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S

Seadog

Member
Joined
Aug 15, 2009
Messages
19
Location
New England
Hi Everyone

I am really exicited that my wife found this site as I could use some advice. I am 57 years old and have been diagnosed with Bicuspid Aortic Stenosis. I am now having shortness of breath and pain in chest and arm. My Cardio has recommended surgery to replace my valve and will go for cath on Wednesday. Since we live in the small state of Rhode Island, I have decided to go to Mass General. I am wondering if someone knows where Mass Gen might rank in this procedure.

My next dilema is Mechanical or bio valve replacement. Both my wife and I are quite active and are avid scuba divers. I am afraid that if I choose the mechanical valve my diving days are over, but after reading so many people returning to active sports it sounds like you can still be flexible with a mechaical valve and coumadin. Are there any divers here with mechnical valves?

Look forward to hearing from you. Thanks! Bill
 
Bill ... Welcome to the zoo :D... I am not a diver but I know there will be someone along who is ... we have folks that skydive, bike, golf etc ... go on with their lives and Coumadin has not changed that ... I have had zero issues on Coumadin and I do a lot of swinging in the trees:p .... My advice is go with what your gut and what your doctors suggest ....
 
Hey Bill,
newbie here too, there is a ton of info on this site. Mass General is listed at 4th by US News:

http://health.usnews.com/health/best-hospitals/heart-and-heart-surgery-hospital-rankings/

And this is for all types of heart surgery, not just the standard valve job.

I had my surgery done 20 yrs ago at Deborah Heart & Lung and had a great surgeon - he's gone on to do over 10,000 surgeries. Only reason I mention this is that Deborah doesn't even rank on their list. So I think you'll be in good hands at Mass Gen.

As for your ? regarding mechanical, I have a St Jude mechanical, no problems w/coumadin therapy. I was an avid weight lifter until a few years ago and a back injury. Have sky dived, mountain biked, I was even a bouncer for 8 yrs at a sports bar - you should've seen my doc's face regarding that one.

Everyone is going to give you a different opinion, but here are two actual facts 1)unless you are doing contact sports, there should be no complications w/a mechanical valve and your sports/hobbies. 2) If you have a bio valve there is a good chance you will need another surgery 10-15 yrs later. And a second surgery at 67-72 would obviously carry a little more risk than at your current age.

Good luck w/your decision, whatever you decide will be better than what you have now - I meant that in a positive way, don't mean for it to come off the wrong way.

Keith
 
whatever you decide (tissue or mechanical) is the right choice for you; we have had people younger than you choose tissue for professional reasons (army personnel are not allowed in combat areas while on anti-coagulants) and people older than you, way older than you, choose mechanical.

As for the diving, haven't a clue, sorry. Maybe your cardio or surgeon might know, or might be able to refer you to someone who might know. One reason I can think it might not work is if the coumadin affects the absorption of oxygen or nitrogen or something along those lines, making you more - or maybe less! - susceptible to "the bends";

Anyway, welcome to the forum!
 
Wow...

Wow...

Hi to you all,

Last night when I found this forum, all I could think was "wow", what a great site. It's been a scary couple of weeks as we scramble for resources and a hospital for Bill's surgery. I am Seadogs's wife. We met when we were teenagers in high school (just a couple of years ago, LOL!).

This site is a wealth of information, thanks to you folks. I feel a little bit of relief. We're learning so much here and will be better able to ask the important ?s when we return to MGH.

Any other threads you think might help us? Please point us in that direction as we learn to nav about the site.

Thank you for this wonderful network of support.
 
Welcome you two!

I found the site not long ago myself and everyone has been so extremely supportive with a wealth of great information. Keep posting any questions, everyone here is happy to answer.

Take care,
Lori
 
Welcome to the both of you. You found the best place to ask questions and get alot of great information. I can't answer your question on scuba diving but I bet there someone that will come along that can. Hope you get all the answers you need.
Take Care
 
Seadog welcome.

You at an age where if I were presented with the option, I think I'd go for the tissue valve. There are no cold hard facts as of yet, but the new generation tissue valves should last around 20 years.

As for mechanical and scuba, I haven't found anything as of yet that supports that it cannot be done other then folks falling for the "You'll bleed to death" Coumadin myth. Still checking.

While your in the progress of valve selection, I suggest you do some reading up Coumadin from the way it should be and not as myth as many sites have posted. I suggest www.warfarinfo.com . It is run by our now retired pharmacist and certified anticoagulation expert, Al Lodwick. There is much information to be had there. Feel free to stop in the anticoagulation forum as well.
 
Welcome to the site, Seadog, and Waggilytail.

The valve choice decision is yours to make and whatever you decide will be right for you. At age 57, or even at my age (60) I would opt for mechanical, becaue even if a tissue valve lasts 20 years, who wants a reoperation at age 80? We're all living longer and both of my parents lived well into their 80s. But it's a personal call. There's plenty of info here on both types of valves.

I'm a diver also. I would hope that there are no counterindications for diving post op but I don't know for sure.

Best wishes,

Jim
 
http://www.phpbbplanet.com/docvikin...10dc0655e8e3d5701fac0bfcdb7&mforum=docvikingo

Posted: Wed Mar 12, 2008 3:19 pm Post subject: scuba and aortic valve replacment

--------------------------------------------------------------------------------

scuba and aortic valve replacment
Post by: fran dorney on November 07, 2007, 12:41:48 PM
dreamed all my life of someday scuba diving,now i have the money and the time."but" i had an aortic valve replacement 1999. i am fit and well had no problem with anticoagulant medicine. its a mechanical valve for the treatment of aortic disease. can anybody give me a definite answer,can i dive or not. whats the risk. fingers crossed.

