can be dealt with, if not then just put it out of your mind and follow the observation schedule.

I hope you find this helpful advice from Marcus Aurelius

1655072044985.png


Best Wishes
 

pellicle

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Hi
I just wanted to say that once we have been diagnosed with valvular heart disease we are often exposed to greater risk of ongoing needs for surgery (especially if it was a genetic origin rather than some disease like Scarlet Fever) as we age. To me the answer has always been to accept this, to be pleased we live in a time when more life can be granted with modern advances and to manage things conservatively.

I don't recall how old your wife was at first OHS, but I hope she got at least 30 good years of life before being introduced to the life including surgery.

Best Wishes

My wife had a ROSS procedure and a mitral valve repair in her 1st OHS. So she went from a 2 valve disease (AV and MV) to 3 (AV, MV and PV). It was a long, complex surgery and the surgeon was running out of time and tried to do a quick MV repair (commissurotomy) rather than replace it. 3 years later, her MV repair failed and she had her 2nd OHS to replace it with a bovine tissue valve. Her AV and PV valves were running fine at that time and did not require intervention.

17 years later, her bovine MV was now leaking moderately-severely and required intervention. Her surgeon recommended that her MV be replaced with a mechanical valve and during that same surgery, her AV also get replaced with a mechanical valve to reduce the likelihood of a 4th OHS (note she did get a 2nd opinion with another surgeon who said he would only replace her MV with a tissue valve, not mechanical valve, and would not replace her functioning, but slowly declining, AV and PV valves in that same OHS but she did not go with this surgeon). So in her 3 OHS, she got mechanical AV and MV's, porcine for her PV and a simple repair of her TV (so now she has 4 valve disease).
 

MdaPA

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I don't recall how old your wife was at first OHS, but I hope she got at least 30 good years of life before being introduced to the life including surgery.
You nailed it, she was 30 during her first OHS. And good years of life continued, if not more, after each of her surgeries. Her motto is "always keep moving" and "there is always someone worse off than you".
 

pellicle

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You nailed it, she was 30 during her first OHS. And good years of life continued, if not more, after each of her surgeries. Her motto is "always keep moving" and "there is always someone worse off than you".
she sounds like a great woman to be married to. I was fortunate to also have a bit of that.
 
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