Small Valve, Big BSA - Issues?

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ARGreenMN

ARGreenMN

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Joined
Mar 30, 2010
Messages
638
Location
Woodbury, MN (USA)
Apparently size matters. I've got the smallest St. Judes Regent they make - 19 mm (keep your comments to yourself lol). And my Body Surface Area (BSA) is currently 2.4 (6'2", 245 lbs). On St. Judes website there's a chart showing the safe valve sizes for different BSAs. I'm in the red :eek: because my effective orifice area index (EOAI) is less than .80. I've known that for a while, but just getting around to doing some research on what it all means. My surgeon's assistant mentioned that was the only thing they were a little concerned about (small valve size they had to put in, cause my aorta is apparently small - you know what they say - small aorta, small valve).

So, my question... Does anyone know what complications it can cause by having a small valve and large BSA? I thought I remembered reading somewhere that "pannus" is a complication that can be caused by that, but can't find that article now. And, does anyone know what symptoms should I keep an eye out for? And.... If I lower my BSA by losing some weight, does that help? Talk about incentive to lose some weight!!! But, even if I get down to 220, which is about as low as I think is realistic, I'd still be at a BSA of about 2.3, which is still in the red on that chart...
 
PS, here's the chart I'm referring to:

EOAI%20Chart.ashx
 
Too small of a Valve for the needs of your body is often referred to as "Patient-Prosthesis Mismatch".

The main problem caused by such a mismatch is that your heart can't pump enough blood (and oxygen) to meet the needs of your body, especially as you try to raise you level of exertion.

Sometimes a Larger Valve is implanted (by stretching the Aorta I *assume*).
Carbomedics has a "Top Hat" valve where the Valve rests outside the attachment point thus allowing for a larger opening.

YES, losing weight would help the issue but as you noted would still leave you on below the desired ratio.

You may want to discuss your options with your Cardiologist and Surgeon (maybe even other surgeons).

'AL Capshaw'
 
Andy, I don't have any info to pass along to you on this topic, but just wanted to say you might want to do a search on this on here if you haven't already. I know there have been several people who have posted on this subject before. Hopefully, it won't cause you any problems down the road.

Kim
 
Thanks guys! Duffy, I like that last article! But good advice Al to talk to some more professionals about it - especially about whether I need to limit exercise (so far, they've all said no limits needed). Kay, good idea to search for that on the forum (I always forget to do that first).
 
Andy, I've seen that chart while browsing the net during my own search to learn if my valve
could actually be a size too large for my tiny body.
Regent 21mm is what I have and man, oh man, can that sucker ever pump. I've stayed on BBs to calm it down.
Surgeons like to put in the largest AV that they can, but as you have discovered, sometimes that is not possible
due to aorta limitations.
Also worthy of note is that the Regent is fitted Supra Annularly, like the OnX and TopHat.
 
I think the size of your valve compared to your body and if it is a problems or how much of one probably depends on a few things. I know if a valve is used that is smaller than you need and would fit, it can cause issues. Also I believe one of the problems if the valve has a smaller opening it would take less pannus to block it or cause problems, because the same amount of tissue grown would cover more of the area of a small valve than it would a larger one.
BUt The rest I think would depend on things like IS your entire heart smaller than is "normal" for your body size, or are the rest of the measurements pretty "normal" and just your Aorta and Aortic valve small. Justin's valve is large, but that isn't necessarily a good thing, because his heart is enlarged, so of course his valve is bigger. SO i think this is one of the cases that is really different for each person and the best place to get answers would be your cardiologist.
 
Thanks Bina & Lyn. I think my 6 month echo in November will tell me a lot more. All my numbers (pressure gradients, etc.) looked good a couple wks after surgery when they did the last one on me. As long as it still looks good in Nov (which so far they have no reason to doubt) I'll be happy. The other good news (I think) is the Regent valve has lower gradients than most valves (except On-X) so hopefully that helps - although that chart was from St. Jude's Regent Website...
 
Andy i have a 21 carbo medic 18 years ago for arotic,Jan 2009 they did a St. Jude they told me i'm a mismatch to
they were gonna change out the aortic when they did the mitral,but i was high risk for surgery and my cardio's keeping close eye on it
the big thing prior to mitral surgery i was full of scar tissue in the arotic valve and size was issue but they didn't change it out then
and say i'm a mismatch for this reason to due to scar tissue i lost my valve ticking,once they cleaned out the scar tissue it ticked again.
I really wanted both done but Doc says im a one surgery valver for now
 
I'd have a nice long chat with your surgeon if I were you. Only he can tell you why he did what he did. As you know I had a big old leaflet tear(too small a valve = too much pressure with increased work load/stroke volume) which gifted me with a surgery 5 years post the last. Got a new mechanical valve 2 sizes bigger and an incredulous look from my new surgeon at the size of the old valve put in. BTW I fit the BSA INDEX for my old sized valve so that shoots your BSA theory out the window. It all goes back to the surgeon-he/she better know their stuff
 
Measure the length of your index finger, mutiply by the diameter of your bicep, divide by your weight, add your inseam length and subtract your waist size. That should get you close. Otherwise, just use the formula you found on google ;) For the others, here's a web site that estimates you your BSA - you just have to type in your height and weight:

http://www.halls.md/body-surface-area/bsa.htm

LL - my surgeon (or actually his assistant who had talked to him) said they had to use a smaller one than they would have liked because of the relatively small size of my aorta. So I trust he was right about that, I was just wondering what symptoms to watch out for that might indicate there's a problem brewing. Sounds like SOB and the other symptoms I had prior to surgery would start coming back if something goes haywire.
 
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