aortic valve problem

Quoted message said:

Subject: aortic valve problem
From: "Robert" [email hidden]
Date: 8/15/2003 12:32 PM Mountain Daylight Time
Message-id: <[email hidden]>

I wonder if you guys can help me out. I had an echo which showed aortic
stenosis due to aortic valve problems. The question I got for you guys is
can the heart heal itself or is it going to get worse with time.
Thanks for any responses
Robert

Or .. if iron causes airway stenosis .. can iron ALSO cause aortic stenosis ..
?

Chest. 2002 Apr;121(4):1355-7. Related Articles, Links

Syndrome of iron pill aspiration.

Lee P, Culver DA, Farver C, Mehta AC.

Department of Pulmonary and Critical Care Medicine, Cleveland Clinic
Foundation, Cleveland, OH 44195, USA.

Bronchial stenosis (BS) consequent to iron pill aspiration (IPA) has been
observed in few reported cases. This condition is often irreversible and may
necessitate lobectomy in severe cases. Unlike most foreign bodies (FBs), the
iron pill disintegrates in the airway and cannot be detected on bronchoscopy.
However, bronchial biopsy and lung tissue may reveal iron deposits along with
airway inflammation months after the aspiration. Thus, IPA can be diagnosed by
a triad of aspiration, airway inflammation, and iron deposits on histology even
in the absence of an FB. We report a case of IPA with BS in which the diagnosis
was established by bronchial biopsy and was successfully managed with balloon
bronchoplasty and therapy with topical mitomycin C.

PMID: 11948075 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------
------

Who loves ya.
Tom

Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking

Ah, valve patients were my least favorite when I worked in the cath lab.
The thing is, unless you let it get very bad you will never experience
serious symptoms. When you do experience symptoms, it makes for a messy
surgery and recovery period.

The human body and especially the heart are remarkable in their ability to
compensate for a flaw. An aortic valve is the last entry point of
circulation to the body. When it is stenotic, it makes for a smaller
opening. A murmur will be heard when listening to the chest with a
stethoscope and many patients can hear the murmur as the blood rushes up
their carotids. In fact, one patient who had an aortic valve replacement
told me that he thought he was dead because he could no longer hear his
heart beat. I fooled him. I made him sit up and eat soup and he was
utterly convinced that heaven would have been more kind🙂

When a patient has continual chest pain which often occurs from multiple
lesions they are in pain. They are unable to do what they need to do to get
through the day. After bypass surgery, there is an initial recovery time
but then they feel better than before. Much better. They appreciate having
had the surgery. With valve patients, unless they wait too long, they have
no appreciation of waking up from surgery without chest pain. They do not
feel better than before. Depending on how late in the game it is,
well......., the recovery might be worse than any symptoms pre-surgery. It
doesn't mean that the surgery hasn't prevented a plethora of future
problems.

Meanwhile, I have had many patients who delayed surgery because they didn't
feel bad. When they eventually decompensated, it was ugly. Most made it
through surgery but it was tough on them and tougher on the nursing staff
(we didn't have valium ordered for us). I have yet to see a valve problem
correct itself. I do know that the vast majority of patients do very well
post valve surgery. It helps if the patient was otherwise healthy prior to
surgery.

Finally, echocardiograms are an art. Although I trust the docs that I have
worked with implicitly, I would get a second opinion if any of them told me
I needed a valve replacement. To be sure, I would have a heart cath for
more accurate measurements of the valve.

j

"Robert" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

I wonder if you guys can help me out. I had an echo which showed aortic
stenosis due to aortic valve problems. The question I got for you guys is
can the heart heal itself or is it going to get worse with time.
Thanks for any responses
Robert

"Julianne" <[email hidden]> wrote in message
news:riD%a.6449$uh6.2652@lakeread05...

Quoted message said:

Ah, valve patients were my least favorite when I worked in the cath lab.
The thing is, unless you let it get very bad you will never experience
serious symptoms. When you do experience symptoms, it makes for a messy
surgery and recovery period.

The human body and especially the heart are remarkable in their ability to
compensate for a flaw. An aortic valve is the last entry point of
circulation to the body. When it is stenotic, it makes for a smaller
opening. A murmur will be heard when listening to the chest with a
stethoscope and many patients can hear the murmur as the blood rushes up
their carotids. In fact, one patient who had an aortic valve replacement
told me that he thought he was dead because he could no longer hear his
heart beat. I fooled him. I made him sit up and eat soup and he was
utterly convinced that heaven would have been more kind🙂

When a patient has continual chest pain which often occurs from multiple
lesions they are in pain. They are unable to do what they need to do to

get

Quoted message said:

through the day. After bypass surgery, there is an initial recovery time
but then they feel better than before. Much better. They appreciate

having

Quoted message said:

had the surgery. With valve patients, unless they wait too long, they

have

Quoted message said:

no appreciation of waking up from surgery without chest pain. They do not
feel better than before. Depending on how late in the game it is,
well......., the recovery might be worse than any symptoms pre-surgery.

