MItral valve regurgutation

[Miraclex2]

Dr Fett . I went to see Dr Felker yesterday and he was concerned with the severity of my mitral valve regurgitation . I know that it is secondary to the Lv enlargement and not a primary valve problem . He did say that in some cases that it was of benefit to do a MV repair to decrease the load on the heart. I think ,also that mv problems can lead to heart failure . these are my questions

1. Does the severity of MV regurg impact rate of recoverry in ppcm.
2. If it is severe at this stage will it cause progression of my ppcm if not corrected?
3. Is surgery for MV repair a big open heart procedure or can it be done with robotics?

Ladies if any of you nhave this problem too please can you just tell me of your experiences if you dont mind sharing

[amyls]

Juliana,
My SIL had valve replacement back in 1999, when she was only 27. Not related to PPCM, but she recovered well, and the scar is barely visable. She had a stept infection go to the valve.They thought they'd have to replace it with a metal one, but they were able to clean off the infection and it healed on it's own. When they finished, though happy, they said she would probably need a new one 5 yrs later. It completely healed itself, and as of now, she won't need a second surgery.

God Bless
amy

[SerenaWelsh]

Juliana, I can answer some of this for you. Some mitral valve replacement/repair can be done through minimally invasive procedures, but not all facilities are equipped to do this. You'd want to ask Duke if they are.

http://www.or-live.com/nyu/1283/ for more info there.

My mother had hers replaced at the same time she underwent open heart surgery and a multiple bypass back in 2000. She ended up with a procine (pig) valve and it's holding strong today, 7 years later.

[JAMESFETT]

Thank you for this report of your appointment with Dr. Felker. If mitral regurgitation (MR) is due only to PPCM, in general the more MR, the more advanced and severe the PPCM because it means that there is more left ventricular dilatation. The most common scenario is for the PPCM to improve, the size of the left ventricle to shrink, and the MR to become less; so in that situation MRr with PPCM is not of great concern. In your own situation I am uncertain from your report if there is actual anatomical abnormality of the valve leaflets themselves, in which case the cause would not be PPCM. The work in valve replacement for a valve affected by severe stretching in dilated cardiomyopathy and the actual size of the left ventricle would be a different category and I would yield to the valve surgeons for trusted info.

James

[Erin]

Just wanted to throw this out there -- Dr. Fett, do you know anything about this?

According to a show on Discovery channel, doctors have been able to bioengineer or "grow" a heart valve from the patient's own cells! It's a fascinating process that only takes a month or two, if I remember correctly. It was beautiful to see the completed valve "working." They have not yet transplanted one into a human heart, but maybe that's not too many years away? They said it would be so much more effective than procine or other valve replacements that are currently used. Isn't that something?

[MissaBaby]

My echo when I had an EF of 35% and my heart was a bit larger said 'mild mitral regurg.' Now that it is 50% and my heart size is a bit smaller, the echo still says 'mild regurg.' So, I am not sure when that will correct or maybe it won't. I guess my heart still has some shrinking to do..??!

[JAMESFETT]

Mild mitral valve regurgitation due to PPCM means nothing, and is not hemodynamically significant. Even if it is present forever that does not make the outlook worse.

James

[Miraclex2]

Dr Fett . There is no damage to the valve ,just not closing due to stretching from ppcm and dilated lv. Does that help ?

[JAMESFETT]

to Juliana: yes, that helps. I assume then, that Dr. Felker feels that the mitral regurgitation that you have is both due to the PPCM dilatation of left ventricle, and possibly could be helped by valve replacement? One clue that the MR could be stressing the left ventricle more is by increased left ventricular muscle wall thickness. Does your posterior wall or interventricular septal wall exceed 12 mm? The answer to potential benefits would have to come from the cardiac surgeons.

to Erin: there is lots of work going on with "cellular cardioplasty" in which functioning heart muscle is strengthened by injecting immature stem cells that go on to develop into cardiomyocytes. I have attached in the news section one article about that. I have not read about this being used to develop new or repair old valves, but I suppose it is feasible.

James