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 60.

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Q : 1 05/18/2010	My friend (20) had strep viridans sepsis one week ago and was found to have large vegetation on mitral valve in addition to congestive heart failure. She was treated in the vascular Critical Care Unit, placed on six weeks of antibiotics and is supposed to return for surgery. At that time they will determine by echo if it will be a repair or a replacement. Should she get a second opinion from you? She should definitely come here to the University of Maryland Medical Center to be evaluated by Dr. James Gammie, who specializes in not only mitral valve surgery but endocarditis as well. We probably have the largest experience with endocarditis in the nation. Please do not hesitate to contact me so that I can guide you/your friend through the process. My name is Mary- I am Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 2 05/18/2010	Is there any benefit of a porcine vs. bovine tissue valve when the decision is made to replace the mitral valve? Not particularly. Both valve types are durable for up to 10-15 years in the mitral position (shorter durability for younger patients). A mechanical (metal) valve should be durable for a lifetime but requires anti-coagulation with Coumadin (blood thinner). The best option is always to have a mitral valve REPAIRED (not replaced). If you have any further questions, please do not hesitate to contact me. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 3 04/08/2010	My mother just come out of the hospital after mitral valve replacement surgery (open) with a tissue valve. She is complaining about not being able to sleep on her back. Is this to be expected or should we be concerned? It's not unusual to have difficulty sleeping on your back after heart surgery. Most people have difficulty breathing and/or pain whenever they sleep on their back after heart surgery. This can last for several weeks. Some people even prefer to sleep on recliners or upright in their bed after surgery. If she is having increasing difficulty sleeping on her back (because of shortness of breath or pain), she should consult with her cardiologist or heart surgeon. Please do not hesitate to contact me if you have any further questions. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 4 03/03/2010	My husband is 54-years-old, not obese and used to be a very active sportsman. In 2007, he had open heart surgery to have his mitral valve repaired (due to leaking and regurgitation). After the operation, his cardiologist said that the operation had only been partially successful and that it would have to be redone at some point. My husband takes his medicine as instructed but has not seen a cardiologist in two years. He would much prefer the minimally invasive surgery, however, he worries that because he has already had one operation that he might not be eligible for this. Do you perform the minimally invasive mitral valve repair or replacement on patients that have already had a traditional operation? Unfortunately, your husband would likely not be a candidate for minimally invasive mitral valve surgery due to having had prior heart surgery. However, he may still be candidate for mitral valve re-repair surgery. At the University of Maryland Medical Center, we specialize in mitral valve surgery and perform a lot of operations similar to your husbands (redo- operations). We would be more than happy to review your husband's records to evaluate his candidacy for (minimally invasive) mitral valve repair surgery. I would also be more than happy to answer any other questions that you may have. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 5 02/21/2010	My mother is scheduled for an open MV repair (or replacement) with Dr. Gammie. She is undergoing a cardiac catheterization next week to determine if there is also significant coronary artery disease (CAD). If there is CAD and she needs a coronary artery bypass surgery (CABG), which one is done first during the operation, the CABG or the MVP? How much does this extend the time on the bypass machine? Do you also perform the CABG or only the MVP? CABG surgery and mitral valve repair/replacement surgery is performed at the same time. The CABG part of the operation is divided up into a couple different parts. Dr. Gammie would do PART of the CABG operation first. Then he would do the mitral valve repair, and then finish up with the remainder of the CABG surgery. Performing CABG surgery does extend the time on bypass. The length of time depends on how many bypasses need to be performed. On average, for a triple bypass, about 45 minutes is added to the bypass time. If you have any further questions, please do not hesitate to contact me. My name is Mary- I'm Dr. Gammie's physician assistant.
Q : 6 02/16/2010	I was diagnosed with fairly severe mitral regurgitation today. My cardiologist wants to do a transesophageal test followed by a catheterization and then surgery. I am a very active 70-year-old athlete with atrial fib. Would I be a good candidate for the minimally invasive mitral valve repair? Should I proceed with the next test? Yes, you may be a candidate for minimally invasive mitral valve repair surgery (as well as the Cryomaze procedure at the same time, which would help to eliminate your atrial fibrillation). We would have to review your medical records as well as the results of your TEE (transesophageal echo) and catheterization before making any determinations about your candidacy for minimally invasive surgery. After these tests are completed, we would be more than happy to review them for you. Please do not hesitate to call me if you are interested in moving forward with being evaluated for surgery. My name is Mary- I can be reached at 410-328-5842.
