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72 year old: whether to go for Mitral valve replacement?
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AshSri posted:
My Dad is 72 years old. Doctor recommends "mitral valve" replacement. We are unable to decide whether to go for an operation or live with it. I am adding diagnosis here.I would like to get your opinion on whether to go for surgery or not. I also have pictures taken in the lab. Dont know how to upload them.



Primary illness: MITRAL VALVE PROLAPSE SYNDROME WITH SEVER MR IN SINUS RHYTM NYHA CLASS III.
Coronory angiogram: Atherosclerotic coronary artery disease with non — critical lesions.
Recommendation: Mitral valve replacement / repair
Associated disease: systemic hypertension & COPD: Emphysema.



Paraseptal, centriacinar emphysematous changes noted in both lung fields. Emphysematous bulla noted in subpleural region of posterior segment of right upper lobe. Coronary artery calcification noted. Mile thickening of lower part of the right side major fissure. Minimal fibrotic stands noted in basal segment of bilateral lower lobe. Subcentimeter right paratracheal and pretracheal lympnodes noted. No evidence of pulmonary collapse. No evidence of bronchiectasis / cavitation. Mediatinal position and contents including the trachea and its bifurcation, thoratic aorta, the main pulmonary artery and its branches appear normal. No bony destruction seen.


Both adrenal glands are normal. No abnormal soft tissue nodule / mass lesions seen. Visualized sections of liver and spleen normal. Paraseptal , centriacinar emphysematous changes noted in both lung fields.


COLOR DOPPLER ECHOCARDIOGRAPHIC REPORT:
Arotic value: AO:33.1mm. LA:39.9mm
Ventricular function: IVSd:12.7mm EDV:133.38ml, PWd:10.2mm ESV:39.21ml LVIDd:52.7mm EF:70.60% LVIDs:31.4mm FS:40.32%
Doppler paramters:
Mitral velocity (cm/s) : E 97, A 94, pulmonary 88cm/s aortic 148cm/s
Left ventiricle : normal LV systolic function. No Regional wall motion abnormalities.
Right ventricle: Normal right ventricle size and function.
Pericardium : normal
Mitral value prolaspse: Marked prolapse of both leaflet. SAM: nil. PML motion: normal. Thickening: nil, Clacification: Nil.
Aortic valve: thickening sclerosis. Flutter : nil, begetation: nil. Calcification: nil.
Pulmonary value : flutter : nil. Vegetation : nil.
Tricuspid valve: Thickening: normal. Flutter: nil.
Valve Regurgitation: mitral : mild. Aortic: trivial. Ricuspid: nil. Puilmonary: Nil.
Comment: No regional wall motion abnormalities. Normal LV systolic function. Marked prolapse of both leaflets.



Lab results:
BP: 140, Pulse : 76/mt . CVS: PSM (+)
ECHO: MVT syndrome, eccentric posterior wall hugging Grade II + MR present.
WBC count: 11900 cells/mm3. Neutrophil: 88%, lymphocyte:9%, eosinophil:3%, haemoglobin: 13.4gm% packed cell vol:44% blood esr:10mm fall at 30min,20mm fall at 60 min, RBC: 4.9mil/mm3, mcv:89.8fl mch:27,3pg, MCHC:30.5% Platelet count: 2.9 lakhs/mm3. Blood urea:30mg serum creatine: 12.mg%. NEE serum: clear Serum colestrol:183mg% . triglycerides:83 mg% HDL:42mg% non-hdl: 141mg% ldl:124%, VLDL:17mg% TC/HDL:17mg% TC/HDL:4.4


Medication given: Amifru 1/2, telma 40mg -1, strovas 10mg -1, serobid rotacaps 2 puffs twice daily.
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billh99 responded:
I assume that otherwise his health is good.

What is his activity level?

What kind of symptoms does he have?

And what kind of limitations does he have? And have his doctors indicated if the limiting factor is the COPD or the MVR?
 
