Progression of TR and PH Post-MVR?

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deek

Well-known member
Joined
Oct 1, 2008
Messages
201
Location
Saginaw, Michigan
I'm 7-8 weeks post-op mitral valve repair and recently had two echos (one rountine, ordered by my local cardiologist; one repeated) and both indicated Moderate to moderately-severe TR with PAP's of 69mmHg on the first and 59mmHg on the second. LVEF was between 35% and 40% and the report indicated wall motion abnormalities along with systolic and diastolic dysfunction. My question is this: Is this normal post op? Will this improve? My cardiologist said that she suspects the mild to moderate PH and moderately-severe TR are the result of the early post-operative phase and will improve, if not resolve. What's disturbing to me is that on all my tests prior to surgery (and I've had many) only "trace" TR was indicated. Theorectically, isn't TR and PAP's suppose to regress post MVR? I've since done some research on the subject and found this isn't always the case and because of this some centers/surgeons are repairing the TV at the same time as MVR. One such article (The CardioThoacic Surgery Network) stated "Modern cardiac reconstructive surgery should pay more attention to this frequently forgotten valve pathology, which is killing many of our patients." Kinda scary. Anyway, I was just wondering if any of you have experienced this post op? I've also noticed that my recovery isn't progressing as I think it should...I'm still extremely fatigued and my exercise tolerance is poor, regressing instead of progressing. Is this something I should alert my surgeon of? I realize that echos are not all that reliable but I can't have an MRI due to having a pacemaker. As for a cath, I think it's too soon as I'm only 7-8 weeks post-op.Thank you so much in advance for your help!
Dee
 
A sideway note. Since you had your pacemaker implanted recently, you should be able to do an MRI under controlled circumstances. They discussed it for me who have a full AV node block type III, but ended up with a contrast CT instead, since that would be enough (and cheaper I'd guess).

::g
 
Dee,

I will share with you what happened with me hoping it sheds some hope for you instead of anxiety and fear which enveloped me from December to mid-April.

I had surgery in September and was feeling better in every way every day and was overly joyed and happy. I was walking and exercising and on the go every day and for the whole day. I invited 14 family members for Thanksgiving! I was feeling great! In December, I started losing my energy and stamina and had lots of SOBs. I had no energy not even to dress up, I stopped walking...no more cooking, just roaming around the house. I had an echo and it showed moderate TR (which was trace before surgery), left ventricle enlargement, Mitral valve regurgitation which topped my fears and pushed me off the top of a beautiful cliff. My surgeon listened to my heart and found it crispy...he did not care for the echo results. He asked me to repeat echo in six months! He ruled out my heart as the cause of my fatigue.

To cut story short, he was right...my fatigue and SOBs were due to the fact I pushed my heart hard and it was forcing me to slow down! and here I am today feeling great again :).

In my humble opinion, I wonder if your fatigue is due to being the perfect mother, the perfect wife, and the perfect housewife, forgetting the need for rest that you owe to yourself and to your heart to heal at its own pace. Slow down and see how you start feeling. If I am wrong, I shall keep you in my prayers that this be resolved.

Have you had comple blood work, CBC, electrolytes, and vitamins deficiency?!

In my case I was way down with my Vitamin D.

Good luck.
 
As Ross said, it is still early, but didn't you have PH and pressure problems before surgery? I don't remember Did you go to a PH speciallist or if you had a right cath or did they say if you had primary or secondary PH, I don't know how high your lung pressures are and if that can be what is effecting your tricuspid valve, Do you know how the pressures are in your right ventricle?
 
Lynlw said:
As Ross said, it is still early, but didn't you have PH and pressure problems before surgery? I don't remember Did you go to a PH speciallist or if you had a right cath or did they say if you had primary or secondary PH, I don't know how high your lung pressures are and if that can be what is effecting your tricuspid valve, Do you know how the pressures are in your right ventricle?
Click to expand...

I did have uncontrolable HBP for two years prior to my MVR and my PAP were between 36mmHg and 69mmHg on previous echos prior to surgery. I have not had a right heart cath as none of my physicians thought it necessary. My systemic BP has amazingly stayed at normal levels since my surgery. The only numbers I have from my echos are pulmonary artery pressures of 59 and 69mmHg. I know echos aren't reliable with this but isn't it too soon for a right heart cath? Thanks a bunch! D
 
Eva said:
Dee,

I will share with you what happened with me hoping it sheds some hope for you instead of anxiety and fear which enveloped me from December to mid-April.

