British Heart Foundation
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Any composers / musicians with Mechanical Heart Valves? Please help!

Any composers / musicians with Mechanical Heart Valves? Please help!

Calling all musicians, especially composers and sound engineers, who are living with mechanical heart valves. I have been strongly recommended to have a mechanical heart valve to replace my bicuspid aortic valve, and I also have to have a graft on my aortic root as I have an aneurysm. I may still get the choice to have the valve repaired or a tissue valve instead, but not sure.

My livelihood and passion is writing music, particularly composing for film and TV. I am very concerned that the internal ticking / thumping sound of the valve will create a metronome which will prevent me from composing my music. I am also concerned that I will have to give up session work as any recording of myself playing instruments will pick up the noise of the valve.

Are there any musicians out there who have overcome this problem, or did you have to change career? Any comments would be very gratefully received, thanks!

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I cannot answer completely, as I do not have any artificial valves. However, as an Engineer (with some acoustic experience), I would seriously doubt that you would hear anything whatsoever, as it would be embedded in several inches of sound absorbing material (you!) I believe when you "hear" your own pulse, its not the heart valve that you hear, it's the blood flow in arteries near the ears

I leave the question, hopefully, to others with actual experience of that which you describe, who will, again hopefully, be able to reassure you

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Thanks very much for replying, much appreciated! I've been reading around and it does seem like I would generally hear more of an internal 'thumping'. I'm going to try looping an aortic valve sound and composing with that playing through headphones, hope that this will be a realistic test! It sounds like having a graft for my aortic root aneuysm will increase the volume though, so that's a worry. When I mix and master my soundtracks I'm wondering if the heart valve sound might interfere with my ability to listen closely and notice flaws in the music / sound - so if you have any any thoughts on that as an engineer I'd be really grateful, thanks!

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Thanks so much for your reply! That's really good news that you can't hear your valve. Do you know what sort of valve you have, is it the standard St Jude valve? I've heard there are newer brands such as the On-X and the Sorin and some may be louder than others. I also have to have a graft on my aortic root next to it due to an aneurysm, so this may possibly increase the volume of mine, plus I'm very thin so I fear the noise may be quite noticeable. Did you have to have a graft on an artery too, or was it just the valve that needed replacing? Thanks again, and apologies for asking more about your situation!

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I a,m a jazz and rock guitarist and composer of library music for TV and film. But I am slightly deaf in my left ear. What help can I get? Neville Pearson Plymouth Devon

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My bro in law has one, after about 6 months the crocodile from peter pan sound goes away, i understand cells stick to the valve in some way and make it go quiet. His was quite loud at first, nothing 2 years later - now as an avid listener :-)

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Thanks so much for your reply! Does the sound of the valve annoy your brother in law and distract him from working, or as he got used to it now?

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It never bothered him, but anyone could hear it after it was fitted, not now, to others its silent. Havent asked him if he can ever hear anything.

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Thanks!

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Thanks, that's really useful information and I'll ask the surgeon about this when I meet him!

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Have a search on YouTube for mechanical heart valve sounds. There are several you can listen to.

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Thanks so much, brilliant idea! I have only found one clip of a prosphetic aortic valve so far and it doesn't say in the blurb if it's a tissue one or mechanical though probably the latter as it's a recording of a young person, it's here on youtube:

Have you come across any other mechanical aortic valve recordings? If not, no worries, thanks again!

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I'm new on here - possibly youtube links don't work here as the one I posted above hasn't worked, apologies!

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I just Googled 'artificial heart valve sounds' and found lots. I think it's only the mechanical ones that make a noise.

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Thanks, I was searching inside youtube which was probably limiting my results!

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There is a difference between being conscious of one's own heart beat, which is not audible to others, and the sound of the mechanical valve, which is audible externally to other people. It's dependent not surprisingly on hearing - children always hear it, and generally it becomes less audible with the age of the listener. The sound is basically like a loud watch ticking, and bystanders often mistake it for this. Several people have recorded their 'ticking' on youtube, if you want to listen. Mechanical valve sounds have been measured, one report says 49-53 decibels, and another 40-43. Unfortunately the aortic graft for your aneurysm would serve to intensify the sound.

The valve does not get any quieter ( cells sticking to it would be bad news!) but most people who choose mechanical valves seem to get used to it and eventually tune it out or even find it comforting!

I do sympathise with your dilemma. Unfortunately there is no perfect artificial valve, and the choice is between warfarin / ticking or accepting future reoperation. It's a very personal choice, but it's important to remember the choice of mechancal or tissue is up to you, not the surgeon..

