Repeat mechanical valve surgery

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Hi. I had a St Jude mechanical aortic valve in 2006. I have recently been hospitalised with shortness of breath and arrhythmia. It was found that one of my leaflets is stuck closed with what they think is scar tissue. I am on a four week trial of an anti platelet med in addition to Coumadin but surgeon thinks I will need a new valve within a month. I am 42 and very scared about going through this again. Anyone have a familiar story??
 

pellicle

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Hi

sorry to hear this. Actually I think that the treatment you're being directed towards is not the ideal treatment. You should ask your team (as a matter of urgency) why you are not being treated with tPA...

tPA
is:
https://en.wikipedia.org/wiki/Tissue...ogen_activator

Tissue plasminogen activator (abbreviated tPA or PLAT) is a protein involved in the breakdown of blood clots. It is a serine protease (EC 3.4.21.68) found on endothelial cells, the cells that line the blood vessels. As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown.
This is recommended also as the strategy by the Stroke Association (whom have more urgent needs to unblock clots in the brain):

http://www.strokeassociation.org/STR...ubHomePage.jsp

the first bullet point on their page:
Considered the gold standard, tissue plasminogen activator (or Alteplase IV r-tPA) is an FDA-approved treatment for ischemic strokes.
of course if your leaflet is blocked by pannus (ask them specifically about that ... https://en.wikipedia.org/wiki/Pannus ) then tPA will not work. You need clarity if valve leaflet ts blocked by pannus or by thrombus (NB a clot).

If Pannus, then there are surgical methods of removing pannus by catheter as far as I know (depending on which side of the valve its growing from) that do not involve valve replacement.

One member here was able to avoid a reoperation due to what sounds almost the same situation as you:
http://www.valvereplacement.org/foru...air-or-replace

she had tPA administered.

antiplatelets drugs will do nothing because they will just stop it growing bigger (but maybe not as its a thrombus not a platelet cluster), to break down a thrombus you need tPA

Best Wishes
 
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pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
7,123
Location
Queensland, OzTrayLeeYa
some reading which supports the possibility of pannus removal without valve replacement

https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/1749-8090-7-62

The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement.

A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve.
 

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