Tissue valve deterioration - signs, symptoms, etc.

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but as agian said if people disagree with statements we have a right to respond,
you may note that I welcomed your responses, I guess that everyone has the right to respond except me? Sorry that I've taken them personally (and I mean that of myself). Only one person has sought to discuss the issues, you know, engage with the evidence I offer to support my assertions.


Heck noone has even accepted the points raised that I have said I made a mistake in my wording, was not careful and clarified what I meant. Not a peep ... not a "oh, well when you put it that way ...", nothing.

So you see, its hard to see from where I sit that this isn't personal.

The remaining protagonists just disagree with what I say, offer no evidence and refuse even to discuss the articles I mention. That's not really much of a response if you ask me, but I have not in any way suggested you don't have that right, I have only encouraged discussion so saying to me "we have a right to respond" is ironic and represents yet more twisting of my meanings if you ask me.

Being an Aussie I'm a bit short to the point too ...
 
I listened to the Mayo presentation that Pellicle referenced, and I can't determine the accuracy of his statement that, and this is in my own words, tissue valves have been known to develop clots at roughly the seven year mark and then anticoagulation therapy is necessary. As Bryan mentioned, the literature I found stated that the risk of clot formation of tissue valves is greatest in the time immediately (three months) following valve replacement. Coumadin is frequently prescribed for patients who receive a tissue valve for a period of up to three months post-op, but then discontinued as the likelihood of thrombosis lessens.

So to answer one of the original questions posed in the thread title, in my opinion, if my valve had thrown a clot at the seven year mark therefore necessitating anticoagulation therapy, I would consider it a sign that I was nearing the time for valve replacement.

Thankfully I've passed the seven year milestone.
 
cricky pellicle why do you have to be such a drama queen, its not all about you, people disagree on here all the time, you have made good points in some of your posts but sometimes people will have another opinion, i hope you just let this matter drop and not reply with another long and elongated reply , this is a forum for open discussion take it as that, just because people disagree dont keep taking it on the chin, duck and dive a little it hurts less,
 
Pellicle

Your post prior to this one you stated was the last on this matter

Please let's accept that we all have opinions

And more importantly mechanical and tissue valves are equally good

And save or prolong life

No need to reply
you may note that I welcomed your responses, I guess that everyone has the right to respond except me? Sorry that I've taken them personally (and I mean that of myself). Only one person has sought to discuss the issues, you know, engage with the evidence I offer to support my assertions.


Heck noone has even accepted the points raised that I have said I made a mistake in my wording, was not careful and clarified what I meant. Not a peep ... not a "oh, well when you put it that way ...", nothing.

So you see, its hard to see from where I sit that this isn't personal.

The remaining protagonists just disagree with what I say, offer no evidence and refuse even to discuss the articles I mention. That's not really much of a response if you ask me, but I have not in any way suggested you don't have that right, I have only encouraged discussion so saying to me "we have a right to respond" is ironic and represents yet more twisting of my meanings if you ask me.

Being an Aussie I'm a bit short to the point too ...
 
VegasBAV,
I too have asked how long will my tissue valve last? I appreciate the diverse responses on this thread, everyone has different circumstances, sensitivities and perspectives, so it’s nice to learn from each other. I’ve read a fair amount of articles in learning about my condition, they’re all helpful, but it’s also noteworthy that on occasion even experts will differ in their opinions.

Just a few qualifiers, first I agree with past comments that no matter the valve choice people going through this for the first time are making a choice to save their lives and both valve types are good choices depending on circumstances and the individual. The second thing, for new readers on the forum, is I think that most who have been active on this forum for a long time know more than me, honestly, so take my opinion with a grain of salt, and your cardiologist and surgeon know more than me (obviously).

But back to the original question, how long do I think my tissue valve will last? I won’t get into all of my varied thought processes of why I chose a tissue valve, but after the honeymoon was over and I was feeling strong I started to wonder what if things don’t work out so well for my valve, should I start to press the pedal down and live even faster in case of problems down the road (probably never a bad idea to live fully)? This question didn’t bother me too much, but it did pop into my mind when I thought of another operation in what I assumed, even with newer generations of valves to be about a 10 to 15 year average. I had read about longer expectations with the newer treated valves (in general depending on your age at operation), but I had also heard of those that had their valves degrade sooner than average, so in making my initial decision I took what I thought for my age would be a realistic and somewhat conservative range of 10 to 15 years knowing it could be just 7 years or I thought 18 at tops.