Though I am not a musician I am a keen classical pianist (see username!) and also love going to piano recitals. I hated the idea of my ticking audibly at concerts, and this certainly influenced my choice against mechanical, as well as problems my husband had on warfarin. I was also willing to accept reoperation, but for many people the prospect of reoperation understandably trumps everything else!

I suggest you buy a loud watch and see if it affects your working routine and if a microphone picks up the sound.

All the best in your choice.

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My bro in laws is carbon fibre, the surgeon said the surface was coated and ‘something’ was supposed to grow on it over time, i can say if thats the reason but there is zero doubt, it was loud when fitted, it is to an observer silent now.

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Thanks! It's good news that the sound lessened over time and I'll ask my surgeon about this, just in case some mechanical valves have special coatings.

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Thanks so much for your in depth reply and suggestions, it helps enormously to hear from another musician in my position, I'm really grateful! I'm so glad you were able to chose a valve that meant you could carry on playing piano. and enjoying music. That is another concern of mine, that music just won't sound the same anymore and would be less enjoyable to listen to.

If you don't mind me asking, how have you got on with your tissue valve, has it lasted quite a long time so far? I'm 40, so I would definitely need re-operation at some point, and they seem to generally reccommend mechanical valves for my age-group.

How did you find out about the aortic root graft making the valve sound louder? It makes sense that it would amplify the sound, and that is a worry. I will definitely discuss that aspect with the surgeon, thanks very much for flagging it up!

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Hi Bicuspid,

No need to panic or stress! (not good even if there was nothing wrong!)

I had an AVR replacement in Oct 2015 and had a pre-emtive double by-pass at the same time. This was done to prevent any future work and was told that the only time they would go back in would be in a situation where I would have everything to gain and nothing to loose!

I have a titanium ONX valve and the grafts were harvested from my left arm

(Had friends who had similar ops at the same time and their grafts were taken from their thighs. My experience is that I have recovered quicker and had no restrictions unlike they have! maybe it is just them though)

I was advised to go mechanical as I am active and was "only" 57 at the time. The consultants (yep lucky me with opinions/advice from two leading folk) in their opinion/experience, was that I would probably need a soft tissue valve replace in 10 or 12 years time and not so easy with the aging process etc.

I would say that during the first 16 weeks I was aware of the "metronome" inside me (my son said they had just put in a second hand watch in me!)

However, this disappeared as the chest scar healed and now I find that I only hear it when I am tired and stressed and in a room of silence.

I have asked others beside me if they can hear it and the answer is "No" It is a bit like breaking wind or a stage whisper where one is aware of what is going on and because it is in your body you sense it more.

I play in a ceilidh band and have been next to sensitive mikes etc. and nothing has been disturb. Even had fun setting up a Mike and me standing with it against my chest. Only time it could be heard was in stethoscope mode (mike right against my bare chest lol)

Have been on film sets, TV and radio studios, Recording sessions and live stage with no noise or side effects.

My musician friends, who have pacemakers, have more of an issue with radio mikes etc. but again no change of career just techies aware of transmitting frequencies!

Hope this all helps

The bigger issue is that the patient has the decision about what valve type.

I wanted a soft tissue as I had an aversion to warfarin.

I stated this and was guided by the consultants as to why a metal valve may suite me better, both with quality of life now and in the future.

They were concerned that future replacement(s) would be difficult due to the aging process when involving scar tissue that would develop with the first op regardless of what valve.

With the metal valve I have it will last way beyond my need for it!

Good luck and I am always here if you need more

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Thanks so much for your in depth reply and support, very much appreciated! It's really reassuring to hear from another musician who has had the same difficult choice as me, and to hear that your mechanical valve has not stopped you performing or recording in any way.

Another musician on here flagged up that having a graft on my aortic root right next to the mechanical aortic valve may well make the sound of my valve louder though , did you have to have any kind of graft on the root of your artery next to the valve? I'm not sure how the bypass operations work, apologies!

I've also heard that the ON-X valves might work okay with lower than usual doses of warfarin as they are newer than the old St Jude valves, have you been able to keep healthy on a relatively low dose, if you don't mind me asking?

Thanks again!

