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AF Association
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Mitral Valve Regurgitation and Afib

Hi everyone I am going through an odd patch - I had previously been told, by my EP, of the options I have for calming down/?stopping my persistent AF, which was discovered the same time as the leaky mitral valve. After lots of tests I have had a letter to say the regurgitation is moderate to severe and although my symptoms are, together with the problems of the old Afib, really bad, they are going to do nothing,(the options have been swept under the carpet) except have suggested I have a Watchman device (only done privately) in order that I can come off Apixaban as I have already had a pituitary bleed. Has anyone had a mitral valve repaired - was it diagnosed as severe or moderate-severe? Any advice would be really appreciated folks. Thank you!

Cheruboo

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All I can tell you is that a leaky valve will exacerbate the AF. When the ventricle contracts blood shoots backwards into the atrium and hits the back wall which over time will cause stretching and disruption of the natural pathways. I can't comment on repairs as no experience in that field but if possible then it should ease the AF burden.

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Thanks Bob, I think the Afib is valve induced,and as you say the leaky valve then steps up its action. I, for a few years, had irregular hb, and then it all kicked off, I think I am probably going to have to seek a second opinion, not sure where to go, I live in Somerset and my Cardiac Unit is Bristol, maybe I should think about London? If I had an easy “ sit in the armchair and read life’ it wouldn’t be so bad, but I have a severely disabled daughter, which means I have to lift bend and be quite physical, and obviously cope with that old devil stress, not a good recipe for Afib. I do appreciate your wisdom thank you again!

Cheruboo

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Just up the road from me in North Devon then. I had all my treatment in London mainly because back then there was no EP department locally.

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Hello Neighbour - I was wondering whether to try the Brompton they may have a broader view - I think I really do have to try for my family as well. All good things

Cheruboo

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I had both mitral and bi cuspid? Valves repaired in 2005. I had continuing a fib. That is worse now but 13 years later,the valves are just beginning to leak again.

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hi, i have two leaky valves and had a catheter ablation 6 weeks ago for PAF , i didnt know about the valve problem and 9 months previous to the ablation i had an echocariogram that showed nothing! My EP specialist said the heart valves had undoubtedly caused my AF and my atrium was very enlarged due to stretching. When i mentioned the previous echo he said it only shows up sometimes when you have a transoephagal echo, sorry its spelt wrong! i had one of the those whilst they did the ablation. He said he would write to my GP who would decide what course of action to take next but that they would probably leave well alone unless they became a serious problem!! Which doesn't do us any good worrying! He also said my AF wont be cured because of the size of my Atrium and i will probably have to go back for a second do. I have has at least 10 episodes since the ablation but they arent as severe although more frequent and don't last as long probably 2 to 3 hours instead of 24.

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Hi Luisa1987

Will you discuss having the valves repaired with your GP? Not sure whether your diagnosis was moderate or moderate-severe ? I hope everything settles down for you and the EP thinks of another way to help you. Did he indicate that the the valve repair/replacement would improve the Afib episodes, reducing their frequency? Perhaps your GP is better than mine, she is really brilliant at general things, but cardiac is not her subject - can’t have it all I suppose.

Cheruboo

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I have had mitral valve repair. I will write later today. I had written a lengthy response to you cherubic but it just disappeared. Very annoying. Which country are you in?

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Hi Luludean

I am in Somerset England, and I know how frustrating it is spending a lot of time on a message then wham it disappears. I do hope you manage to retrieve it - thank you for your help!

Cheruboo

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I had mitral valve repair surgery 3 months ago. I was fortunate to be referred to Hammersmith Hospital from Watford Hospital where I'd been seeing an EP as I had Atrial Tachycardia. I had experienced this only once, and was taking bisoprolol for it. I was told the valve problem (moderate to severe regurgitation, but with good ventricular function) was possibly a trigger for the tachycardia, as Bob has explained above. I also had a parathyroid problem, another potential trigger, which was resolved by an op 7 weeks before the heart surgery.

I was a suitable case for minimally invasive surgery - accessing the heart by an incision between my ribs - a right mini thoracotomy- rather than opening the chest with a sternotomy. Not all hospitals are able to offer this version, and it could be worth looking for one that does, to at least find out if you are suitable. The advantages are a quicker recovery and less pain. The actual repair done is the same which ever way they get in!

I had 3 incidences of AFib in the 10 days following the op, and was given Amiodorone to take for 3 months - which I have stopped taking a week ago. I am hoping the Amiodorone kept my heart rhythms in order while my heart had a chance to recover from the disturbances of the op. Time will tell! S o far, so good, but I know Amiodorone takes a while to clear from your system. I see the EP in Watford just before Christmas and he has arranged for me to have a 24 hour Holter monitor before I see him.