After my operation which included a few complications I asked my surgeon would I still have a chance of getting 10 to 15 years out of my new valve, he said I’m “hoping” you get much more than that. I still have some diastolic dysfunction, left ventricle doesn’t relax as much for refill after 50 years of pushing through my old narrow unicuspid aortic valve and we watch my mitral valve since it’s leaking, so despite wondering about how long my aortic tissue valve will last I could end up needing another operation on a different valve, after all I have a congenital heart condition. At the end of my last annual visit my cardiologist said, I think you’re going to grow to be an old man (heck, a few people think I’m already there), and that I may or may not need attention to my other heart issues along the way, and that my tissue valve may even last the rest of my life. I thought, okay, “the power of positive thinking”, unless he knows of some impending scenario where I will be hit by a bus tomorrow and so will out live my valve. Who knows what my natural life expectation will be (70, 75, 80...). So I think I will be best served by focusing on being as healthy as I can and do my annual echos and see where it goes from here while enjoying my second chance. Now I know things aren’t that simple, some of us are dealing with serious multiple health concerns, need to make hard decisions, our families may depend on us being around for as long as possible, etc. But for me, I will do all I can but also get out there and put some miles on my valve, if the wheels come off sooner than expected then I’ll have to gear up for surgery, hopefully thankful that I will get the opportunity to fix things again. It’s hard to predict, I know as the valve ages I should watch for signs of degradation, e.g., shortness of breath during exercise, fatigue, dizziness, swollen ankles, etc.. My annual cardiology check ups should be informative as I plod along (currently doing well).

Best wishes with your tissue valve!
 
Forrest, I applaud you on a very well thought-out strategy. I also agree -- none of us can know what the future holds for us. We can only make the best decisions we can, then make the best of the life those decisions afford us. I fully intend to wear out my tissue valve, but I am not going to worry about when that will happen. As you have discerned, I think it best to just live life and deal with what life brings, as it comes. I chose my tissue valve for the quality of life I felt it would afford me. I knew about its potential limitations and chose it freely. I also realize that I may need another valve, and that the procedures may or may not be vastly different than they were the first time. That's all part of making that informed decision.

I believe that as long as we keep up with the scheduled "maintenance" (cardio visits, echo's, etc.), we will have plenty of warning as things begin to deteriorate. At the present, things are as good as can be expected. I know I will probably need my pacemaker replaced before any valve work, so I will not be out of the cardio's care in my lifetime. That is fine with me. Just as my car sees its mechanic regularly, I plan to take my body to its mechanics regularly to assess its condition and address any needed maintenance sooner rather than later. That's all we can do.
 
Thanks Rachel and Steve. And Steve, I like your car maintenance analogy! Too bad we as humans can’t just “buy a new car” when our car (body) has structural issues, but it’s nice to be able to keep the same auto running by paying attention to it.
 
totally agree guys, you cant live for what or will not happen in 10yrs time, you have gotta enjoy life now and be glad we have been given this chance,One final thing steve which i disagree with, beef tastes better than pork lol .
 
I don't know, Neil. I do remember thinking that if they ever re-run those old Burger King commercials where Clara Peller (the little old lady) shouts "Where'e the beef?" I will probably answer "Here, sir!"

I wonder what Cort does -- he has one cow valve and one pig. . . and the last time we got together it was obvious that he is not a vegetarian.
 
Someone had posted on this forum before that he had asked his doctor “How will I know when it is time to replace my valve.”

His doctors’ reply was “you will know.”

My test results never change much and my doctor told me he didn’t think my symptoms were being cause by my heart, but he did send me to a surgeon. It was me listening to my inner self. After having surgery I breathe so much better. My heart valve fell apart when the surgeon tried to repair it and I was given a tissue valve.
 
OP here. I appreciate the responses. I saw my cardiologist a few days ago for my one year from surgery echocardiogram check up. I asked him the same question, he said that failing tissue valves become stenotic and the main thing that would show up on an echocardiogram would be a high gradient. He said that if the median gradient got up to 30 or 40, that might indicate significant failure leading towards surgery.

The echocardiogram report says that the mean gradient from my St. Jude trifecta valve one year after surgery is 4, the peak gradient is 8.

Also, my left ventricle has shrunk in size by 20% - 25% in the year since the surgery. It was only borderline enlarged before, now it is very much normal sized. Pretty, pretty, pretty good.
 
Hey Vegas, that's a great gradient! Matches up perfectly to what the St. Jude website claims. What valve size do you have? Check out the link:

http://professional-intl.sjm.com/products/sh/tissue-valves/aortic-mitral/trifecta


OP here. I appreciate the responses. I saw my cardiologist a few days ago for my one year from surgery echocardiogram check up. I asked him the same question, he said that failing tissue valves become stenotic and the main thing that would show up on an echocardiogram would be a high gradient. He said that if the median gradient got up to 30 or 40, that might indicate significant failure leading towards surgery.

