Imperfect Heart Valves - Treasure the Ordinary Day

Background


With every beat of his heart, my husband's bovine aortic valve leaflets open and close. He received that valve 10 years ago. Statistics gave us hope then that, given his age, this valve might last about 20 years.

 Statistics are just that, nothing more.

 They are not promises.

 After just 8 years, there was evidence that one leaflet had begun to deteriorate. And we have been told that artificial tissue valves can fail suddenly.

Can We Avoid An Emergency?

Mechanical valve removed from my husband in 2006

We have already been through urgent situations because of his aortic valve. First it was his own BAV that put him abruptly into pneumonia and heart failure.

 Then, 15 years later, it was complications from scar tissue (pannus) and strands on his mechanical valve that injured him, sending particles to his brain.

 Each time, we were blindsided by the suddenness. Now, with this tissue valve showing a problem, is there anything we can do to be better prepared?

Sudden Failure

I am thinking of two people with bovine valves whose symptoms became severe suddenly. They found themselves urgently needing another surgery. One, a woman, had "redo" surgery locally to replace the valve. She was too sick to travel anywhere else. The recovery was not easy, but her life was saved.

 And then there is a young man. He developed severe symptoms, in a place far from the surgeon who performed his first surgery. He had to make a difficult decision. Step on a plane and fly for hours to reach his surgeon again, or entrust himself to whoever was local. He stepped on the plane. I still remember the relief I felt when I knew his plane had landed.

A failed bovine valve that required urgent removal

Knowing this, I wonder, can we know ahead of time, before it is urgent? We have been told that one reason for sudden problems is calcification buildup at the "hinges", the bottom of the leaflets where the tissue bends as the leaflets move. And when the valve leaks (regurgitation, insufficiency) for whatever reason, severe trouble can develop. These are two key things (the hinges, the leakage) that help me understand, removing some of the fear that comes with uncertainty and mystery.

Keeping Watch

When he first received this bovine valve, because of the severity of what happened with his mechanical valve, he was watched closely. Then it was checks just once a year, as things continued to look good. Just when we might begin to think all was well, there was the damaged leaflet!

These last two years, his bovine valve has been watched more closely again. The interpretation of his regular echocardiogram was rather alarming two years ago. A TEE (transesophageal echo, which requires anesthesia) was more re-assuring. The damage to that  leaflet is at the top, not at the hinges!

This leaflet does not move far enough to open as fully as it should, but the other two leaflets do. All three of them close well, so there is no significant leaking.

Another echo followed by a CT scan recently showed the valve about the same. Good news, for now!

Imperfect, Life Extending Solutions

I remember again how we were told 26 years ago that he was fixed for life. Today we know that for my husband, these artificial valves, first a mechanical and then one made of bovine tissue, have been life saving but imperfect solutions.

Coping in Our Three-Foot World

In the book No Hero, Mark Owen writes in chapter three about fear and the three-foot world. It is something he learned in rock climbing training. Not to look down, not to look off in the distance, not even to look for help from others. Focus on the things within reach, things that you can do. We can do that!

In our three-foot world, we do not have to live in fear of things in the distance that no one can control. Here is what we can control:

• living a healthy lifestyle
• monitoring blood pressure and taking blood pressure medication accordingly 
• listening to his body, knowing that even mild symptoms are messengers
• keeping appointments to check on the valve
• learning from information as it emerges about artificial heart valves 

Treasure the Ordinary Day

This thought comes from a Swedish proverb. It would be so easy to forget that every ordinary day  is special, a treasure. For us, a day when, with every heart beat, an imperfect valve opens and closes well enough to make it a perfect day!

With very best wishes to all who,

like we do,

 live each day with an imperfect heart valve.

 May you have many perfect days.

~ Arlys Velebir