It

Quoted message said:

doesn't mean that the surgery hasn't prevented a plethora of future
problems.

Meanwhile, I have had many patients who delayed surgery because they

didn't

Quoted message said:

feel bad. When they eventually decompensated, it was ugly. Most made it
through surgery but it was tough on them and tougher on the nursing staff
(we didn't have valium ordered for us). I have yet to see a valve

problem

Quoted message said:

correct itself. I do know that the vast majority of patients do very well
post valve surgery. It helps if the patient was otherwise healthy prior

to

Quoted message said:

surgery.

Finally, echocardiograms are an art. Although I trust the docs that I

have

Quoted message said:

worked with implicitly, I would get a second opinion if any of them told

me

Quoted message said:

I needed a valve replacement. To be sure, I would have a heart cath for
more accurate measurements of the valve.

j

Thanks J
I was never told to get a valve replacement with the only thing my doc
saying was to have a repeat echo every 5 years. I do appreciate your
complete reply with some good points. I do have mild breathing problems
occasionally and am wondering if any symptomatic relief is better than doing
the surgery when time comes.
thanks again
Robert

"Phil Holman" <[email hidden]> wrote in message

Quoted message said:

I have a biscuspid aortic valve with stenosis. Prognosis is surgery
within 5 to 20 years. The way this was presented by my cardiologist was
that I don't get a choice about waiting. The criteria is the velocity,
pressure drop or remaining valve area. These values will obviously
coincide with symptoms.

Say Phil,
Are you experiencing any symptoms now and do they get that criteria values
from an echo or cardiac cath?

Robert

Quoted message said:

Quoted message said:

Finally, echocardiograms are an art. Although I trust the docs that I

have

Quoted message said:

worked with implicitly, I would get a second opinion if any of them

told me

Quoted message said:

I needed a valve replacement. To be sure, I would have a heart cath

for

Quoted message said:

more accurate measurements of the valve.

Interesting advice. Does this include diagnosis of bicuspid aortic
valve.

Phil Holman

"Robert" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

"Phil Holman" <[email hidden]> wrote in message

Quoted message said:

I have a biscuspid aortic valve with stenosis. Prognosis is surgery
within 5 to 20 years. The way this was presented by my cardiologist

was

Quoted message said:

Quoted message said:

that I don't get a choice about waiting. The criteria is the

velocity,

Quoted message said:

Quoted message said:

pressure drop or remaining valve area. These values will obviously
coincide with symptoms.

Say Phil,
Are you experiencing any symptoms now and do they get that criteria

values

Quoted message said:

from an echo or cardiac cath?

Funny you should ask about symptoms. I end up at the cardiologist's
office because following an upper respiratory infection I can't get my
heart rate above 130 (competitive masters cyclist) and this puts me at
the back of the pack instead of the front. The echo reveals a bicuspid
valve with blood velocity of 2 m/s (1 m/s is normal and surgery is
usually needed at 4 m/s). I'm now on an annual echo check for
progression and it is my understanding that prior to surgery, a cath is
done to check out the condition of the aorta and coronary arteries.
However the bicuspid is not the reason for the low HR so the search is
still on. We've done blood testing, pulmonary scans, a sleep apnea check
and so far all have come up negative. Next is a possible biopsy and I'm
not to keen on that. I can still ride 200 miles a week at a more
moderate pace determined by my lower HR.

Phil Holman

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Robert said:

I wonder if you guys can help me out. I had an echo which showed aortic
stenosis due to aortic valve problems. The question I got for you guys

is

Quoted message said:

Quoted message said:

can the heart heal itself or is it going to get worse with time.
Thanks for any responses
Robert

This valvular lesion typically does not improve with time but generally

gets

Quoted message said:

worse.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Thanks Dr Chung, I was wondering as I have hypertension of several years is
this one cause for this?
Is there any medical treatments for symptoms of this problem?
Thanks
Robert

On Sat, 16 Aug 2003 23:14:18 -0500, "Julianne" <[email hidden]>

Quoted message said:

Meanwhile, I have had many patients who delayed surgery because they didn't
feel bad. When they eventually decompensated, it was ugly. Most made it
through surgery but it was tough on them and tougher on the nursing staff
(we didn't have valium ordered for us). I have yet to see a valve problem
correct itself. I do know that the vast majority of patients do very well
post valve surgery. It helps if the patient was otherwise healthy prior to
surgery.