The echocardiogram report says that the mean gradient from my St. Jude trifecta valve one year after surgery is 4, the peak gradient is 8.

Also, my left ventricle has shrunk in size by 20% - 25% in the year since the surgery. It was only borderline enlarged before, now it is very much normal sized. Pretty, pretty, pretty good.
 
My valve is 25mm, my surgeon said he expected the gradient to be 6 after surgery, so I'm pleased with a mean gradient of 4 a year later.
 
You said,

I'm just against the people who are somehow against mechanicals as if people who choose mechanicals are unwise for choosing that. Something which I feel exists here in much greater proportions than the other way round.

What I'm hearing, from the tone of your posts (largely condescension and sarcasm, thus far), that I've read as a newcomer to this group, it seems that while you have a decent amount of knowledge about artificial valves, you're imagining that people who are against mechanical valves themselves (due to not wanting to take warfarin, or for ANY other reason), are judging you in some way. Unless someone actually comes out and says that "people who choose mechanicals are unwise for choosing that", I think it's a ridiculous and rather self-centered assumption to make (ie, that people express opposition to mechanical valves to suggest that you're unwise, rather than exercising their RIGHT to have an opinion on valves that's different from the one that "you" have.

In other words, IMO, your choice to take it personally when someone expresses support for tissue valves, or opposition to mechanical valves, is causing you to respond in nasty and sarcastic ways to people, which undermines the good that some of your information might have done, because some conclude that you're an ass. I'm sure you're a good person, beneath the defensiveness and sarcasm, so if you can put aside your ego, and not feel so affronted that someone doesn't like mechanical valves, blood thinners, or whatever, I think the good information you provide here (ie statistics, etc) would be a lot better received. Reading several your posts so far, gives me the sense that you're an unhappy and bitter person, at least at present, yet while it sounds like you've been through a lot, I can assure you that you're not the only one!

Please consider dropping the defensive attitude, "I'm just against the people who are somehow against mechanicals, AS IF people who choose mechanicals are unwise for choosing that" (emphasis mine), and allow people the right to be for or against whatever the hell they want to, for their own reasons-without worrying about you taking it as a personal attack. I realize that's pretty blunt, but it's honest, and I'm facing this decision soon, so frankly, I don't need the aggravation of reading your sarcastic putdowns and digs against others, when I'm attempting to gather information about the pros and cons of various valves. I wish you nothing but the best, but to be honest, I don't need the additional stress of reading your sarcastic lectures right now...

If you wfocus more on the actual facts (as you see them), rather than animosity against people whose choices or opinions you don't agree with, I suspect that the info you offer would be a lot more welcome, and people could absorb it better, without feeling obligated to agree with you so you won't make unfriendly comments about them, too. People often remember the "tone" of another person's remarks, and their attitude, more than the actual words, so IMO it's not so much what you say, but "how" you say it that a lot of people will have a problem with. I think I'm talking about respect here, and I truly hope my bluntness will do you more good than harm, if you'll consider how much some of your sarcasm seem to be pissing some people off. Trust me, I can be EXTREMELY sarcastic and cutting when I want to be, but people here have serious heart concerns, and some of us are facing surgery soon-so nobody needs more stress. Thanks for considering, and I hope you can understand what I'm saying.
 
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Of course you're stressed, why wouldn't you be? But don't forget we're all in the same boat. We make better decisions when we're objective, so if reading posts by someone adds to your distress... don't read them. Why would you willingly expose yourself to something you know is going to piss you off?
 
BookGuitarGuy,
Welcome to the forum. I hope never to have as much experience as Pellicle, but I very much appreciate his efforts to share his.

If you are looking for information about different valve choices it might be more constructive to start a new thread and share a little about your situation. The members of this forum have a wealth of experience. In any case I recently posted some info about tissue vs. mechanical, so I will share it again here in the hope that it is helpful:

Here is an article on the AHA web site that may be helpful: http://circ.ahajournals.org/content/117/2/253.full. See especially the figure containing a decision tree. Also, there is a good example using a 50 year old man with a 30 year life expectancy, and determining the risks with either choice, tissue or mechanical valve. The net is that in this example the risk of death is slightly higher with the tissue valve and the risk of illness is much higher with the mechanical valve. While I generally prefer to look at the data, as this article does, there is a lot of value to read on this forum about the experiences of people that have actually been through it. I'll also point you to a good presentation on valves done by the Mayo Clinic: http://www.valvereplacement.org/foru...ht=mayo+clinic. The biggest point I took away from this presentation is that good/self monitoring of INR levels may reduce some of the risks for those with mechanical valves.
 
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