Post AVR (mosaic Bio-prothetic)

[shirish315]

I had undergone AVR with medtronic bioprothetic 25mm valve in Jan 2012. Since then I have been on medications and the present medication is as under: Meteprolol 12.5 mg once daily, Aspirin 75 mg once and crestor 10mg once daily.

The echo in June 2012  was taken as one of the doctors expressed that there is faint systolic murmur (though my surgeon stated it is common feature). However, results showed normal function with AVG 12/7. EKG within normal limits. Sr.triglyceride 165 and LDL as well as VLDL are border. BP is 124/82. Heart rate is 76. No specific symptoms. Please advise whether can stop meteprolol to avoid side effects. Is systolic murmur common as indicated by my surgeon? Any measures?

[shirish315]

Thank you so much. All the Best.

[Smiley2000]

Hi there,

I had Mitral valve repair done in March 2008.  My resting HR was 130+ for a good 3 months after the op and then it stabilized.  Post op echo's even to date, show mimimal mitral valve incompetence and at some stages even Aortic valve leaks.  So mimimal leaks on some or even the valve that was fixed, is normal finding and does not need medical intervention.

I would advice you to go for a Cardio check-up and in consultation with your Cardio, you can start weaning yourself from the meds.

All the best,

[shirish315]

Thank you so much. There is no perivalvular regurgitation. The surgeon confirms that it (mild murmur from leaflets) is common feature. I shall try to taper off meteprolol and watch. the cardiologist had prescribed it as the heart rate during some period was 94 bpm. As rightly pointed out routine check up is necessary for such procedure.

[skydnsr]

A faint murmur after AVR isn't anything to freak out about.  It does need to be watched, to make sure it doesn't progress.  But then again, even if you didn't have a murmur at all, your valve would still need to be watched to make sure you didn't develop a murmur or other problems.  Careful monitoring is part of the life of someone who has had a heart valve replaced.

I would be interested to know whether the echo showed the source of the murmur.  I would want to know that the sewing line looked secure and that there wasn't any regurgitation in that area.  The reason I mention this is because I had to have my own AVR very prematurely redone when I developed early perivalvular regurgitation.  Wherever the murmur was coming from, I would be interested in the cardiologist's opinion about what to expect with it in the future.  

If the murmur was coming from the leaflets, and if the cardiologist told me that it was normal, I wouldn't have any reason to challenge or question that.  It's not a "normal" valve, after all.  It's an arificial device that allows you to live.  It's wonderful to have it, but IMO there's no reason to expect it to be identical in all ways to a native valve.  I would just keep my follow-up appointments, and I would expect to have a routine yearly echo.  

As far as the metoprolol goes, the two indications for that drug in this situation, that I am aware of, are for heart rate and blood pressure.  If you can get off the drug without any adverse effects on your heart rate or blood pressure, then maybe you can do without it.  You're on a low dose, so it's hard to see that it could be doing all that much, anyway.  I would ask the doctor for a trial off of it, to see.  If the doctor thinks that this is a critical medication for you, I would want to know why.

I was on 200mg of metoprolol per day, at one time -- plus other blood pressure medications.  That's how out of control my blood pressure was, pre-surgically.  Post-surgically, I have been able to taper off of the metoprolol entirely.  It took a long time to get  down to zero on that one, but I hear you about the side effects.  It's a medication that I'm glad I don't have to take right now.  

Good luck with everything.