question about my echo

[joy]

I had my echo done a while ago, and I was actually wondering what they would do if I needed my Aortic valve replaced? It has minor insufficiency and they are watching it, but what if it has to be replaced before my mitral valve wears out again? Would they replace both valves at once or would they just replace my aortic valve? When I had my mitral valve replaced it worked the way it was supposed to.

 

[Anne-Marie]

Hi Joy,

I have a question along the same lines, I hope you don't mind if I tag it on to yours. When I had my first echo Jan '02, it was noted that my mitral valve was "thickened". I'm going in for an AVR. On this site, someone mentioned that radiation to the chest can affect both the mitral and the aortic valves. I was going to ask the surgeon if when he was operating if he could assess the mitral valve. If it's going to need replacing in a few years, I'd rather get it done with at the same time. Would they replace the valve as a sort of pre-emptive action or do they not do that until the valve is severely incompetent?

 

[pegne]

Joy and Ann Marie

Joy and Ann Marie

I don't know about replacing the valves but while I was in having my failed Ross Procedure fixed (a new aortic and pulmonary valve) they decided to repair my tricuspid valve. It had minor insufficiency. And now when I think about it (sometimes its hard to keep track) I remember they repaired my mitral valve when they did my Ross procedure. Both times they decided to do this because they felt it was better then opening me up again. I imagine that the fewer times they open you the better. But I don't think they will replace a perfectly good valve. These were my 3rd and 4th surgeries.

 

[Johnny Stephens]

I went into my surgery thinking it was only going to be an aortic replacement. Multiple echoes had shown that the aortic valve was clearly stenotic..absolutely no question that it needed to be replaced. There was also some evidence of "minor" stenosis in the mitral valve, but multiple doctors and my surgeon said it didn't appear to be significant enough to merit replacement, and hadn't changed much in 3 years, if at all. During my prep meeting with my surgeon, he stated that he would inspect it from the back side through the aortic valve during the surgery, and even if there was some minor stenosis, his tendency would be to leave it alone.

A TEE done at the beginning of surgery changed the course dramatically, as it showed that my mitral valve was actually as bad off as my aortic valve. They also found out at that time that I was suffering from secondary Pulmonary Hypertension (which has since resolved).

I had chest radiation for Hodgkin's 22 years before my valve troubles came up. My *personal* advice would be to discuss with your doctors the possibility of having a TEE well in advance of your surgery, as that would have helped clarify things for me and correctly set my expectations. My group of doctors tend to favor doing the TEE when everyone is in la-la land for the surgery.

Joy, I suspect the decision in your case would all boil down to timing...how close you are to the expected lifetime of your mitral valve prosthesis when it comes time to address the aortic. The big question for you here is that you're fairly young, and to do them separately would mean a total of 3 operations for you (counting the one you've already had). I'd bet that they'd take care of it while they were in there ... but I'm not a doctor

I hope this is helpful....

 

[Anne-Marie]

Hi Johnny,

Thanks for the information. I had a doctor's appointment today and asked about the mitral valve. He told me that the first echo (Jan 02) showed thickening of the mitral but no evidence of prolapse or stenosis. As with your doctor he said they wouldn't consider replacing it just for that.

 

[John Cochran]

As I understand it, a person can have a less-than-perfect valve that doesn't ever need replacing. Not all valve problems are progressive. It's when the valve is so bad off that the heart starts to enlarge, or when a person becomes symptomatic, that surgical intervention is considered.

--John