Leaking Valve at Ring

[Daveb]

Hi All,
I had an AVR for a BiCuspid AV/Stenosis in Dec 2010. The surgeon used a minimal sternotomy and everything went well. I was running at 6 weeks and life was happy.

In March (12-14 weeks post surgery) I started to feel a little sluggish, but thought it was just because I was training pretty hard. In the middle of April I had to leave work because of chills and fever. I went to my PCP, she ran some blood tests, thought it was pneumonia and prescribed some oral antibiotics. After the 10 day antibiotic course I was feeling a little better, but started having some breathing issues, and coughing issues, still with chills and fevers.
On May 12 she ordered a blood bacteria test. On May 13th I got calls from PCP, Cardiologist, Surgeon and Hospital to get to the hospital ASAP, so I was admitted for endocarditis. They started IV antibiotics. An echo showed that my valve was almost completely destroyed and I had surgery on the 18th. The surgery went OK, but a piece of the vegetation broke loose and I suffered a stroke on the table. I regained consciousness three days later and had minimal use of my left arm, but everything else was OK. Within a couple of days I regained more use of my arm (now at 7 weeks I have regained about 90-95% use).
Came home from the hospital on May 26th and recovery progressed pretty smoothly. I was (and am) still getting IV antibiotics, but my strength and energy continues to get better every week.
At 6 weeks I saw the surgeon and he said that everything was good and released me to work and start being more active. ( I have been walking and doing easy bike rides).
At 7 weeks (this week) I saw the Infectious disease doctor and he thought that he heard a diastolic murmmer and wanted an Echo to see what was going on. The Echo showed a small leak at the ring of the new valve where it is sewed on. I have contacted the surgeon and i am waiting for his call.

Has anybody had a replacement valve leak and do you know what the general procedure is for repairing the leak? Does the leak heal itself overtime?

My wife and I are a little concerned because it has been a very stressful 3 months.

Thanks
Dave

 

[catwoman]

Dave:
Sorry you've had to undergo 2 surgeries in such a short period of time. I'm surprised your PCP did not immediately order cultures when you had the chills & fever. My PCP is pretty quick to order blood cultures when I've felt puny -- 3 times since my surgery, the first time just about 4 weeks post-op. He's had a couple of patients with endo.

Are you referring to lateral regurgitation or perivavular regurgitation? I have perivalvular regurge; my understanding is that native tissue didn't seal over where the ring & valve were sewn in. (I could be wrong on my take of the situation.)
Mine was found 4 years ago when I had my annual echo, and my cardio ordered a TEE to get a better look. I changed cardios 2+ years ago and the new one ordered a TEE after my annual echo 2 years ago. That TEE showed no change from 2007.
I have my annual echo in about 2 weeks. I'm keeping my fingers crossed that things are the same.
My new cardio told me that if things stay the same, I'm safe. If the regurge significantly increases, the only solution is another surgery. When my husband had his 1-year recheck for his MV repair, I spoke to his surgeon about the regurge. He said you can generally live with it; if it worsens significantly, the valve will have to be replaced.
I'm sure your doctor will be considering ordering a TEE.
I feel fine. I do use the regurge as a "crutch" to demand downstairs hotel rooms, when available. Don't want to schlep luggage up stairs. I've had to evacuate hotels before and it's a PITA (did it 2 weeks ago at the Hyatt Regency in Reston (VA) Town Center; luckily, I was in a 2nd-floor meeting room, not in my 10th-floor guest room).

 

[ottagal]

Dave,
I just read your post and just wanted to say that I am so sorry to hear of all you have had to endure including another surgery. You are due for a break.
I am sure others who are more knowledgeable on the topic of perivalvular leaks will chime in soon.
Thinking of you and and sending you positive vibes.

 

[nngbwh]

I am sorry to hear that. Let's hope the surgeon called you back with good news. Keep us posted.

 

[ken taylor]

Dave my positive thoughts will be with you today. I hope things turn for the better. Dave may I ask where are you and who did your surgery.

 

[wxman]

Hope you get good news.

I developed fairly significant leaking at the suture line about 4 years after my surgery. It appeared I was headed for another surgery. Fortunately, over the last 4 years the leaking has decreased quite a bit...so things are good again. I never had any symptoms during any of this. My cardio suspects that scar tissue has continued to close up the gaps that developed between the valve ring and the heart tissue. I am no Dr...but my case shows that this problem can improve over time. Good luck!

 

[catwoman]

Hope you get good news.

I developed fairly significant leaking at the suture line about 4 years after my surgery. It appeared I was headed for another surgery. Fortunately, over the last 4 years the leaking has decreased quite a bit...so things are good again. I never had any symptoms during any of this. My cardio suspects that scar tissue has continued to close up the gaps that developed between the valve ring and the heart tissue. I am no Dr...but my case shows that this problem can improve over time. Good luck!

Reading wxman's post reminded me of one good thing seen in my last echo: My cardio was happy to see an improvement in the gradient, which in turn made me very happy. I had forgotten about that.
So ... you can have improvements even though the regurge is still there.

 

[Daveb]

Thanks everybody. I am still waiting to hear from the surgeon, but I do have an appointment with the cardiologist next week. Google research shows that there are some places doing a catherter repair to leaks. But if mine is just a small leak and doesn't progress, and has minimal affect on my health, then I will probably live with it as long as I can, as I am not looking forward to another procedure in the near future.

Ken, the surgery was performed at Oregon Heart and Vascular Institute in Springfield, OR by Dr. David Duke.

 

[Gail in Ca]

Jeez, you have been thru the ringer, that's so crappy! Having had endocarditis in '08, I can relate. My mechanical AV was leaking mildly around the ring due to the bacteria causing damage. I had to have it replaced because my anemia just wouldn't get better.
I would think if it isn't affecting your life, and it's a mild to moderate leak, they might wait. My doc moved my AV up along the aorta to get it out of the area of damage.
The best to you. I'm so sorry you got endocarditis, and now are having these issues to deal with.