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AshSri replied to billh99's response:
His health is normal. He is still walking, going to the Bank, doing house hold work, helping my mom etc. As of today, he is still active. During the past 12 months, three times, he blanked out completely and collapsed. Within few minutes he woke up and started his normal activities. After continuous 30 minutes of work, he gaps for 5 to 10 minutes. After that he seems to be OK. His dad had angina.

He worked on passenger diesel train engine for nearly 30 years. He is exposed to pollution and diesel smoke. He was a smoker too. He has occasional breathing trouble. He says, he is unable to walk for long distance and can't carry more than few 2 Kgs of weight.

Test report of "Helical plain CT study of the chest with HRCT study of the lungs" says:

-paraseptal centriacinar emphysematous changes noted in both lung fields.
-Emphysematous bulla noted in subpleural region of posterior segment of right upper lobe.
- mild thickening of lower part of right side major fissure.
- minimal fibrotic stands noted in basal segment of bilateral lower lobe.

Echocardiogrphic reports says:

- marked prolapse of both leaflets
- no regional wall motion abnormalities
- normal LV systolic function.
- Mild mital regurgitation
- no pulmonary hypertension
- no pericardial effusion
- aortic valve selerosis No AS / AR Trivial

Conclusion of full report says:
- COPD,
- systemic hypertension,
- dypsonea on exertion since 6 months,
- occasional angina and PND,
- serial ECGs : normal
- ECHO: MVPS, mild MR (diagonstic services)
- CVS; ESM
- CXR: Emphysema
- TMT: positive due to angina. Had hypertension on TMT.
- Echo rechecked: MVPS; ecentric post posterior wall hugging grade II MR.

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Doctor recommends MVR (assuming MVR is Mitral Valve Replacement) to be done. He says, only when the heart is opened up, he will know the status and recommends presence of plumonologist. He says, lungs can't be revived and only medicines can help. Oxygen supply is weak and calcification is present in the lungs.

I really appreciate your opinion. All I am ( he is) looking for is his last peaceful days, that's where we are stuck and unable to take decisions.
 
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James Beckerman, MD, FACC responded:
While I cannot provide a medical recommendation in this forum, it does seem as though your dad has significant mitral regurgitation - which is leakiness of the mitral valve. In general, if people develop symptoms from this condition - typically shortness of breath and fatigue - we discuss the possibility of mitral valve repair or replacement as an approach to improve symptoms and potentially lengthen life. All surgeries have risks, so it's important to discuss these risks and any alternatives with your dad's doctor. I hope all goes well.
 
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AshSri replied to James Beckerman, MD, FACC's response:
Thanks Doctor. One question though. When you say "significant mitral regurgitation", are you deciding based on the condition of blanking out and fatigue?.. Can mitral regurgitation change depending on body condition at that moment, which in turn can cause significant leak?
 
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AshSri responded:
Doctors operated my dad's heart on 10/8/12. He is in ICU still. Will be transferred out of ICU tomorrow. He is able to talk and communicate. Don't have full details yet about the fixes done to his heart.
 
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cardiostarusa1 replied to AshSri's response:
Thanks for the update.

Hope his recovery goes as smoothly and quickly as possible.

Best of luck to your 72-years-young dad down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)


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WebMD/WebMD forums does not provide medical advice, diagnosis or treatment.
 
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AshSri replied to cardiostarusa1's response:
Dr, I heard this morning that my "young dad" is walking and drinking juice . Looks like he will be walking out of the hospital in a day or two. Thanks to his Dr and Drs like you, doing dedicated work and saving life.

(My uncle (my dad's brother) is in serious condition. He went through an operation removing a cyst in his abdomen. He got infected with super bug and his organs have started failing. His wife and my mom are sisters. Seems that's what is life. Both my dad and my uncle are talking about each other. I wish no one gets this super bug slow poison. He is talking fine on and off, but the organs are failing.)