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Ask The Expert Archive

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Mitral Valve Surgery Archive Questions

Below are Dr. Gammie’s answers to Mitral Valve Surgery questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 75.

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Q : 1

How and when ( pre-operative or intra- operative)do you decide if the mitral vale in case of severe mitral valve regurgitation is repairable or not?

We determine if the valve is repairable by reviewing the echocardiogram preoperatively. We then can give the patient an estimated repair rate but always have to have a plan B for replacement before going into the operating room.

Q : 2

Is the mitral valve repair surgery performed on elderly patients, close to 94 years old? If so, how dangerous is it?

Yes, we can perform mitral valve surgery on elderly patients. It truly depends on the patient and their other comorbidities in determining their risk for surgery.

Q : 3

What test do you use to determine the mitral valve is the problem when the patient is experiencing fluid around her lungs?

You would need to have an echocardiogram to evaluate all of your heart valves including the mitral valve. This is basically an ultrasound of your heart. It is not an invasive procedure and has no risk. Pleural effusions or fluid around the lungs may have several causes. Your primary physician would most likely investigate and send you for series of testing to determine the cause.

Q : 4

My husband, age 52, had a mitral valve repair done 16 years ago. It's now showing signs of fusing again. He's also been in afib all this time, takes Warfarin, Digoxin and Lipitor. Is a second valve repair possible? Or is it more likely that it will need replacing?

A second valve repair may be possible. It truly depends on how the valve looks by echocardiogram and in the operating room. The surgeon attempts repair first and then, if not satisfied, will replace the valve. I would suggest that your husband go to a surgeon who specializes in mitral valve disease like Dr. Gammie. The average heart surgeon does 5-10 mitral valve operations a year. Dr. Gammie does over 200 per year. If you have further questions or would like to set up a consult, please call 410-328-5842.

Q : 5

Are cardio fitness exercises, such as the elliptical, safe for patients with moderate to severe mitral regurgitation? I used the elliptical for 12 minutes yesterday and my heart was still racing this morning.

Yes, you can exercise but you should not push yourself. If your heart was racing and lasted even after exercise, you should see your cardiologist. People with mitral regurgitation can develop an irregular rhythm called atrial fibrillation. If you have frequent palpitations, your cardiologist may want to consider putting a holter monitor on you to check for atrial fibrillation. If you are having symptoms, you may want to be seen by a cardiac surgeon sooner than later.

Q : 6

I need my mitral valve repaired, but do not want to undergo surgery. I also have arrhythmia. Are there any other options?

Unfortunately, there is no medicine that can cure mitral valve disease--medicines only help with symptoms. A leaky mitral valve is a mechanical problem and requires surgical intervention when the leakage is at a severe state. As for your arrhythmia, sometimes this can be corrected with a cardioversion or shocking the heart or controlled with medications. Filomena Koenigsberg, CRNP

Q : 7

I find little or no information on post operative repair/replacement surgeries dealing with an occurrence of a plaque-like lining on the bi-leaflets of the tissue valve that replaced the failed repair. What is available for treatment of this build up?

There is nothing you can really do to decrease the formation of plaque around your valve or on the leaflets. You need to continue to have close follow up with your cardiologist and have serial echocardiograms. If the repair failed, you may be considered for a second operation to fix your valve or replace it. If you have a severe leak to your valve, reoperation should be considered. Filomena Koenigsberg, CRNP

Q : 8

Why is traditional heart valve replacement recommended for an 86-year-old patient diagnosed with tricuspid regurgitation instead of minimally invasive heart surgery? I would have expected that minimal invasive heart surgery is less traumatic and a lower risk.

Minimally invasive tricuspid valve surgery involves placing a cannula (plastic tubing used for the heart-lung machine) into the femoral artery. Patients who are older (75 years and above) are more likely to have calcification of the femoral artery. This calcification can become immobilized by the cannula, causing a stroke.

Q : 9

In general, do you advise 80-year-old patients experiencing some shortness of breath to get mitral valve surgery? What would you expect for a recovery period?

Have you been diagnosed with severe mitral valve regurgitation (leakage)on a recent echocardiogram? If so, surgical evaluation would be indicated (even for those who are >80yrs old). Recovery after surgery varies significantly from patient to patient. However, the average length of stay in the hospital would be about a week (assuming no complications), and the recovery period is usually 1-3 months. Please do not hesitate to contact me if you have further questions. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.

Q : 10

What is the recovery time and out of work time for Mitral valve repair surgery?

This varies significantly from person to person. On average, the length of stay in our hospital is about 4 days, and the average amount of time out of work is about 1 month.

Q : 11

Do you actually open the heart to perform a mitral valve repair?

Yes. We open the left atrium of the heart in order to visualize and operate on the mitral valve.

Q : 12

After mitral valve surgery, what is the typical heart rate range?

Post-operative heart rates differ significantly from patient to patient. However, in general, most patients' heart rates tend to be higher than before surgery. Most patients are placed on a beta blocker after surgery, which helps to keep the heart rate down in the normal range - below 100, ideally between 70-80.

Q : 13

What is the criteria for mitral valve repair? I had an RF ablation for AFib and during a recent echocardiogram I had mitral valve prolapse with moderate regurgitation as well as an audible murmur. Should I be pursuing repair quickly?

Surgery is indicated for those with severe (not moderate) mitral valve regurgitation. Dr. Gammie also performs the cryomaze procedure for atrial fibrillation. --Mary, Dr. Gammie's physician assistant

Q : 14

I was told that my mitral valve is deteriorating and that my aortic valve has two leaflets fused shut. Can one, or both of these cause my attacks of angina?

Having severe aortic valve stenosis (severe narrowing of your aortic valve) can cause symptoms of chest pain. Have you had a recent echocardiogram? Have you had a stress test or cardiac catheterization performed? You should consult with your cardiologist (or family physician) about your symptoms. --Mary, Dr. Gammie's physician assistant

Q : 15

I was told that my mitral valve was leaking, causing my heart to pump harder from time to time. The specialist said that it won't worsen over time or cause me serious heart problems in the future. How serious are mitral valve leaks? I feel my heart pumping harder at lest eight to ten times per day and experience a lot of lightheadedness.

Some people will have mitral valve leakage (regurgitation) which will remain stable and never require an operation. However, the only way to know how severely your mitral valve is leaking is to have an echocardiogram performed. Severe mitral valve leakage/regurgitation will likely require surgery. If you are having symptoms of heart palpitations and lightheadedness, you should consult with your primary care physician or cardiologist. --Mary, Dr. Gammie's physician assistant

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