Q : 7 01/11/2010	I had a mitral valve repair 4 years ago. Unfortunately, it did not take and I am back to where I was in 2005 with severe regurgitation. My cardiologist says I very likely will need a replacement this time and that rules out minimally invasive surgery. I run three days a week and am asymptomatic. Though you cannot diagnose, do you believe someone in my position may be a candidate to get this done without another open heart surgery? Do you feel this type of surgery should be done soon? A re-operation on your mitral valve would most likely require another sternotomy (incision down the middle of your chest). However, there is still a possibility that your mitral valve can be re-repaired, versus replaced. If your most recent echocardiogram showed severe mitral valve regurgitation, surgery is probably indicated at this point. Please do not hesitate to contact me if you have further questions or if you would like us to review your records to determine your candidacy for minimally invasive surgery. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 8 01/11/2010	I have pretty much decided that I should undergo AVB. I am 71 years old. I have a stenotic atrial valve. I just had a heart cath which resulted in the conclusion that my plaque deposits were less than 30%. I have a pace maker to control my SSS condition. Am I a good canditate for AVB? Have you had cardiac (heart) surgery in the past? If not, have you been told that you are not a candidate for conventional aortic valve surgery? If you answered no to both of these, you are probably not a candidate for AVB surgery since we reserve this operation for those who are older (usually older than 75yo), those who have had prior heart surgery/sternotomy, and those who were considered too high risk for conventional aortic valve surgery. We do, however, have a surgeon in our group, Dr. James Brown, who specializes in minimally invasive aortic valve surgery. Please let me know if you would like to be considered for this operation. I would be more than happy to connect you with Dr. Brown's nurse practitioner. If you have any questions, please do not hesitate to contact me. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 9 01/08/2010	I had a mitral valve repair on June 8, 2009. Do I need to pre-medicate for dentist appointments? Yes, we do recommend pre-medication for dentist appointments for those who have had mitral valve repair or replacement surgery. If you have any questions, please do not hesitate to contact me. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 10 12/15/2009	If I am having minimally invasive valve repair and have one artery 70% blocked, how do you repair that artery? Unfortunately, you would probably not be a candidate for minimally invasive mitral valve surgery if you have a coronary artery that is blocked 70%. You would likely require coronary artery bypass grafting in addition to your mitral valve operation, and this cannot be performed through a minimally invasive incision (only sternotomy). We would need to review your information in order to make this determination though. If you would like for us to review your records, please do not hesitate to contact me. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 11 12/08/2009	What should I know about Aortic Stenosis pig valve replacement? Please see this section of our site for more information first: http://www.umm.edu/heart/aortic_valve_replace.htm The UMMC Web Team
Q : 12 12/06/2009	I have been diagnosed with moderate to severe mitral valve regurgitation. A TEE showed "severe", however, the cardiac cath showed normal pressures in all chambers. I was put on Lasix and Lisinopril, but I still have fatigue, shortness of breath and a cough. My PFT's were all normal. My cardiologist is perplexed with the normal pressures and will be talking with the surgeon. I just wanted to know if maybe there is an answer I can know before I speak with them. It is possible to have normal pressures in the setting of severe mitral valve regurgitation. The TEE is the BEST test to determine the severity of your mitral valve regurgitation. We would be more than happy to review your TEE and medical records for a second opinion or to answer any other questions that you may have. Please do not hesitate to contact me. My name is Mary- I'm Dr. Gammie's physician assistant. I can be reached at 410-328-5842.
Q : 13 12/01/2009	When should one consider having the mitral valve repair surgery? I experience shortness of breath if I bend down too quickly or if I stand up too quickly. When an echocardiogram shows that you have severe mitral valve regurgitation, surgery is usually indicated. Have you had a recent echo performed? Many things can cause shortness of breath. You should consult with your PCP or cardiologist about these symptoms. 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 : 14 11/25/2009	I am a cyclist who was recently diagnosed with mitral valve prolapse and moderate to severe regurgitation. The only symptoms I currently have are decreased stamina, feeling light headed after my heart rate gets above 180 and a cough after exercise. My cardiologist is suggesting we wait before considering treatment. When is a symptom a symptom? I do not have the classic text book symptoms, but am not excited to wait for them to appear. Could my athletic performance improve if the regurgitation is corrected? What is the durability of repair? Typical symptoms of severe mitral valve regurgitation include shortness of breath when climbing stairs/inclines/hills or when bending over to tie shoes, decreased stamina, increased fatigue, decreased exercise tolerance, and sometimes a dry cough. Once you are diagnosed with severe mitral valve regurgitation, surgery is usually indicated (regardless of the presence or absence of symptoms). Dr. Maurice Enriquez-Sarano at the Mayo Clinic provides some good evidence-based medicine regarding timing of mitral valve (repair) surgery. You may want to do a literature search on some of his publications. Yes, your athletic performance should improve after the operation. Regarding durability- research has shown that less than 10% will require a re-operation after 20 years (so pretty durable). Your main focus should be on having your valve REPAIRED (versus replaced) and sooner rather than later. Mary- Dr. Gammie's physician assistant.
Q : 15 10/25/2009	I am a 51 year old female, and have had mitral valve prolapse and moderate regurgitation for many years. I had an echo last week, and my numbers have gotten worse. My doctor recommends repair of the mitral valve. I am having heart catheterization next Friday, will this determine which way they will approach the surgery? Yes, the cardiac catheterization will determine if you have any blockages in your coronary arteries. If you do have significant blockages, you would not be able to have minimally invasive surgery since you would also need coronary artery bypass grafting surgery, which can only be performed through a sternotomy. However, to get a better look at the mitral valve and how to approach repair of this valve, an echocardiogram (specifically a TEE- transesophageal echo) should be performed. Mary- Dr. Gammie's physician assistant.

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