Finally, echocardiograms are an art. Although I trust the docs that I have
worked with implicitly, I would get a second opinion if any of them told me
I needed a valve replacement. To be sure, I would have a heart cath for
more accurate measurements of the valve.

Very interesting post - thank you. When I had my first echo at the
end of 2000 I was told "it's not desperate, you can go home", i.e.
leaking and regurgitating mitral valve and leaking aortic (I had been
feeling poorly or a while but this is the UK). I pushed for treatment.
I did not have my surgery until Nov last year as another "nasty" got
in the way and had to be dealt with. The surgeon could not repair my
mitral valve as it was too narrowed. He said he would not "put me
through" an aortic valve op at the same time. It was the TOE that gave
all the information about my heart valves, not the echocardiogram. I
know my aortic valve will not correct itself but I was told I would
not get symptoms from it - never understood what that meant. Now have
a pacemaker as I developed worrying arrythmias. Also now in SR.

..........

With valve patients, unless they wait too long, they have

Quoted message said:

no appreciation of waking up from surgery without chest pain. They do not
feel better than before. Depending on how late in the game it is,
well......., the recovery might be worse than any symptoms pre-surgery. It
doesn't mean that the surgery hasn't prevented a plethora of future
problems.>feel better than before.

Ooh, My Bad, as my kiddo says. I was reading in a hurry and sort of assumed
that the original posted had been referred for surgery and was looking for
an alternative.

There are complicated mathematical computations that go along with assessing
a stenotic valve. (Luckily, a good computer can do this but so can I if the
formula is laid out in front of me and I have several hours to kill.) My
original intent was to state that many times a stenotic valve indicates
replacement long before symptoms become evident.

So sorry if I misled anyone. The truth is that there are different kinds of
valves and they all have advantages and disadvantages. Tissue valves tend
to last less long than prosthetic valves. Prosthetic valves on the other
hand require continuous anticoagulation which can be a severe inhibitor of
lifestyle to some folks. There are cultural concerns as well. My uncle had
a Jewish patient he referred for surgery. The surgeon recommended a tissue
valve and yet the tissue came from a pig. The Jewish patient declined that
option because it wasn't Kosher.

Meanwhile, if a surgeon states that the math is right for a valve
replacement, I still recommend a cath for absolute certainty. Also, a delay
in surgery could be dangerous.

I will refrain from posting when I am tired and read things that aren't
written

j
<[email hidden]> wrote in message
news:[email hidden]...s

Quoted message said:

On Sat, 16 Aug 2003 23:14:18 -0500, "Julianne" <[email hidden]>

Quoted message said:

Meanwhile, I have had many patients who delayed surgery because they

didn't

Quoted message said:

Quoted message said:

feel bad. When they eventually decompensated, it was ugly. Most made it
through surgery but it was tough on them and tougher on the nursing staff
(we didn't have valium ordered for us). I have yet to see a valve

problem

Quoted message said:

Quoted message said:

correct itself. I do know that the vast majority of patients do very well
post valve surgery. It helps if the patient was otherwise healthy prior

to

Quoted message said:

Quoted message said:

surgery.

Finally, echocardiograms are an art. Although I trust the docs that I

have

Quoted message said:

Quoted message said:

worked with implicitly, I would get a second opinion if any of them told

me

Quoted message said:

Quoted message said:

I needed a valve replacement. To be sure, I would have a heart cath for
more accurate measurements of the valve.

Very interesting post - thank you. When I had my first echo at the
end of 2000 I was told "it's not desperate, you can go home", i.e.
leaking and regurgitating mitral valve and leaking aortic (I had been
feeling poorly or a while but this is the UK). I pushed for treatment.
I did not have my surgery until Nov last year as another "nasty" got
in the way and had to be dealt with. The surgeon could not repair my
mitral valve as it was too narrowed. He said he would not "put me
through" an aortic valve op at the same time. It was the TOE that gave
all the information about my heart valves, not the echocardiogram. I
know my aortic valve will not correct itself but I was told I would
not get symptoms from it - never understood what that meant. Now have
a pacemaker as I developed worrying arrythmias. Also now in SR.

.........

