One sunny Saturday afternoon, I found myself chatting with another woman who also was waiting in line. We had a common goal - getting a smog test done on our cars. Somehow, our conversation turned to heart valves, and we discovered something else in common - our husbands both had valve replacement surgery just over 20 years ago. Their surgeries were done locally only a few months apart - the same hospital, surgeon, and type of mechanical valve. Her husband had two valves replaced - both his aortic and mitral. My husband had his bicuspid aortic valve replaced at that time.
As we chatted, she told me that her husband was still living, but he had suffered more than one stroke over the years. I told her that my husband suffered a massive stroke caused by strands of tissue that had formed on the intake of the prosthetic valve, broken off, and traveled to his brain.
She told me that his doctors want to replace her husband's mechanical valves. She was not specific about what was wrong, why the doctors wanted to "redo" them. I told her that my husband's mechanical valve was replaced in 2006, as soon as possible after his stroke, to prevent even further injury to his brain.
And then she voiced what we both were told two decades ago - that mechanical valves would last much longer than a human life span. Yes, they were supposed to last . . . . And it is true, the valves did not break, but still, here we were years later - despite the innovation and careful engineering of these valves, there had been complications, serious complications, after all.
In addition to the tissue strands that had formed on his mechanical valve, my husband also had something called pannus, a kind of scar tissue that his body had formed around the valve opening. There are many questions about why and how this happens - and no real answers. In my husband's case, a little over 15 years after its implantation, the valve that had kept him alive became a significant threat to him, and the affects of the injury to his brain from those strands remain with us nearly six years later.
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Mechanical Valve With Pannus & Strands
Removed From My Husband in 2006 |
I realize now that the mechanical valve implanted in my husband had only been used in humans for 13 years at the time he received it. There was a great deal of understandable enthusiasm at that time about improvements over prior, more primitive mechanical solutions. But time has continued to inform the medical community about both mechanical and tissue valve options. Today, the message to heart valve replacement recipients is about choosing the valve they prefer. Yes, there is more information available about the outcomes, so that patients can make informed choices about repairing or replacing their heart valves. And there is part of that message that is important to understand - there is no perfect solution, but there are life-saving options. This recent paper from Japan ,
Current status of the mechanical valve and bioprosthesis in Japan, expresses well the message and decisions for those with heart valve disease.
Since that sunny afternoon, I have thought from time to time of this woman and her husband. She told me that he refused the offer to have surgery to replace his two mechanical valves. If he doesn't have surgery, I wonder what he will experience, how he will feel. And if he should at some point decide to have surgery, what the outcome would be.
I remember her face, her eyes, as we spoke - I saw something there beyond our words. We were two strangers sharing a rare understanding - the ups and downs, the joy and the pain that had come to us over the years because of heart valve disease.
Perhaps I am thinking of this today because I remember it is soon time for my husband's echocardiogram. We keep an eye on his "new" tissue replacement valve, as well as his own mitral valve, which is "a little leaky".
And I remember, that without something being done those many years ago, I would not have him here today. And I hope for better solutions, more understanding of the complexities, for those with heart valve disease.
At the Bicuspid Aortic Foundation, we do not forget that we must press for a better and brighter future for those with heart valve problems, including those who, like my husband, from their first breath of life face a future that will include heart valve disease.
Arlys Velebir
President and Chairman
Bicuspid Aortic Foundation
