Left Ventricle Remodeling after AVR

Help Support ValveReplacement.org:

Heart_Fit

Member
Joined
Sep 2, 2017
Messages
8
Location
West hollywod CA
Hello everyone!

I just completed my second open heart surgery last week. My first surgery was a valve repair, this surgery was an aortic valve replacement (mechanical).
One thing I can’t seem to get out of my head was that after the surgery, the surgeon told my mom everything went well but that my ventricle was significantly enlarged. Then somewhere along the lines ‘praying’ was brought up, as though the enlarged ventricle was something to be worried about quite a bit.

I am 31 years old, have had consistent echos the past three years and all along I’ve been told the enlargement essentially correct itself after surgery and that id live a long happy life. Now I’m concerned.
Can anyone shed some light on what maybe the surgeon was saying? Or If it was taken out of context? I meet with him in a few weeks and am hoping to ease my mind a bit.
Thanks!
 
Last edited:

LoveMyBraveHeart

Well-known member
Joined
Aug 6, 2019
Messages
119
Location
USA
Hi! I think it was possibly taken out of context.

After Mathias' last surgery, his left ventricle at 4 weeks post op had already begun to return to normal size. Of course, ask your surgeon about this, but I believe if the LV dilation was caused by the valve regurgitating, it is completely possible to return to almost normal, if not completely normal, size and function. I hope that your recovery is going well otherwise!
 

LoveMyBraveHeart

Well-known member
Joined
Aug 6, 2019
Messages
119
Location
USA
No problem! I'm sorry it wasnt an in depth answer, but I'm sure one of the many smart folks on here will swoop in soon and answer this in detail for you. I know how hard it is to have your questions left unanswered!
 

DDT77

Well-known member
Joined
Dec 9, 2017
Messages
49
Location
NC, USA
Hi,

Your heart had been working hard to get the needed blood to your body. Due to the valve issue, the left ventricle had to work harder than it is meant to. So you were overworking part of the heart, and it gained muscle to compensate (too much and you may become musclebound?). Now that your valve is working as it should, the heart no longer has to work overtime to get the job done, so the muscle atrophies back to normal. Here are couple of links to start:
https://www.mayoclinic.org/diseases-conditions/left-ventricular-hypertrophy/symptoms-causes/syc-20374314
https://my.clevelandclinic.org/health/diseases/17168-left-ventricular-hypertrophy-enlarged-heart
I agree with Jill. Sounds like something may have been heard and taken out of context. I think my hypertrophy was well mitigated a few short weeks after valve replacement as well.

cheers!
 

leadville

Premium Level User
VR.org Supporter
Joined
Aug 28, 2017
Messages
305
Location
Greater Manchester, England
Mine had returned to normal by my 6 month scan after my AVR
i was told prior to surgery that it was significantly enlarged/thick

I don't think you should worry (y), the body loves homeostasis
 

Agian

Well-known member
Joined
Jun 10, 2013
Messages
2,312
Location
Adelaide, South Australia
Heart Fit, if the surgeon told your mother to pray over this, that's just dumb, because it implies something sinister may be going on. Hopefully, you have taken it out of context.

This may reassure you: A year after my AVR the echo showed both ventricles dilated. The cardiologist told me nothing to see... See you in two years. When I mentioned the ventricles (as you do in normal conversation) he rattled off some malarkey about the septum. Two years later, as in earlier this week, my echo showed 'remodelling' and now the ventricles are normal size. What this means is that things can normalise, but it may take some time.

He told me he was 'delighted'... that's nice. I like it when middle aged bogans talk posh.
 

SCOTTT

New member
Joined
Apr 24, 2016
Messages
2
Location
Edmonds, WA
Hello everyone!

I just completed my second open heart surgery last week. My first surgery was a valve repair, this surgery was an aortic valve replacement (mechanical).
One thing I can’t seem to get out of my head was that after the surgery, the surgeon told my mom everything went well but that my ventricle was significantly enlarged. Then somewhere along the lines ‘praying’ was brought up, as though the enlarged ventricle was something to be worried about quite a bit.

I am 31 years old, have had consistent echos the past three years and all along I’ve been told the enlargement essentially correct itself after surgery and that id live a long happy life. Now I’m concerned.
Can anyone shed some light on what maybe the surgeon was saying? Or If it was taken out of context? I meet with him in a few weeks and am hoping to ease my mind a bit.
Thanks!
Prior to my AVR in October, 2013 my LVED was measured at 76mm. I had a biscuspid aortic valve with severe regurgitation (>50%) and it was replaced by a St Jude mechanical valve. Within 6 months my LVED decreased to 55mm and this spring (5.5 years post surgery) it was measured at 49mm. I am 54 years old and very active (ultra marathoner before and after AVR), so from my experience I would say that at 31 years old and as long as you have no other heart issues (infections, rate, pressures, CAD, etc) I would not worry.