With valve patients, unless they wait too long, they have

Quoted message said:

no appreciation of waking up from surgery without chest pain. They do

not

Quoted message said:

Quoted message said:

feel better than before. Depending on how late in the game it is,
well......., the recovery might be worse than any symptoms pre-surgery.

It

Quoted message said:

Quoted message said:

doesn't mean that the surgery hasn't prevented a plethora of future
problems.>feel better than before.

Hi! I'm so glad there is a current thread about this.

My husband was just diagnosed with this last week.(It's been an
interesting turn of events about a spider, a sprained ankle, a
followup dr. appt, and a heart murmur) He's young (31, and in good
health) but was having an occasional tightness of the chest before
this. He went to a dr. about it probably 3 years ago, was diagnosed
with anxiety and sent home with a prescription for anti-anxiety drugs,
which he never took.

His cardiologist is concerned because his valve is functioning at
about 1/2 its capacity. He's going to have a heart cath on Thursday.
The cardiologist talked to him about having a mechanical valve
replacement.

I have questions about activity afterwards for both procedures. If he
has the heart cath on Thursday, would he be able to go to work on
Monday? (He's a web designer where he sits at a desk all day therefore
not a lot of activity, but still)

Also, after the valve replacement surgery, what is the usual time for
recovery? how long will it be before he could drive again, or take out
the garbage or have sex? (I know everyone is different, but I'm
looking for ballpark figures)

Also, I keep reading about with the mechanical valve that warfarin is
usually prescribed to ward off blood clots. Pregnant women and those
planning to become pregnant shouldn't take it, but what about men who
are planning on becoming fathers?? We dont have children yet, but
would like some eventually.

His health is the most important thing to me and these are *very*
minor things on the scale, but I'm curious.

[email hidden] (Amber Marchewka) wrote in message news:<[email hidden]>...

Quoted message said:

Hi! I'm so glad there is a current thread about this.

My husband was just diagnosed with this last week.(It's been an
interesting turn of events about a spider, a sprained ankle, a
followup dr. appt, and a heart murmur) He's young (31, and in good
health) but was having an occasional tightness of the chest before
this. He went to a dr. about it probably 3 years ago, was diagnosed
with anxiety and sent home with a prescription for anti-anxiety drugs,
which he never took.

His cardiologist is concerned because his valve is functioning at
about 1/2 its capacity. He's going to have a heart cath on Thursday.
The cardiologist talked to him about having a mechanical valve
replacement.

I have questions about activity afterwards for both procedures. If he
has the heart cath on Thursday, would he be able to go to work on
Monday? (He's a web designer where he sits at a desk all day therefore
not a lot of activity, but still)

He should be able to.

Quoted message said:

Also, after the valve replacement surgery, what is the usual time for
recovery?

This varies. Usually, most folks are able to get back to their
routine in a few weeks.

Quoted message said:

how long will it be before he could drive again, or take out
the garbage or have sex? (I know everyone is different, but I'm
looking for ballpark figures)

I would ballpark it at a few weeks. YMMV :-)

Quoted message said:

Also, I keep reading about with the mechanical valve that warfarin is
usually prescribed to ward off blood clots. Pregnant women and those
planning to become pregnant shouldn't take it, but what about men who
are planning on becoming fathers??

Not a problem.

Quoted message said:

We dont have children yet, but
would like some eventually.

Understandable.

Quoted message said:

His health is the most important thing to me and these are *very*
minor things on the scale, but I'm curious.

Again, understandable.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

On 19 Aug 2003 07:00:57 -0700, [email hidden] (Amber Marchewka)

Quoted message said:

Hi! I'm so glad there is a current thread about this.

His cardiologist is concerned because his valve is functioning at
about 1/2 its capacity. He's going to have a heart cath on Thursday.
The cardiologist talked to him about having a mechanical valve
replacement.

I have questions about activity afterwards for both procedures. If he
has the heart cath on Thursday, would he be able to go to work on
Monday? (He's a web designer where he sits at a desk all day therefore
not a lot of activity, but still)

Also, after the valve replacement surgery, what is the usual time for
recovery? how long will it be before he could drive again, or take out
the garbage or have sex? (I know everyone is different, but I'm
looking for ballpark figures)

Also, I keep reading about with the mechanical valve that warfarin is
usually prescribed to ward off blood clots. Pregnant women and those
planning to become pregnant shouldn't take it, but what about men who
are planning on becoming fathers?? We dont have children yet, but
would like some eventually.

His health is the most important thing to me and these are *very*
minor things on the scale, but I'm curious.