I had surgery in September and was feeling better in every way every day and was overly joyed and happy. I was walking and exercising and on the go every day and for the whole day. I invited 14 family members for Thanksgiving! I was feeling great! In December, I started losing my energy and stamina and had lots of SOBs. I had no energy not even to dress up, I stopped walking...no more cooking, just roaming around the house. I had an echo and it showed moderate TR (which was trace before surgery), left ventricle enlargement, Mitral valve regurgitation which topped my fears and pushed me off the top of a beautiful cliff. My surgeon listened to my heart and found it crispy...he did not care for the echo results. He asked me to repeat echo in six months! He ruled out my heart as the cause of my fatigue.

To cut story short, he was right...my fatigue and SOBs were due to the fact I pushed my heart hard and it was forcing me to slow down! and here I am today feeling great again :).

In my humble opinion, I wonder if your fatigue is due to being the perfect mother, the perfect wife, and the perfect housewife, forgetting the need for rest that you owe to yourself and to your heart to heal at its own pace. Slow down and see how you start feeling. If I am wrong, I shall keep you in my prayers that this be resolved.

Have you had comple blood work, CBC, electrolytes, and vitamins deficiency?!

In my case I was way down with my Vitamin D.

Good luck.
Click to expand...

Eva,
Thank you SO much for sharing your experience with me. It makes me feel a whole lot better. I'm glad things worked out for you and hope this is the case for me too! I have had a complete blood work up and everything looked good. Maybe I am just expecting too much out of myself; it just seems like others on here are further along and doing more. I know everyones different though.
Thanks, Dee
 
deek said:
I did have uncontrolable HBP for two years prior to my MVR and my PAP were between 36mmHg and 69mmHg on previous echos prior to surgery. I have not had a right heart cath as none of my physicians thought it necessary. My systemic BP has amazingly stayed at normal levels since my surgery. The only numbers I have from my echos are pulmonary artery pressures of 59 and 69mmHg. I know echos aren't reliable with this but isn't it too soon for a right heart cath? Thanks a bunch! D
Click to expand...

I'm sorry I should have asked the question better, I was wonderring if you had a right cath before surgery to get a good picture of the PH? Justin tends to get problems with his tricuspid valve, but his are because of the pressures in his right ventricle and pulm conduit, so the blood backs up
 
Lynlw said:
I'm sorry I should have asked the question better, I was wonderring if you had a right cath before surgery to get a good picture of the PH? Justin tends to get problems with his tricuspid valve, but his are because of the pressures in his right ventricle and pulm conduit, so the blood backs up
Click to expand...

Nope. No one thought I needed it...but I'm starting to think I might. How long does one have to wait post-op for a RHC? Has Justin had to have anything done with his Tricuspid Valve?
 
deek said:
Nope. No one thought I needed it...but I'm starting to think I might. How long does one have to wait post-op for a RHC? Has Justin had to have anything done with his Tricuspid Valve?
Click to expand...

I'm not sure how long. Justin hasn't had to do anything with his Tricuspid, so far when he gets his conduit/pulm valve replaced/opened with stents ect, most things go back to mild.
I know Nancy mentioned it before, but did you ever see a PH specialist? maybe they could shed a light on some of the issues
 
Lynlw said:
I'm not sure how long. Justin hasn't had to do anything with his Tricuspid, so far when he gets his conduit/pulm valve replaced/opened with stents ect, most things go back to mild.
I know Nancy mentioned it before, but did you ever see a PH specialist? maybe they could shed a light on some of the issues
Click to expand...

I have not. Perhaps I should. I guess I was never really concerned about it because no one else seemed to be...but now I'm starting to wonder. Like I said, my systemic blood pressure has stayed down since my surgery, but the pap's have not...I do know these are two completely different things but my doctors always attributed this to the MR and HBP...said it would go away after surgery. I was surprised to see that they haven't as of yet and even more surprised to find my "trace" TR go up 2-3 grades. Seems odd to me...but everything about my situation seems odd. LOL! Should I ask my doctor to refer me to a PH specialist?
 
I think you should be concerned if it's still showing after 6 months. Your body is going through major restructuring and it does take time. These early events often resolve.
 
Ross said:
I think you should be concerned if it's still showing after 6 months. Your body is going through major restructuring and it does take time. These early events often resolve.
Click to expand...

I agree with Ross, your heart is still healing /remodelling so I would wait a few months for things to settle down to your new 'normal" and go from there. I was wondderring if you had the tests when to the PH specialist before surgery, because that MIGHT give a better idea why you are haivng the PH now.
 
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