new member

[buncle]

i would like to thank all of you for the wonderful information provided here.i have been reading and learning from you for the past year and it has made my situation much better haveing your knowledge you go by.thank you from the bottom of my heart.my situation is i started having pvc's about 2 years ago and not knowing what they were it scared me to death.i went to my gp and he didnt hear anything and sent me home.3 months later sent me for 2 mri's on my head and neck.(quack) found nothing duh.so i found a cardio. that did a echo and found a leaky aortic valve.i had all the normal tests done and he said we would watch it.so ehcos every 6 months and coreg and lisinopril drugs.less pvc's but still every day.learned to kinf of live with them.after last ehco mid july 09 showed heart enlarging and had a heart cath.time for a new valve.a friend of mine has sold pacemakers for 30 years and knows many heart surgeons and he is in the operating room on many occasions.so he should know the best.i had my appointment with dr. michael mack in dallas yesterday.he said my aorta is inlarged and will fix itwith a dacron tube.and interesting to me he said the valve looked ok that it is being streched and wont close properly because of the aorta.never thought of that guess thats why he is the dr.i said i guess that rles out min evasive surgery?his answer was no.he would have no problem fixing the aorta and replacing the valve if nessasary via mini stern cut about 2 inches long.i was very happy to hear this!so scheduled for sept 17th.
our discussion included alot of valve talk that i would like to pass on that should be very interesting to those deciding on valves.we talked about mech. and tissues valves.i personally want to avoid coumidin and the ticking would drive me crazy personally.but, at 53 i have issues with another surgery.the dr. said with 1st generation tissue valves age was 65 or older-2nd gen age 60 or older now the 3rd gen valve (edwards with therma fix 55 or older is the guideline for min age for least chance of reop.
so i reminded him i am 52.this dr. was the 1st in the u.s to use the transcatheter method for delivery of a valve.he was asked by edwards to be the 1st to install there latest bovine model (theon?) he said by the time my tissue valve wears out (if i have to have one) this will be the method of delivery.i read where a hospital (cannot remember which) in another state has just done their 100th transcather valve placement.this dr. has been practicing over 24 years and if you google him you will see he is the real deal.
so to me valve choice becomes a no brainer.
i am not a dr. i am only passing on what i was told.

 

[Danny]

good luck

good luck

Hello, and im new here also... I hope everything goes well for you...Your rightn when you say the folks here have a ton of advice and answers.Im sure glad i found this site. Im sure youll be fine, and good luck.

 

[Karlynn]

Welcome - glad you found us. I wish you much success with your surgery!

 

[hall]

Welcome! Glad you found us, sorry for the reason. Best of luck to you.

 

[netmiff]

same as above, welcome, but I am sorry you had to find us - no-one should have to go through this, the thought of OHS can be quite terrifying. I was 52, and chose mechanical, I really don't to ever have to do this again, although I know the only guarantees in life are death and taxes

As you get closer, feel free to post your questions, and even your rants as your nerves start winding up the waiting is the worst part.

 

[Freddie]

I too want say "Hi" and "Welcome"

 

[buncle]

i am scheduled for a ct scan so the dr. will know better if the valve is just streched or damaged.has anyone ever heard of a streched valve by an enlarged aorta? thanks for the warm welcome.

 

[Bryan B]

i am scheduled for a ct scan so the dr. will know better if the valve is just streched or damaged.has anyone ever heard of a streched valve by an enlarged aorta? thanks for the warm welcome.

Buncle,

I had a Ross Procedure in March of 04 and they recently found out that my aortic root was dilated to 4.3cm. Because the aortic root was dilated it was causing mild regurgitation (basically stretching the valve just enough so that the leaflets of the valve don't make an airtight seal.

Then they did a cardiac MRI and found that in addition to my dilated aortic root (which was measured at 4.43cm on the MRI) my aorta is dilated to an average reading of 5.27cm. This also causes the aortic valve to regurgitate (or leak). On the MRI the reading was that I had mild to moderate aortic insufficiency (regurgitation / leakage). My cardio and the radiologist specializing in cardiac MRI's who did my test told me that the leakage in my aortic valve is entirely due to my dilated aorta and aortic root. The "big" question is whether or not they feel that they can repair the aorta without having to replace the valve. I'm sure the only way they would consider this option is if they think the aortic valve would return to normal (no leakage) after repairing the aorta. This procedure is called the "David" procedure and is a very technically difficult procedure. But this will be my first choice if they think it's feasible.

