Yikes! Aortic valve leaking after surgery. Anyone else?

[DachsieMom]

I had surgery 4/9 to replace my aortic valve with a st Jude mechanical valve and part of my aorta replaced. I went for a routine echo today (almost 10 weeks post op). Apparently I have a peri valvular leak which is more than the cardiologist would normally expect. He said he was "not ready to send me back in the OR today", as I am not having symptoms. I am totally shocked. I am 42. I thought I was fixed for life and can't go through this again (and my surgeon may retire soon as he is 65....who knows?) He said that as long as it does not get worse, I could live with it, but if it gets worse, it is another OHS. There is also a possibility that scar tissue could form and plug the leak, but he did not seem confident since I am already 10 weeks out. Apparently this occurs when the enflamed heart shrinks back to normal size after surgery. Has anyone heard of this? I am pretty upset. My instinct is that it will just generally get worse as I age anyway, which makes another surgery more likely. My EF was 65 percent. I forgot to ask about restrictions. I am running pretty quickly at cardiac rehab (almost 6 mph). Hope that did not contribute to it. I plan to call my surgeon when he gets the report to get his view, but hoping someone else has been through this as well.

 

[Northernlights]

DachsieMom, this is really bad luck - what stressful and unexpected news. Small paravalvular leaks are not that uncommon, but it is unusual for them to be large enough to cause problems. You are obviously not symptomatic, and it's important to remember that it may well be that the leak never gets large enough to need dealing with. As you have probably seen, Joanne has just posted about her father's paravalvular leak - and mentions the possibility of closing the leak with a transfemoral or transapical patch instead of a full surgical re- operation. The leak will need to be monitored, but I would suggest that if you do need another operation or a patch in the future, you go to a centre with particular expertise in this, rather than back to your old surgeon. Here is a bit more info on leaks and their causes:

'Paravalvular leaks are the result of an incomplete seal between the sewing ring and annulus. This may arise from abnormal pressure or traction forces
on the prosthesis occurring after surgery. Several factors are known to increase the risk of PVL formation. They include annular calcification, infection, suturing technique, as well as the size and shape of prosthetic implant. The early occurrence of PVLs is usually associated with the technical aspects of the surgical implant. Late PVLs are commonly a consequence of suture dehiscence caused by endocarditis or the gradual resorption of incompletely debrided annular calcifications.'

 

[DachsieMom]

Thank you. I went to Yale, which has a specialized aortic center and great reputation. I had a CT scan 8 weeks post op. I did not hear of any issues - I wonder if this leak can just develop? Wouldn't it have been seen on a CT scan? I haven't spoken with my surgeon. He wants to see the echo disk. I would appreciate hearing anyone else with this - I am young with young children so am really nervous. What are the other places that do this procedure you mentioned? With my life, I need to be close to home. Hopefully scar tissue may still form and/or it doesn't change, so I can live with this forever. Sorry for the ramble, I am still in shock. I forgot to ask about restrictions - still plan on doing same at rehab.

 

[Northernlights]

Well, I would think that Yale would mean a suture problem was less likely! I am obviously no expert on this, but all imaging has its limitations. It may well be that the echo has over-estimated the size of the leak and it is nothing to worry about. I would agree that anything problematic would be expected to show up on CT. Re leak closure, all I know is that catheter closure is fairly new, and thus you wouldn't want someone who'd only done six; and if you had to have a re-op you are obviously a very good candidate. But it may well not come to that at all. I imagine you may need more imaging to establish the situation, but I really hope your surgeon is reassuring when he sees the echo. But it is tough to go through this anxiety.

 

[dornole]

So - you had a CT just two weeks ago that was fine? And you obviously are doing really well symptom-wise with your rehab. Hope that means either 1) echo was false and nothing is wrong or 2) the leak is nothing critical and/or not deteriorating, at least not rapidly. Even if you need a re-do eventually, it sure would be nice for your kids to grow up a little first and for you to catch a break from surgery. Thinking about you and really hoping things go your way.

 

[pellicle]

Hi

depending on where and how and what its possible there could be a non surgical solution, I read that paravalvular leaks can be "plugged"

http://www.escardio.org/Guidelines-...ication-after-implantation-of-prosthetic-valv

read section C of that

best wishes

 

[wxman]

I had some leakage right from the start...but not significant. About 3 years after surgery...the leaking became more significant and it looked like I was headed for a re-op. However...subsequent echos over the next several years showed the leak diminishing again to acceptable levels. I am now 12-years out from surgery...with no symptoms and leaking still at acceptable levels. So...don't panic yet...as this could easily resolve itself over time.

 

[DachsieMom]

Thank you so much, everyone. My surgeon said it is virtually impossible for me to have a leak based upon the type of valve I have (I think it is connected to something as one connected piece) but he is sending me for an echo to be sure. He thinks the blood the cardio saw in his echo was a different source (I can't recall the entire explanation, but the surgeon seemed confident).

 

[DachsieMom]

Update - saw my surgeon today. He said I am fine. I can't begin to repeat his explanation correctly, but basically the St. Jude valve has three jets, what the echo drs and cardio saw is not really a paravalvular leak - it is part of how the valve is designed to work. He said anyone familiar with the specific valve would understand (funny, since he had me do a repeat echo at his own hospital following the echo at my cardio, and apparently even those docs misunderstood). I do believe him, and I think he would tell me the truth if there was an issue. I have a valve which is connected to the Dacron tube - it is one piece. I am very relieved. Thank you to everyone.

 

[dornole]

So happy for you. Very glad you're healthy!!

 

[Superbob]

It is so good to read this happy outcome. There is a lesson here, too, that echo results are inexact and sometimes misleading. When I moved here and got a new cardio and echo tech, they were positive they saw an aneurysm. I had a follow-up CT and got the tapes and videos for that and the echo and sent them all back to my surgeon in Virginia, and he found that I was perfectly okay -- I have a combined root/valve replacement and they were not understanding its configuration and how it worked (and it continues to work well after almost 11 years)....

So anyway, thanks for posting your experience, which can help others. And cheers for your good outcome and hopes for continued good health.