Oddly enough, my surgeon was also concerned about my left ventricle dilation, enough that he told my wife post AVR that I could possibly need a heart transplant within 5-10 years. However my cardiologist wasn't worried at all as he'd been plotting my progress for 12 years and had seen several cases where the left ventricle remodeled back to normal range (<55mm) post surgery. In other words I also had two different doctors with two different opinions. Again, it's all dependent on the patient and circumstances involved. Had I shown rapid progression of my LVED then my cardiologist would have recommended surgery sooner. Since I was asymptomatic and my LVED was increasing slowly I was able to wait 12+ years for AVR and the remodeling resulted rapidly just as my cardiologist predicted. Please don't waste any time or energy worrying about the surgeon's comments. Focus instead on healing up and getting on with your life and your body will take care of the rest.
 

vitdoc

Well-known member
Joined
Apr 16, 2017
Messages
81
Location
Southern Ca.
There are different criteria used for deciding when to fix a valve. Regurge and stenosis act differently on the heart muscle. With high gradients the muscle thickens more than dilates. With regurge more dilation than thichening at least initially. The trick is to go in when the heart has not developed irreversible changes. When I was 29 it was noted that I had developed changes on my ECG suggestive of impending irreversible strain on the left ventricle.I had a gradient of 70mm of mercury across the aortic bicuspid calcific valve. Surgery was scheduled in a few months. I persisted in playing basketball and had a syncopal episode in a game. I decided to stop playing until the surgery. I ran into the cardiologist in the hospital we both worked and mentioned the fainting episode. He freaked out and pushed up the surgery. Apparently a not uncommon exit from the mortal coil with aortic stenosis is sudden death from arrhythmia. After the surgery my ECG changes reversed along with the wall thickening. But if one waits too long this does not always happen. Moral of the story get a good cardiologist.
 

matty

Member
Joined
Jan 5, 2017
Messages
14
Location
Australia
Hi Heart_Fit.
When I found there was an issue with my heart I already had "severe left ventricular enlargement". 3 months post valve replacement I still had some lvh. By 6 months all measurements had returned to normal. If my severely regurgitative valve was discovered earlier I would have had surgery a long time before I did. I don't think you're in that boat .... Your situation has been monitored so I would imagine your heart won't need to remodel as much to get back to normal.
 

Agian

Well-known member
Joined
Jun 10, 2013
Messages
2,312
Location
Adelaide, South Australia
Law and Order
State Coroner finds Ike Zerk would be alive today if specialist cardiologist Dr Phillip Adams had made follow-up call

IKE Zerk would be alive today if his cardiologist had made a simple follow-up phone call to an interstate surgical team, an inquest has found.

IKE Zerk would be alive today if his cardiologist had made a simple follow-up phone call to an interstate surgical team.

State Coroner Mark Johns has found SA cardiologist Dr Phillip Adams failed to check if the surgical team in Melbourne had received Ike’s test results, which would have put him on the operation list.
The 14-year-old was in urgent need of a replacement heart valve.

Dr Adams sent the test results by mail but the Melbourne team never received them so he was not operated on.
He died on a Barossa football field in March 2015 — six months later after the vital tests.
His test results showed he should have been operated on within three months.

On Friday, lawyer Claire O’Connor spoke for Ike’s parents Jordan and Megan Zerk outside the Coroner’s Court, saying they were happy with Mr Johns’ findings.

“The mind-blowing issue that’s at the centre of this inquest is that something as simple as a follow-up phone call would have seen Ike with a surgical team and he would have been operated on,” she said.
“He would have been alive today — that’s the absolute tragedy of this case.

“The main finding is that Ike’s death was foreseeable and preventable and it was the failure of Dr Adams to provide proper care for Ike in three ways that have led to his death.”

Mr Johns found Dr Adams failed to call the Melbourne team to check they had received his referral letter and test results and advise his parents that Ike should have been on an operation list and living a quiet life.
“He failed to ensure that the September 2014 correspondence was indeed received by the Melbourne team,” he said in his findings.

“That was a part of his care for Ike and a part of his duty as a cardiologist.”
“Had the report made its way to Melbourne, Ike’s parents would have become aware of the need to prepare for surgery.

“It is quite clear from their evidence and their high level of concern for Ike’s wellbeing that they themselves would have made the decision to cease Ike’s sport immediately.

“He would not have been at football practice in March 2015.
“Indeed, he would likely have had his surgery well before then.”

Mr Johns also found the Melbourne team did not receive an earlier letter by Dr Adams in December 2013, which should have raised alarm bells about the way in which he sent future information.
“In those circumstances it was incumbent upon him to exercise great caution with his subsequent correspondence,” he said.

