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Forum Name: Valvular Heart Diseases

Question: mv repair-proceed?


 willprid - Mon Apr 07, 2008 3:26 pm

Hi
I'm a 58yr male. Diagnosed severe mv regurgitation in 2003-watchful waiting since on a 6 onthly basis by ecg and echo. My cardiologist now reccommends that he repairs the valve. My problem is that I am virtually asymptomatic- ocasional slight palpitations, bp normal and pretty active (skiing, gym, tennis), not breathless except with exercise. I am told that my heart is not enlarged and the condition is no worse than the past few years but I should have the procedure while I am relatively fit and healthy and that it could get worse without warning and become permanently damaged. I am reluctant to submit to major surgery with 1 to 2% mortality rate whilst I feel perfectly healthy. My cardiologist is very experienced in mr repair surgery.
 Dr. A. Madia - Tue Apr 08, 2008 10:38 pm

User avatar Hi Willprid,

Mitral regurgitation [MR] has several causes. Mitral Prolapse, rheumatic Mitral Regurgitation, Ischemic [Papillary muscle dysfunction], Dilated cardiomyopathy are the main ones. If it is ischemic [history of past heart attacks or frequent angina] it is imperative that a coronary angiogram be done first.

If it is mitral valve prolapse, the degree of prolapse and the degree of MR has to be severe to warrant a valve repair surgery.

Rheumatic Mitral regurgitation is often associated with Mitral stenosis and sometimes with other valve involvement. Here also if MR is severe does valve repair become necessary.

In Dilated cardiomyopathy MV repair alone almost never suffices and some form of LV volume reduction surgery is indicated.

It all depends what is your degree of MR from color Doppler report. Also, is LA [Left Atrium] grossly enlarged? Is there a clot in the LA? What is the size of the LV? What is the ejection fraction?

These are the variables that will affect the outcome of the surgery. By the way 50 units of alcohol a week is on the higher side. What are you taking Viagra for? Is it for Pulmonary Hypertension? Because in that case your heart is in gross failure and surgery may be counter productive.

Best wishes,


Apurva
 willprid - Wed Apr 09, 2008 1:17 am

Thanks for your reply Dr Madia
I should have given more information. I have a mitral valve prolapse-I have had an angiogramme which was normalecg is normal and there are no other signs of heart disease. I take viagra following a procedure for prostate cancer.
I have been told that my heart size is within 'normal limits' and that the condition is no worse than it was but that I should have the repair because a positive outcome is more likely while I am relatively healthy. I have no idea what the echo doppler readings are and I assume my specialist would be an expert on interpreting the echo information.
My dilema is that to take the risk of major surgery now seems unnecessary when the condition is no worse than it has been for the the past few years.
willprid
 Dr. A. Madia - Tue Apr 15, 2008 12:40 am

User avatar Hi Willpred,

Only mitral prolapse, No rheumatic, no angina, normal angiography, normal EKG, no Pulmonary hypertension, heart size normal- no dilatation of LV or LA and no symptoms like shortness of breath. My instinct tells me to wait for surgery.

Apurva
 willprid - Wed Apr 16, 2008 5:06 am

Hi Dr Apurva
Thanks for your feedback. I am arranging an appointment with my surgeon to discuss the matter further.
Bill Priddle (willprid)

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