Severe measurements and no symptoms. I think its time.

[mcarmical]

After 13 years of being diagnosed with Aortic Stenosis my latest Echo came back with significant changes. I have watched my valve opening go from 1.5 to 1.0, and gradient from 20 to 40, then hold there for several years. My latest echo no shows the valve opening at .7 and the gradient at 60. I'm still without significant symptoms. A little more winded after climbing stairs, a little more likely to sneak in a nap during the day. I've always known about a heart murmur since I was a kid, so I am sure I have always had regurgitation issues. So I am leaning towards getting surgery done in the next couple of months before an event damages my heart. I would like to hear opinions of others who have been at this point and what factors were the final trigger to schedule surgery.

I am also curious about valve selection. I am leading toward mechanical because I do not cherish the thought of doing this twice. I have had cardiologists tell me a second operation in ten years could be done with the TAVR treatment but I am not sold on that possibility.

I am 51 years old and I have no other major health issues.

Thanks for reading my post and happy holidays everyone!

MIke

 

[Paleowoman]

I would like to hear opinions of others who have been at this point and what factors were the final trigger to schedule surgery.

The final trigger for me was the cardiologist referring me to cardiothoracic surgeon and the surgeon saying I needed surgery. I did switch cardiologists and therefore, in effect, got a second opinion on this. I had no symptoms at all, not even a tiny bit. All the best !

 

[nngbwh]

My cardiothoracic surgeon recommended a mechanical valve. I like him and have complete faith in him. Wishing you the best !

 

[RunMartin]

I was 48 when I had my AVR and like you I had been waiting for over 20 years. My valve opening had reduced to a size similar to yours so it was time to get replaced. I opted for mechanical but any new valve is better than leaving it alone. All the best.
Martin

 

[skeptic49]

My mean gradient is still in the high 30s...but I had a mild heart attack and stroke that landed me in the hospital for a week. Tests ruled out CAD, so the valve is the suspected culprit. It's also possibly throwing off embolisms giving me mini-strokes (Lambl's excrescences). Not great. Just goes to show that we're all different. I wanted AVR before heart damage but the numbers were not in the severe range. So it took actual damage to trip the wire in my case.

 

[big_L]

Like you I was asymptomatic or at least I thought I was. I was 54 and my measurements had also crossed the thresholds, so after 20 years, the Dr started talking about surgery. I was also concerned about long term irreversible damage to the heart. There's also a risk of sudden cardiac death, if you go untreated. I was told this risk is 1% per month. Compare this to the odds of not living through surgery (maybe 1% or less) and the math is clear.

Now, 15 months after surgery, I can say that I'm much less winded after exertion than I was the year before surgery.

I too went mechanical. I find the warfarin management to be a fairly minor annoyance.

One surgeon told me the same thing about the TAVR for a second replacement. Frankly, I didn't believe him and my opinion of him changed after he told me this. The surgeons view surgery as just another day at the office, while for us. it is a huge deal. I also believe that many of the surgeons don't understand much about warfarin management and overestimate the hassle factor. After all, they don't do the long term management of the patients. There's a lot of information available about TAVR, tissue vs. mechanical, warfarin etc. Read us, sleep on it, make up your mind and move forward.

Good luck. I wanted the surgery to be no more than a speed-bump in my life and that's exactly how it turned out.

 

[tom in MO]

I too was asymptomatic when they told me it was time . Within the month i had a dizzy spell. After surgery I realized i was not asymptomatic, The degradation had just been so slow I did not notice. After surgery, I was "pinker" too. Good luck.

I was 55 and chose mechanical 'cause I hate operations and did not people messing around with my heart more than once : ). To me it was worth the risk and annoyance of warfarin, but I still wish I did not need it. Either choice is still on the road to life.

Don't woit too long, they took mine out 3 months after I was told to schedule surgery and my surgeon said it was in bad shape.

 

[Paleowoman]

I was definitley asymptomatic before surgery and it wasn't my imagination ! No symptoms at all - apart from anxiety about the operation (valve area size 0.9, mean gradient 38, peak gradient 68, and ejection fraction 79% on referral for surgery). It's taken me almost a year to get back to my pre-surgery fitness and health !

 

[mcarmical]

Many good responses here. Thank you for your input. My wife would probably disagree with my no symptom diagnosis. Stairs are more of a challenge, Chasing a dog will also quickly bring me into the anaerobic danger zone, not something I practice often however really whooped my ass. A slight dizzy spell occasionally. Those are interesting. Easy to blame advancing age probably for some of these changes. The discussion on mechanical vs tissue is especially intriguing. Like many of you, I wish to do this only once in life. The TAVR later discussion is not one I buy into easily. Nothing like an experience like this to appreciate the important things in life.... family above all. My main cardiologist that I like and have seen for several years is in Denver and I currently reside in Austin. Business brings me back to Denver in February and I have an appointment with him to confirm what my new cardiologist in Austin has found. Aiming for a February operation. Would appreciate further comments and discussion. I should change the post to "severe measurements and minor symptoms that I am trying to attribute to middle age."

 

[epstns]

Don't fool yourself. I was asymptomatic until perhaps a year before my surgery. At age 62, I was still jogging 5 days a week and lifting moderate weights. My only admission of a heart-related issue was declining stamina and the sleepiness that we might think was age-driven but was not.

Fast forward almost 4 years post-op. I'm in better shape now than I was before surgery. My stamina is well beyond what I ever expected at my age (now 67), and I can out-do many men years younger than I. I don't run - because my knees won't take it any more. I am still in the gym 5 days a week, speed-walking on an inclined treadmill and riding a stationary bicycle. I still lift weights, but am now restricted to lighter weights and higher reps for muscle toning. It all works for me.

At your age, most of the experts would still recommend a mechanical valve. Once you get into late 50's or 60's, they begin to recommend tissue. Cleveland Clinic has, I believe, started implanting tissue valves in most patients in their mid-50's, but I am not so sure I would go along with that. I had the "which valve" discussion with my very-trusted cardio when I was about your age, and decided that if I had to do it then, I would have gone mechanical. The fact that I was not ready for surgery until my 60's gave me the chance to select a tissue valve. Time will tell if I need another, and if so, by which procedure.

I think you will find that warfarin/Coumadin management is not a major issue. Many here are doing quite well with the drug, some for decades already.

As others have said, the only bad choice is to do nothing. I think you're on the right track so far.

Hang in there. We will be here for you all through the process.

 

[river-wear]

You're 51, not "old" by any measure, aside from the viewpoint of a child. Your description of stairs and chasing a dog sound like early symptoms to me. Looking back, I clearly wasn't having any symptoms - aside from (perhaps!) a little general fatigue. After waiting my whole life and being watched by cardiologists, when my doctor (whom I trust) said it was time to get my heart fixed, I went to see a surgeon. My ejection fraction had fallen from 56% to 50% but my heart wasn't more enlarged than it had been all along.

The surgeon agreed it was time. I ended up seeing a second surgeon, who agreed and was surprised I was asymptomatic. I was hiking up big hills and doing everything else as usual. When the surgeon went in, the leakage was even greater than the tests indicated. Six months later and my life is 100% back to normal, with only the scar to prove it happened. I had planned to get a mechanical replacement if needed, but I was able to get my valve repaired thanks to no stenosis or calcification. I'm sincerely hoping I never have to have another heart surgery too.

Good luck! It's great you're getting a second opinion, especially since it's from someone you trust and have a longer history with.