I do cardiac anesthesia.

Q1. Yes there is a relationship between asd and mitral valve regurg. Causes the left atrium to become dilated and the pulmonary vein to be enlarged which also causes the afib to occur not going into great details....

Many times the suregeons will do a atrial appendage clip and a maze in the open sternotomy scenario for valve replacement. Easy to do when the chest is open.

If valve replacement is not indicated they could do a convergent ablation which is a newer procedure similar to a maze but done through a substernal incision, not sternotomy.

Incidence of patients needing a pacemaker after maze is not high where I practice.

Q2
Standard surgical intervention for a mitral valve is a full sternotomy. There are cases where we do see patients having a “mini mitral” where they don’t do a full sternotomy, but a smaller partial chest opening.

As far as recovery and pain etc. thats patient dependent. We do advanced cardiac anesthesia and do sternal nerve blocks with a multimodal drug approach and extubate (wake up and remove breathing tube) in the OR directly after surgery before going to the ICU. This is not normal nor the standard yet....but many practices are going this direction. You are on slow twitch so I imagine you’re healthier than most and more motivated. Your recovery will be fine. Honestly most people complain about the chest tubes more than the sternal incision.

Hope I helped. Lmk if you have more questions

 
Full Disclosure: I am not a doctor nor have I ever been to med school...

THAT BEING SAID

you just need to HTFU. If your heart explodes it just means you were out of shape. If it doesn't explode - then you aren't working hard enough.

well it partially exploded so, that means i was working just the right amount, ie broke some chordae

thanks for the input!!


looks like cleveland clinic claims to perform many mitral valve repairs with minimal invasive procedure,(87% of minimal invasive cardiac surgeries being mitral repair per their website) not being argumentative here, just like the thought of state of the art less pain and recovery. alas, i dont think i would travel to cleveland for it, but not out of question entirely either

Love that you are waking up and extubating in theatre for some of these cases. I could never understand why during my training we would always keep even the straightforward hearts asleep for transfer to ICU for a prolonged wake up when they would meet all the usual extubation criteria. As they say, the Titanic turns slowly but am glad there are those advancing things in this way.

Jeff, I’m a heart surgeon. I’d be happy to chat by telephone if that would be helpful to you. You ask great questions. It’s hard to do justice here in the Forum. Message me if I can lend an ear.

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Larry Creswell
http://www.athletesheart.org, @athletesheart

I would come and sneak beer into your room for you

I believe beer is contraindicated in my case, plus I seldom drink, too risky IMO with family history of 3 or4 out of 6 in direct family being alcoholics

I may have had my annual beer at company xmas gathering, or save it for that...…….

and this is what surgery looks like :)

As always, you should ask your doctor(s) these questions, and more, until you are satisfied that you understand your specific situation and the risks and benefits of the treatment options. You do not say, but I suspect, that you have severe MR (+?a flail MV) and surgery has been suggested. There appears to be an ASD and prior (brief) history of PAF.

A1-Yes, there is a link between MR (and ASD) with PAF. More important for some as it may suggest an earlier need for surgery. Usually, MAZE is not required for rare PAF, but sometimes it is suggested when there is severe LA dilation as the likelihood of AF in the future is high and surgical Rx can help decrease the risk. Your specific risks/benefits are best discussed with you MD's, who know your specific case. A pacemaker is needed when the heart goes dangerously slow, which is a rare issue with this type of MV surgery.

A2-Severe MR is best treated with MV repair (at experienced, higher volume centers), if able. There are established guidelines as to whether repair or replacement is needed and when timing is most appropriate. The risk of replacement is about double that of repair, but the valve must be able to be repaired (*there are specific markers one looks for on echo testing) and even then, sometimes the repair does not work out and MV replacement is needed, an unfortunate issue as anesthesia is very prolonged in this case.




I have a couple of patients who have had their MV repaired and are back (for years now) being active-running/biking etc.
Good luck to you.

From Jeff’s recent update post with his PMC it looks like he had surgery in September and was back to training before November. Maybe he’ll add a detailed update later.

Ha! I don’t think my patients have GC or other PMC evaluation but I know one of them was back to doing half marathon racing the year after. She was the youngest I had to send for repair.