Title: Re: scuba and aortic valve replacment
Post by: docvikingo on November 08, 2007, 10:18:16 AM
Hi Fran,

Diving medicine does not view placement of a mechanical heart valve as an absolute contraindication to scuba. To be sure there are active divers with similar histories who scuba without adverse event.

However, there are some very important criteria that must be fulfilled prior to seeking training. These include, but are not limited to:

1. The valve continues to function fully successfully and there has been no progression or worsening of the condition that necessitated replacement.

2. Mechanical heart valves usually entail anticoagulation therapy for life. There can be negative effects from diving while on anticoagulants. For example, what might prove to be undetectable or minor bleeding from routine changes in pressure within the ears, sinuses and lungs in the normal diver could result in bleeding with acc**ulation and tissue damage in the diver on anticoagulation. The same holds true for such not uncommon events as falls on the boat and strikes to the body by tanks and dive ladders. And, some have hypothesized an increased risk of spinal cord decompression illness (DCI).

3. Prosthetic valves may not be able to keep up with the cardiac demands imposed by vigorous exertion. The diver candidate with such a replacement would want to be able to achieve or closely approach 13 METS (Stage 4 on the standard Bruce protocol) on exercise stress testing.

4. Be otherwise healthy and physically fit.

5. Obtain a cardiologist's clearance for diving. Proof of this will require a letter from the doctor. Dive training facilities and ops will ask to see it before providing services.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
_________________
Ern Campbell, MD
(scubadoc)

Don't Hold Your Breath!
 
I would really like to Thank you all for being so helpfull and supportive. This has been a pretty scary couple of weeks for both Jill & I. Although, I am still on the fence on which way to go, I am learnring so much to help me make that decision.

Ross, I thank you for finding the DiveDoc site. I am really happy I can now ask some specific questions on Oxygen & Nitrogen absorbtion while on ACT & diving with Nitrox.

Again Thanks to you all !!!!
Bill
 
Don't go running off now, your just getting started. :)

It's hard to make a decision at your age. You could go either way.

I will say this, unless you got a mismatched valve to your heart and aorta, I think this doctor is wrong on #3.
 
Ross said:
Don't go running off now, your just getting started. :)

It's hard to make a decision at your age. You could go either way.

I will say this, unless you got a mismatched valve to your heart and aorta, I think this doctor is wrong on #3.
Click to expand...

Don't worry I am just learning everything and I want to know much more. I have also written to DAN to get thier opinion. This site and you all, have made my apprehension a lot less and that is a good thing.

Thanks again & here to stay
Bill
 
Hey, y'all. welcome to VR. YOu learned a whole bunch within a 24 hr period and that's what VR is all about. we are glad to have you. we are a sticituitiveness group and we stick with you all the way there and lots of us members are still here because we just got so used to vr, made friends so we moved in and have been here for years - and yrs - and........
 
Not to worry, MGH is one of the TOP Heart Hospitals in the country.

You WILL want to ask the surgeon(s) you interview about how much experience they have with BAV *and* Connective Tissue Disorders which often accompany BAV. You may also want to ask about having a Chest CT or Chest MRI to look for aneurism(s) which are often found in patients with Connective Tissue Disorder(s).

We have Several Marathon Runners (post-op) so I'm skeptical about not being able to 'handle the load' with a mechanical valve.

'AL Capshaw'
 
Hi Bill,

Your buddies on the Heart Valve Forum pretty much put my spiel out there. But, I like seeing myself talk, so I've added a bit more.

The primary issue with diving while undergoing anticoagulation is excessive bleeding. Gas-filled spaces within the body, such as the gut, lungs, middle ear and sinuses, are subject to the stresses of equalization inherent in SCUBA. In the individual on anticoagulation, the risk of bleeding, and of excessive bleeding, is increased.

Even more worrisome are the possibilities of a fall on the boat, being struck by heavy gear, run-ins with sharp objects (as can occur on certain wrecks) and similar traumata. These can result in very serious complications in the diver on ACT, be it Coumadin (warfarin) or a kindred medication.

I am not aware of any research linking increased mechanical heart valve-related emboli and SCUBA. However, there are some occasional effects of diving, such as dehydration and platelet aggregation and coagulation activity in response to circulating gas bubbles, that could conceivably contribute.

Given a fully successful replacement and uneventful recovery, about the only remaining concern for an otherwise healthy and fit diver is that prosthetic valves (mechanical or natural) may not be able to keep up with the cardiac demands imposed by vigorous exertion. A diver with such a replacement would want to be able to closely approach or achieve 13 METS (stage 4/12 minutes on a standard Bruce protocol) on exercise stress testing.

Certainly there are individuals with mechanical heart valves who dive without incident while on anticoagulation. But, again, medical release by a knowledgeable physician is the key.

If questions remain, you or your cardiologist may contact DAN Medical Services by phone at (919) 684-2948 (Mon thru Fri, 9am to 5pm EST) or by email at https://www.diversalertnetwork.org/myaccount/mscc/emailmedic.asp

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
 
DocVikingo
Thank you for taking the time to give me some insight on the Pros & Cons. I have a lot to think about with my Valve selection. I am not sure what the 13 Mets measyrement is all about but after my recovery I plan to going back to my gym to excercise and run. Diving is one of our passions and I'm not ready to give it up unless it is truley unsafe . I did write to Dan to seek some more help and should here in the next day or two. Again, as everyone else here I THANK YOU for your time and advice.

Bill
 
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