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Forum Name: Valvular Heart Diseases

Question: Mitral valve and aortic valve surgery


 sharon - Mon Mar 10, 2003 8:57 am

I went to see the surgeon on Friday and a 3-D echocardiogram was performed. The doctors suggested that different drugs be used to decrease the down load in my heart. When I told them that had been done before but my blood pressure had dropped to very low levels they suggested that I try diuretics. I believe that the thought was to buy me several more months, possibly 6 before they do surgery. But why do I need to "buy more time"?If I feel tired most all of the time, and have for so long, what kind of time am I buying. Is there something more that I don't understand? I was also told that if they cannot repair the mitral valve then if will need to be replaced with a mechanical valve, because I am too young (52 years) for a tissue valve. Can you tell me how long a mechanical valve last? The surgeon thought that he could place several stitches in the aortic valve and that should take care of that problem. Since the surgeon would do both valves an incision of 6-8 inches would be needed...is that still considered minimally invasive?

I have a "crazy" history of immune disorders. I had transverse myelitis, years back, after suffering from the flu. I was paralized from the neck down and stayed in the hospital for close to 3 months. It has left me with weak legs and a neuro-genic bladder. So going on lasix sounds like nightmare to me. Somehow I think that running to the bathroom all day is going to be tiring. I all ready get up during the night to go to the bathroom 4 or 5 times, and that is without lasix! 6 years ago I had a bad sinus infection that just didn't want to go away. My immune system decided to attack my optic nerve and rendered me totally lblind. After 7 months of treatment, 6 months on chemo-therapy drugs to depress my immune system, I was able to retain some vision. I am telling you these things because I think that time is not always in my favor and "wierd" things seem to happen quickly in my case. Is my thought process "off base" with this kind of thinking? My neurologist thinks that a valve repair may give me a new lease on life and just generally make me feel so much better.

Perhaps I didn't fully explain my history well to the surgeon. It can be difficult talking with them, especially when they start running the test, because it feels like I would be interupting while they were doing the echo. I think this is a problem for most patients. So I have a date for surgery BUT I also will start on lasix this week. The worse part is that there are still unanswered questions and I don't know how long they will wait until they decide to do the surgery. All the labs were done, as they recommended, and they are only good for 1 month. I sure would just like to get this over and go on with my life...am I wrong to feel this way...am I over-looking a benefit? I would appreciate your thoughts on this. Thank you!
 Dr. Yasser Mokhtar - Tue Mar 11, 2003 1:17 am

User avatar Dear Sharon,

Thank you very much for using our website and for the update.

Decreasing the load on the heart can be done with various medications including lasix, but usually lasix and other diuretics are used when the patient has fluid overload (like swelling in the ankles and legs, fluid in the lungs and around them and so forth). If you do not have excess fluid in your body you could end up with dehydration.

Of course, i have not seen or examined you and i do not know the dose of the lasix that is going to be started but unless you have excessive fluid i suggest that the dose would be small. If you do not have any excess fluid then the best step is to give the medications that take the load of the heart in the least tolerable dose for you.

About mechanical and tissue valves, it was found that mechanical valves survive longer than tissue valves so it makes sense to use mechanical valves in younger patients. The drawback as i already mentionned in a previous answer is that you will have to take a blood thinner for life.

i think the you ought to ask the surgeon the question of why does he want to postpone the surgery unless you are in obvious heart failure and he is giving you the lasix to make your heart failure improve and then wait till your condition stabilizes completely and then proceed with surgery.

About the minimally invasive surgery, minimally invasive means either having a smaller incision or not using the bypass pump. An incision 6-8 inches sounds to me a little bit generous for a minimally invasive procedure as the incision is usually somwhere between 4-6 cm (Still i am not a surgeon and the field of minimally invasive surgery is changing all the time and i am not uptodate on it).

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and please keep me posted.

Yasser Mokhtar, M.D.

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