Good luck in your comeback Jeff!

actually it ended being a tear in the valve, repaired, annular ring and atrial clip installed. I hadn't realized the clip was going in beforehand. no torn chordae full sternotomy...... and ribs still ache at spine from time to time, ugly scar and +10lbs from meds effing with my hypothyroid condition(starting to reverse that finally)

from a performance stand point, my heart related performance is at about 80% now, 16weeks post surgery(8/29). I really ought to adjust ftp in the pmc, but have not at this point. consistently doing mid 6k kJ per week at this point

as far as I am concerned a good comeback will be doing 4 hour rides at 19-20mph. I suspect that will be after all the amiodarone(that stuff sucked and hangs around for a long time, my TSH is still way messed up from it) is out of my system(well, as much as it can be) I am not going to plan on a return to racing, rather, let it happen if it does

I did get a few outdoor rides in in October(160mi), before weather went further south than I cared to ride in outside :)

the little dip beginning December was due to my double dip procedure(50+ colon/endo) :)

Glad you are fixed. Paying the price of surgery is always tough, but living is pretty nice...
Fitness returns, as always, with work, and my athlete patients never have an issue with that one. Good to know the heart valve is fixed, rhythm addressed and you are on the road to recovery.

I'd predict that you'll race next year. Listen to your body. Ask if meds can be reduced/stopped if safe to do so and continue to pursue a life of activity/fitness and triathlon!

meds stopped after 6 weeks due to severe lightheadedness(which persists but slowly improving) I have been able t stand up from sitting 2x in last week without it, yeah, I note when it doesn't happen

afib occurred post surgery in hospital for about 18 hrs, none since.

unfortunately, and I need to inform docs, my svt has returned from time to time. much different than afib…..afib, no ability to produce bike power, svt, hr spikes but effort minimally affected(same as in past)

I make no predictions on racing and won't be disappointed if that level of fitness does not return, as you said, living and enjoying family is pretty nice. I don't plan on attempting any "intervals" until at least 6 months have passed. just slowly increase intensity and monitor the affects :)

dtoce (or other opinions would be greatly appreciated)

My brief background - After an ER visit and cardiologist appointment 2 days later in October 2017 with shortness of breath and pressure/tightness in my chest during normal household chores, I was diagnosed from a stress echo with severe mitral valve regurgitation. December 2017 at age 40 I had my mitral valve repaired through a mini-thoracotamy and a u-shaped annuloplasty was installed at the base of the valve. I have had 2 echocardiograms since and 2 separate cardiologists have similarly said the operation was a success and few of their comments are "left atrium reduced to normal size", "pump function is good" and "regurgitation is mild" which I understand if maintained is acceptable and will likely not cause any future problems.

Besides a daily low-dose aspirin and antibiotics before dental work are there any practical changes I should be making? Exercise limitations? High intensity interval training? Weight lifting?

The other questions I can't seem to get a certain answer on is the (probable) durability of this repair. I have heard it could last my lifetime (50 or more years) or could possibly need re-operation in 10-20 years.

Your input is appreciated.

 
In my humble opinion, anyone having cardiac issues serious enough to need surgery, should certainly reach out to the Cleveland Clinic for consultation.

One year ago this 63 year old washed up bike racer had his aortic valve replaced at the Clinic by Dr. Doug Johnston. He used a minimally invasive procedure that had me working from my own desk within a week, and riding century's after four months.

The quality of care was world class, from the housekeeping staff to the surgical crew. Equally impressive was the cardio rehab staff. They worked with and listen to me, tailoring a program to my individual needs and goals. Never did I feel like a number that had to be processed by the Clinic's system.

If anyone reading this does travel to Cleveland for cardiac work, please feel free to reach out to me. My wife and I live a couple of miles from the CC, and would be happy to entertain your loved ones while the Clinic makes you whole again.

As I always say, make sure you've discussed all of this with your own doctors and insist on answers to your questions-to the point of understanding what you want/need to know. That said, it appears you have had successful MV repair as well with a ring/annuloplasty (which will help maintain the repair) and you already know about asa/AB prophylaxis.

You should discuss your situation about exercise/lifting/strenuous activity/racing-as there may or may not be other associated issues which preclude or suggest limiting activity. If you do not have any of those things, then there is very, very little risk. I have many patients back on the bike or running after successful MV repair. (*Including one who presented during her HM training at age 29, got the repair and raced the next year)

The short and long term success of the MV repair operation is excellent. Techniques have evolved to make re-operation far less likely. Regarding the risk of death, it is best to say that long term mortality compares equally with people of similar age-ie you are now "unlikely to die younger than expected".

Hope this helps.