Aa
mitral valve replacement surgery
I was diagnosed with RHD (mitral stenosis) and had mitral valvotomy done in 1988(open heart surgery/splitting open the mitral flaps) when Im 30 as I was planning for a family. I'm 51 yo now and I underwent gastroscopy & colonscopy at a hospital in Mar2010 as I was experiencing food poisoning and abdomenal distension, Results were clear except for a minor ucler in the small intestinal wall. A month later, my legs swelled and I was warded for CCF and atrial fribillation. I am put on 100mg atenolol, 125mg digoxin, 2mg & 3mg alternate day warfarin & 40mg omeprazole. I have been advised to undergo 2nd open heart surgery for mitral valve replacement (artificial valve) and tightening of the tricuspid valve opening.What are the pros and cons of this surgery? Artificial valve does not need replacement but I have to be on lifelong warfarin medication. What will happen if I choose not to do it? What are the side effects of LT warfarin?
This discussion is related to Mitral Valve/Aorta malfunction and their symptoms.
This discussion is related to Mitral Valve/Aorta malfunction and their symptoms.
I always found Rheumatic heart disease peculiar as it took decades to destroy the valves but it is progressive and unrelenting and given you are relatively young, you will need to have it fixed at some point if you are planning to live awhile longer like til 80.
Rhd affects the mitral valve as it becomes tethered and stiff and just plain gnarly and doesnt open properly. This "stenosis" leads to volume backup into the atrium, this in turns leads to the atrium stretching out and breaking the internodal pathways in the process where the electrial depolarization of a normal heart impulse should travel. In short, stretching the atrium will cause atrial fibrillation.
Once you have it, the more likely you will stay in it or go back into it. Which means warfarin therapy permanently, just as if you had a mechanical valve.
At your age you will want a mechanical valve so it doesnt wear out, they rarely replace mitral valves with tissue if at all. Anyways, why would you want to have this done?
Well because with RHD given what youve said, its inevitable that you will have to have it done.
AND, here's the big thing, you will want to have it done BEFORE your lungs are damaged by the severe mitral stenosis. The lungs operate under a sensitive pressure limit and severe MS will elevate that which can permanently damage the lung tissue.
You dont want to wait and get permanent shortness of breath as a result.
IF you wait and you go into permanent atrial fib, then you are on blood thinners for life anyways as atrial fib requires it to prevent clot formation in the left atrial appendage which can break loose and cause a stroke. So you'll just have to settle in on the notion that warfarin therapy is going to happen no matter what.
The cons are related to the risk of the surgery itself, there is always a risk with openheart surgery.
Unfortunately there is no way around rheumatic mitral stenosis as it is progressive and balloon valvuplasty does not work well as they tend to just re-fuse together.
BUT, having said that, if you are deadset against surgery you can inquire about the balloon valvuplasty option. I think there are still a few places that will perform that, probably have to travel to a different state and really its just a temporary bandaid. You'll need the surgery and might as well get it over with.
Mitral replacement surgery can also ding your left ventricular function, thats a con. But you'll also protect your lung structure by doing having it done, thats a pro and the pros outweigh the cons
As far as the tricuspid valve, while they are in there they might as well do it, if you have severe TR it can contribute to right heart failure but honestly, people can live with a tricupid valve. They dont put them in drug addicts that get endocarditis from IV drug use because they wont be compliant with the warfarin so they just cut the tricuspid valve out and send them back out.
So the pro is 'decreased risk of right heart failure' and since they are in there, might as well do it.
con, none really
Hope that helps
Rhd affects the mitral valve as it becomes tethered and stiff and just plain gnarly and doesnt open properly. This "stenosis" leads to volume backup into the atrium, this in turns leads to the atrium stretching out and breaking the internodal pathways in the process where the electrial depolarization of a normal heart impulse should travel. In short, stretching the atrium will cause atrial fibrillation.
Once you have it, the more likely you will stay in it or go back into it. Which means warfarin therapy permanently, just as if you had a mechanical valve.
At your age you will want a mechanical valve so it doesnt wear out, they rarely replace mitral valves with tissue if at all. Anyways, why would you want to have this done?
Well because with RHD given what youve said, its inevitable that you will have to have it done.
AND, here's the big thing, you will want to have it done BEFORE your lungs are damaged by the severe mitral stenosis. The lungs operate under a sensitive pressure limit and severe MS will elevate that which can permanently damage the lung tissue.
You dont want to wait and get permanent shortness of breath as a result.
IF you wait and you go into permanent atrial fib, then you are on blood thinners for life anyways as atrial fib requires it to prevent clot formation in the left atrial appendage which can break loose and cause a stroke. So you'll just have to settle in on the notion that warfarin therapy is going to happen no matter what.
The cons are related to the risk of the surgery itself, there is always a risk with openheart surgery.
Unfortunately there is no way around rheumatic mitral stenosis as it is progressive and balloon valvuplasty does not work well as they tend to just re-fuse together.
BUT, having said that, if you are deadset against surgery you can inquire about the balloon valvuplasty option. I think there are still a few places that will perform that, probably have to travel to a different state and really its just a temporary bandaid. You'll need the surgery and might as well get it over with.
Mitral replacement surgery can also ding your left ventricular function, thats a con. But you'll also protect your lung structure by doing having it done, thats a pro and the pros outweigh the cons
As far as the tricuspid valve, while they are in there they might as well do it, if you have severe TR it can contribute to right heart failure but honestly, people can live with a tricupid valve. They dont put them in drug addicts that get endocarditis from IV drug use because they wont be compliant with the warfarin so they just cut the tricuspid valve out and send them back out.
So the pro is 'decreased risk of right heart failure' and since they are in there, might as well do it.
con, none really
Hope that helps
What was the underlying cause of your congested heart failure? What specifically is the cause for a valve replacement? With a very experienced surgeon many valve operations can be done that doesn't include replacement.
Long-term, low-dose treatment with warfarin may prevent clots, but it's not without risk. There's a risk of serious or even fatal bleeding — especially when warfarin is taken in high doses or for long periods of time...taking warfarin at a high dose for a longer period of time is only advised for individuals who are at a high risk of developing blood clots that could cause a heart attack, stroke or pulmonary embolism. There is a risk/benefit decision that would require professional judgement.
Thanks for your question, and if you have any further questions, you are welcome to respond. Take care.
Long-term, low-dose treatment with warfarin may prevent clots, but it's not without risk. There's a risk of serious or even fatal bleeding — especially when warfarin is taken in high doses or for long periods of time...taking warfarin at a high dose for a longer period of time is only advised for individuals who are at a high risk of developing blood clots that could cause a heart attack, stroke or pulmonary embolism. There is a risk/benefit decision that would require professional judgement.
Thanks for your question, and if you have any further questions, you are welcome to respond. Take care.
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