If this is not feasible I am torn between a mechanical and tissue valve. This will be my second surgery and I really don't want to have a 3rd one that requires a power saw. If I choose a mechanical valve and the percutaneous replacement of valves become the norm then I wouldn't be a candidate for this method of valve replacement. But if I choose a tissue valve and the percutaneous method of valve replacement has never been perfected beyond using it for patients who would be very high risk for OHS then I set myself up for a 3rd surgery...most likely in my early 60's.

I have a lot to talk about on Tuesday when I meet with all of the "heart gurus" at Duke.

I didn't mean to hijack your thread, but I thought that some of the information I provided about my situation might help with your situation. You are in that "grey zone" between getting a mechanical valve that will probably last you the rest of your life...but you will be on anticoagulants for the rest of your life. Generally this is not a big deal IMO. But as you get older it can start to be inconvenient when you need to have other procedures done where you have to bridge your anticoagulant therapy. But you're just young enough that the latest tissue valves may get you to 70 if you're lucky. If they haven't perfected the percutaneous method of valve replacement then you are looking at another OHS in your late 60's to early 70's. Not that it can't be done at that age, but I'm guessing the mortality rate goes up significantly if you are having your second OHS and you are 70 years old.

 

[ALCapshaw2]

Did you have a BiCuspid Aortic Valve?

Do you have a Connective Tissue Disorder (CTD)?

Aneurisms and "Dilated Roots" are not uncommon in patients with CTD following AVR for BiCuspid Aortic Valves if the Aorta was not also reinforced or replaced at the time of the Valve Replacement.

 

[buncle]

Bryan
I am here to learn all i can and i appreciate your imput.My dr. felt the valve was ok but, would put a c-edwards bovine valve in if he found it wasnt.My valve is not bicuspid.I have total faith in this dr. to make the right design as to what needs to be done.As i mentioned he is one of the very best.
But, we do have a choice as to what valve type we get.Mech or tissue.This issue is what I spent most of my time trying to decide for the past year as I thought the day would come where a decision would have to be made.And I wanted to make it.

My thoughts The 2 big negatives with a mech valve are the coumidin and all the related issues you mentioned.Plus the time and thought you have to put into the testing-diet-pills are your levels right etc. you have to think about your condition everyday.You dont get a day off.Most of us will face other surgeries,diabetes and other issues in our later years that will only make it more difficult.I have read where some members say its not a big deal etc. if thats true for them thats great-but it would not be for me.
#2 I know me and the ticking noise of the valve would be a hugh negative.Again some say you get used to it.Or you cant hear mine. I again am happy for them but, it would be a big issue to me.Also if I had a mech. valve and it had a problem i couldnt get a transcatheter delivered valve in the future.That being said if i choose a mech valve it would be a on-x valve for sure

In my meeting with the surgeon we discussed both valves in detail (in fact he showed me both that he had for samples). I told him for all the reasons above why I didnt want a mech. valve.And the only reason i wouldnt want tissue was the possible reop.Remember this dr. was the 1st in the usa to deliver a valve transcatheter.He is on the leading edge of this procedure.Not a dr. that has read about it-or heard about it.He assured me this will be standard practice in the future. I.E. Before my valve wears out if i in fact need one.So for me this makes the only choice tissue.He said the reason his choice for me was at age 52 was tissue is because of trans cath method is coming along smoothly and quickly.

 

[buncle]

Al
I have read many of your comments over the past year and you have helped me alot I appreciate your efforts as do many others.(the silent majority)
I do not have a bi-c valve
I am not aware of any tissue disorder.

 

[ottagal]

Hi Buncle,

I also wanted to add a warm welcome to this great site. It sounds like you are at peace with your valve choice. To quote one of our members, the new valve (whether tissue or mechanical) will be better than the current one you have.

Best wishes and keep us posted on how you are doing.

 

[Mary]

I put you on the calendar, Buncle, so you're official!