“It is absurd and unacceptable that the life of an otherwise healthy 14 year old should be put at risk by reliance upon the ordinary mail service.”

Mr Johns made two recommendations:
THE Health Minister speak with interstate counterparts about fixing guidelines so there is a threshold for surgical intervention for paediatric patients with a heart condition like Ike’s, and;

A MANDATORY system for all cardiologists treating paediatric patients to lodge information with the Women’s and Children’s Hospital.

“The Women’s and Children’s Hospital should then be responsible for forwarding the reports to the team in Melbourne when that is required,” he said.

“Short of recommending that a paediatric cardiac surgical service be commenced in Adelaide, nothing less than the supervision of the safe transmission of crucial data by the Women’s and Children’s Hospital can suffice.”
In a statement, Health Minister Peter Malinauskas said: “I take seriously all recommendations made by the Coroner.

“I will look at the report in detail and consider the findings he has made.”
Opposition health spokesman Stephen Wade said the Liberals would not commit to an SA paediatric cardiac surgery service.
 

vitdoc

Well-known member
Joined
Apr 16, 2017
Messages
81
Location
Southern Ca.
Law and Order
State Coroner finds Ike Zerk would be alive today if specialist cardiologist Dr Phillip Adams had made follow-up call

IKE Zerk would be alive today if his cardiologist had made a simple follow-up phone call to an interstate surgical team, an inquest has found.

IKE Zerk would be alive today if his cardiologist had made a simple follow-up phone call to an interstate surgical team.

State Coroner Mark Johns has found SA cardiologist Dr Phillip Adams failed to check if the surgical team in Melbourne had received Ike’s test results, which would have put him on the operation list.
The 14-year-old was in urgent need of a replacement heart valve.

Dr Adams sent the test results by mail but the Melbourne team never received them so he was not operated on.
He died on a Barossa football field in March 2015 — six months later after the vital tests.
His test results showed he should have been operated on within three months.

On Friday, lawyer Claire O’Connor spoke for Ike’s parents Jordan and Megan Zerk outside the Coroner’s Court, saying they were happy with Mr Johns’ findings.

“The mind-blowing issue that’s at the centre of this inquest is that something as simple as a follow-up phone call would have seen Ike with a surgical team and he would have been operated on,” she said.
“He would have been alive today — that’s the absolute tragedy of this case.

“The main finding is that Ike’s death was foreseeable and preventable and it was the failure of Dr Adams to provide proper care for Ike in three ways that have led to his death.”

Mr Johns found Dr Adams failed to call the Melbourne team to check they had received his referral letter and test results and advise his parents that Ike should have been on an operation list and living a quiet life.
“He failed to ensure that the September 2014 correspondence was indeed received by the Melbourne team,” he said in his findings.

“That was a part of his care for Ike and a part of his duty as a cardiologist.”
“Had the report made its way to Melbourne, Ike’s parents would have become aware of the need to prepare for surgery.

“It is quite clear from their evidence and their high level of concern for Ike’s wellbeing that they themselves would have made the decision to cease Ike’s sport immediately.

“He would not have been at football practice in March 2015.
“Indeed, he would likely have had his surgery well before then.”

Mr Johns also found the Melbourne team did not receive an earlier letter by Dr Adams in December 2013, which should have raised alarm bells about the way in which he sent future information.
“In those circumstances it was incumbent upon him to exercise great caution with his subsequent correspondence,” he said.

“It is absurd and unacceptable that the life of an otherwise healthy 14 year old should be put at risk by reliance upon the ordinary mail service.”

Mr Johns made two recommendations:
THE Health Minister speak with interstate counterparts about fixing guidelines so there is a threshold for surgical intervention for paediatric patients with a heart condition like Ike’s, and;

A MANDATORY system for all cardiologists treating paediatric patients to lodge information with the Women’s and Children’s Hospital.

“The Women’s and Children’s Hospital should then be responsible for forwarding the reports to the team in Melbourne when that is required,” he said.

“Short of recommending that a paediatric cardiac surgical service be commenced in Adelaide, nothing less than the supervision of the safe transmission of crucial data by the Women’s and Children’s Hospital can suffice.”
In a statement, Health Minister Peter Malinauskas said: “I take seriously all recommendations made by the Coroner.

“I will look at the report in detail and consider the findings he has made.”
Opposition health spokesman Stephen Wade said the Liberals would not commit to an SA paediatric cardiac surgery service.
Probably died from an arrhythmia. But one wonders what was said to the parents by the cardiologist. I would have expected he told them of the anticipated surgery. And probably there was some discussion about activity.
When they did not hear anything did they make any inquiries?
I always tell patients that the remember about themselves better than anyone else. If they don’t hear about something check on it. Sad story but probably plenty of blame to go around.
 
2

Latest posts

Group Builder
Top