Hello Amber, First, these are not minor things. Any heart problem is
a big issue, especially in one so young. I wonder why the
cardiologist is talking about a mechanical valve at the outset. My
surgery was done at a internationally renowned heart hospital in
London and from what I can make out they always offer repair "if
possible". The pig valves seem to be offered to older people as they
don't last as long as the prosthetic valves. Also, some people have
human valves. Every time I go there I notice the sign for the Valve
Bank which amuses me. (Doesn't take much!)
.. I will take Warfarin for the rest of my life and its not much of a
problem except when the INR (the reading taken at the anticoagulant
clinic) is going up and down, as mine is at present. When it was
steady I only used to go to the clinic every six weeks. In the UK,
after heart surgery, a person is allowed to drive after 6 weeks. My
recovery was less than straightforward so I wouldn't have wanted to
drive anyway. I am 67. Now I have a pacemaker as well as the Mitral
valve and have just recd a letter from the licensing authority saying
they will make no adjustment to my driving licence.

..Good luck to you both, Diana

On Mon, 18 Aug 2003 22:22:55 -0500, "Julianne" <[email hidden]>

Quoted message said:

Ooh, My Bad, as my kiddo says. I was reading in a hurry and sort of assumed
that the original posted had been referred for surgery and was looking for
an alternative.

There are complicated mathematical computations that go along with assessing
a stenotic valve. (Luckily, a good computer can do this but so can I if the
formula is laid out in front of me and I have several hours to kill.) My
original intent was to state that many times a stenotic valve indicates
replacement long before symptoms become evident.

So sorry if I misled anyone.

Hi Julianne,

No need to apologise, In fact, I was surprised to see my post on the
group tonight as I got in a bit of a mess with it and thought it was
in the 'waiting' box. Your post did confuse me as pain was not a
symptom with me. My first frightening sympton was palpitations with a
very fast heart rate. I have rarely had heart pain - only experienced
angina once. I was rough after surgery but, apart form the new MV, I
had a very new treatment for AF. My heart rate was very slow and I
had to carry a portable P/maker around for over a week. I believe the
mortality for valve surgery (UK 5%) is higher than that for bypass
surgery. You are probably right that it is possible to say before
surgery whether or not a patient will get a mechanical valve or not.
Maybe the surgeons always like to be upbeat to make us feel more
positive. Diana

For good feedback and information go to the Forum at
www.valvereplacement.com You will find the participants very helpful
and knowledgeable.

--

Herb
Boulder, CO
[email hidden]

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

On 19 Aug 2003 07:00:57 -0700, [email hidden] (Amber Marchewka)

Quoted message said:

Hi! I'm so glad there is a current thread about this.

His cardiologist is concerned because his valve is functioning at
about 1/2 its capacity. He's going to have a heart cath on Thursday.
The cardiologist talked to him about having a mechanical valve
replacement.

I have questions about activity afterwards for both procedures. If he
has the heart cath on Thursday, would he be able to go to work on
Monday? (He's a web designer where he sits at a desk all day

therefore

Quoted message said:

Quoted message said:

not a lot of activity, but still)

Also, after the valve replacement surgery, what is the usual time for
recovery? how long will it be before he could drive again, or take

out

Quoted message said:

Quoted message said:

the garbage or have sex? (I know everyone is different, but I'm
looking for ballpark figures)

Also, I keep reading about with the mechanical valve that warfarin is
usually prescribed to ward off blood clots. Pregnant women and those
planning to become pregnant shouldn't take it, but what about men who
are planning on becoming fathers?? We dont have children yet, but
would like some eventually.

His health is the most important thing to me and these are *very*
minor things on the scale, but I'm curious.

Hello Amber, First, these are not minor things. Any heart problem is
a big issue, especially in one so young. I wonder why the
cardiologist is talking about a mechanical valve at the outset. My
surgery was done at a internationally renowned heart hospital in
London and from what I can make out they always offer repair "if
possible". The pig valves seem to be offered to older people as they
don't last as long as the prosthetic valves. Also, some people have
human valves. Every time I go there I notice the sign for the Valve
Bank which amuses me. (Doesn't take much!)
. I will take Warfarin for the rest of my life and its not much of a
problem except when the INR (the reading taken at the anticoagulant
clinic) is going up and down, as mine is at present. When it was
steady I only used to go to the clinic every six weeks. In the UK,
after heart surgery, a person is allowed to drive after 6 weeks. My
recovery was less than straightforward so I wouldn't have wanted to
drive anyway. I am 67. Now I have a pacemaker as well as the Mitral
valve and have just recd a letter from the licensing authority saying
they will make no adjustment to my driving licence.

.Good luck to you both, Diana