I was fortunate to feel well before both ops, and to be fairly fit. I felt grim for a week or so after the heart surgery - very disconnected - probably due to the long anaesthetic. My fitness took a real knock - I could barely cope with walking up a slope, but I'm back to my old self now.

I needed to have both ops. I understand that to have delayed them would have led to further heart problems, although not imminently. So I'm glad to have them over and done with.

Wishing you well for whatever treatment is decided upon for you.

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Twenty-four years ago I had my Mitral Valve replaced. The medical cardiologist chose the child surgeon for me, in the hope that he could repair it. This failed, and I was given a metallic version. Now, I am glad. I have read somewhere that the failure rate in repairs is higher than having the replacement. This year at Papworth Cambridge, I was told by the kind man who did my echo, that he had seen someone whose metallic valve was still good, after forty years. I read somewhere that newer metallic valves are less prone than the old ones to problems of blood clotting.

I had the op the hard way: full sternum slice. But I have to say, the op is a marvelous op. Just 24 hours after the op, I was sitting in a wheel chair for over two hours, with my wife, waiting for a bed on the ward. I entered hospital in a wheel chair and left (carrying nothing) at a fast walk. The worst parts were the gagging in intensive care -- which is a sign you are ready to breath for yourself, so, knowing that, you are encouraged even in your daze. The other was three difficult nights, with muscle cramps in the shoulders. Again, not dangerous. Night staff in each case made it bearable eg with a stand up all body wash at 2am. Wow, that felt good!

My main points are not to be afraid, and to check if a metallic valve would be better than a repair for you.

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Thanks ILowe really helpful - I think there is a new op that is less invasive - but I am ready to take on anything - just to get the beastie fixed - It must have been a very important time in your life, as you remember it with such clarity. So pleased it has worked for you. Do you remember what category your valve was diagnosed - severe or moderate-severe. It seems this is quite significant in some cases, but I have read it is judged on symptoms?

Cheruboo

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The valve strings broke. I was fortunate, this meant I was fast-tracked and treated as urgent.

After the op, the removed valve was tested, and it was decided there was enough bacteria on it to suspect infection, known as endocarditis. Since this is a killer, it is always treated whenever suspected. Six weeks intravenous antibiotics ie an extra 5 weeks in hospital. Boring. Felt like prison, but they agreed to transfer me to my local hospital, and I was let out daily for walks on the beach.

The leadup was unusual. I generally felt unwell. Then I started getting hot knees, for an hour or so at a time. Then a body temperature of 39C for an hour or so. The doctors dismissed this as my invention. They now say it was 'consistent with endocarditis' which, to be fair, is hard to diagnose. The feeling of unwell slowed me down, and eventually I felt breathless. Then, one night, while on holiday, I could not breathe. I would sit up, gasp, calm down, sleep a little, repeat. Finally my uncle called a doctor, who promptly called an ambulance. The relief when they put an oxygen mask on me! Diuretics cleared the water on the lungs, and I kept up my walking, but always with somebody. That was when an echo gave the diagnosis and I was referred to Cardiff hospital.

So, a late diagnosis of endocarditis almost killed me, but the op was a miracle. I have lived to see my children grow up and I am grateful. I am very skeptical of modern medicine and believe for instance that the evidence is clearly against bypass surgery since the body naturally develops collateral circulation. But, surgery for valves is one of the exceptions.

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It is quite incredible that the main topic we are involved with on Health Unlocked is Afib which we all have in common - but when it all opens up there are so many different hazards lurking for people. We do really need to know these, and thank you for being so informative, it is so helpfull, to be able to go into, whatever we have to face, with our eyes open. I am pleased that you have survived everything.

Cheruboo

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Oh. I forgot to tell you. After the surgery, when I was walking the corridor, my heart started racing. I was promptly confined to bed (grr) for 3-4 days. They called it tachycardia, which they said was "very very common" after such an operation. In those days tachycardia and Afib were not clearly distinguished -- at least not explained to the patients. They put me on Amiodarone and were very blasé about it. I was told I was on it for life, and could get sunscreen on the national health, as if that was the most important question!! Instinct made me ask to come off it after 3 months.

Then over 20 years I would have bouts of tachycardia for up to an hour. Various meds when needed. I never had them while on Flecainide and there was a season where I had to stop that/reduce the dose to 25/25mg. Undocumented. Yep. This is patients doing their own research.

A metallic mitral valve makes you more prone to AF. But I paid no attention till it happened -- a tachycardia that would not stop, that became AF. So, these questions are all related.

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Hi Barb385

I am so pleased you have recovered and are feeling good now. You have given me the impetuous to go for a second opinion - I had begun to waver. Your message has really and truly helped me - thank you so much! My EP - has really given me the run-around - TIME FOR ACTION (wish I felt as strong as those words)

Cheruboo

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Hello Cheruboo. Glad to have been of help - and hope the second opinion helps you choose what you want to do

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