Aortic valve repair

[Vince Kelley]

Hi,
I am a 43 year old male with a leaky aortic valve resulting from rheumatic fever when I was 14 years old. My leakage is rated at 3+. Three years ago I was a 1+. At this point my heart is not enlarged but there is a slight thickening of the heart muscle around my aortic valve. About every 6 months for the last 1.5 years I have gone through a week-long episode of on again / off again arrhythmia. I notice a general weakness and slight shortness of breath at this time while climbing stairs. Other than this I am pretty much asymptomatic and until now have had no limitations on exercising. I have been running for 10 years and was in the middle of training for my first marathon when I had the last arrhythmia episode this last March. That was when I got checked and during a stress echocardiogram in early May found that my leakage had gotten worse. My cardiologist says that I will need a valve replacement sometime in the next 10 years depending how the valve degeneration progresses.

Is it possible to repair an aortic valve that leaks at this rate? Can you tell if a repair is possible by looking at the echocardiogram results? I would obviously prefer repair over replacement because of the lifelong anti-clotting medication I would have to be on after valve replacement.

Other than my faulty valve, I am in excellent health. If it could be repaired, what sort of limitations would I have? Right now my cardiologist has given me the OK to run and bike at a lower aerobic pace, 120

[garyr]

An echo will not provide enough information to the
cardiologist or surgeon to decide on repair over
replacement.

Like you, I had a bout of Rheumatic fever that damaged
my AV at age 13. I had it replaced at the Cleveland clinic
8 weeks ago (I'm 57). Annual monitoring  in early years then semi-annual in the last two years combined with careful management of physical activity put it off for a good 40 years.

Dr. Toby Cosgrove at CCF, who is one of the best at AV repair, was not in the least optimistic about repairing mine but left open the tiny option till he eye-balled it. It was not reparable being calcified, functionally bicuspid, stenotic and regurgitant.

There are some great slides and videos available if you are interested in viewing what one of these diseased valves look like; you'll understand more clearly than I can explain why
it must be replaced once you see what it looks like.

Rather than take up bandwidth here, if you wish to access other URLs while pondering your eventual surgery, my email is ***@****  

[Cleveland Clinic, MD]

Aortic valve disease due to rheumatic valve disease is not usually repairable but it would depend on the degree of damage and the surgeon.  Dear Jim,

Thank you for your question. There are two main options for aortic valve replacement: mechanical and tissue.  Examples of mechanical valves are St.Jude, Star-Edwards and Medtronic-Hall.  The advantage of the mechanical valve is its long life (usually longer than the person receiving it).  The disadvantage is the need for life-long coumadin. There are no long term complications from taking coumadin other than the bleeding risks.

Tissue valves are made from pig or cow hearts and last about 5- 10 years.  The main advantage is not having to take coumadin.  Aortic homografts are tissue valves from cadavers and also do not require anticoagulation and may last longer than other types of tissue valves.  No one really knows how long but it is probably more than 10 - 15 years.  The chief disadvantage of the homograft is availability.  

The Ross procedure transplants the patients own pulmonic valve to the aortic position and places a tissue valve in the pulmonic position.  We are currently doing a few Ross procedures here but they are not as popular as they once were.  

As you can see each option has its pros and cons.  Ultimately the choice is between you and your doctor.  

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