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Hi again,

I have had trouble with the warfarin dosages, however this was due to Dr's NOT looking at my valve detail! All now corrected

The ON-X valve does enable a smaller dosage of Warfarin to be taken, as the INR required is 1.5 (other valves prefer an INR of 2.2 plus I believe)

Now that the dosage is sorted, I am feeling fitter and better than I ever have. Probably have had the problem for most of my life and consider myself very fortunate to be still here.

The noise does quieten a lot as the scar tissue and bone fusion progresses over the months (is louder at first when sitting down doing nothing - also you can control it!)

I found it went so quiet after the natural recovery period anyway

I remember that the first gig I was invited to was 8 weeks after my op.

I was unsure about going and the band were kind enough to invite me to the sound check and it felt okay and was nice to be out and getting on with life again. (Actually glad I went because it was the last time I saw the original two of the group together as sadly one past away a year later. He also had his valve replaced several years before, after several heart attacks and valve problems and it didn't stop him touring the world and playing major concerts, or recording or PR work on radio and TV!)

My problem was during the gig they racked up the volume and the and it was the base and drum vibrations coming through the floor that could be really felt on the actual chest wound. I had to leave the hall and go into a corridor.

Still the feeling of getting "life back to normality" had me staying.

When you hear it "beating" then it is a sign that you need to relax. However, as i said earlier in falls into the stage whisper category where because you hear it you think everyone else can.

I believe that the calcification "problem" stems from the use of harvesting from the leg. Given that the blood flow/pressure/friction in the leg is nothing like that of the Heart.

The BHF are funding a lot in research into this although it all takes time to study and cure.

All I would add is that I know that I wouldn't like to go through the surgery procedure again. Breaking of the sternum is very painful and is a bone not meant to be broken. I know understand why knights of old, who had deep chest wounds in the same place, begged to be finished off by their enemy!

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Hi,

Thanks for the reply

I was on both Aspirin and warfarin after my op in Oct '15.

With a target of 2.5 INR. which was hard to be consistent with.

(whilst obviously following a strict diet and exercising well)

Last August I noticed that my left arm, which had been harvested for the by-pass part, had turned black and blue! I was rushed into hospital where it was established the I was suffering from Spontaneous Compartment Syndrome (with no instance of trauma). I need emergency care from Orthopaedics, Cardiology and Hematology saving both my arm and life.

It transpired that the mix of Aspirin and Warfarin had taken things too far.

I am now regularly recording 1.5 INR and on 5mg of Warfarin.

Still having physio for my arm though but am getting there.

The guys in the US were also of great help.

In the US, I believe the patients, with this valve, are taking minimum Warfarin and regular dosage of Aspirin.

Perhaps the BMA/US and BHF should get together and get this tested sooner rather than later. Also BHF research into calcification of grafts should carry more importance.

I agree that the specific design of the on-x is to reduce flow turbulence and hence is quieter and if the reduced dosage of Warfarin can been tested and agreed then even better for all.

My next "interest" is how robotics can possibly help with Cardio operations. Have seen what it can do for Prostate cancer Operations which is very exciting progress.

Thanks again for the reply, the exciting thing about this site is all the different experiences and help that can be shared and obtained.

My advice to all is never be frightened to ask. There is no such thing as a stupid question!

Happy beats to all

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Thanks so much for telling me more of your experiences, that sounds like a very tough time you've been through with you arm, especially as a musician - I hope you're still able to play your instrument at the moment!

Sounds like the aspirin and warfarin combo can be dangerous. Is your current dosage of 5mg Warfarin quite fairly low, or the normal amount they generally give people?

I expect it all depends very much on the individual and how much they need.

Sending best wishes for a fully recovered arm soon!

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Thanks so much for this technical info, very much appreciated!! It's disappointing that the lower warfarin dosage for the On-x doesn't seem to be sorted yet, and requires aspirin too, but promising that it may possibly be quieter.

I'm struggling to find out how long the On-x valves have been in useage (I'm guessing they are quite a recent innovation), and whether my NHS cardio department will be likely to give me an On-x if I ask them, or if it's still rare in the UK. If you know any of this or where I should look to find out I'd be really really grateful - thanks again!

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I believe in Oct 2015 it was fairly new (Certainly to NHS Scotland)

The positive thing is that if the US results can be verified by BMA then the appears to be little need for Warfarin (which comes in 1,3 and 5mg tablets) 5 Mg is a middle dose although I have been as high as 8mg! (to many conflicting vitamins in veg etc. - now sorted) Also the dosage is flexible e.g. i have been on 5,6,6 which is day 1 5mg day 2 6mg day 3 6mg then back to %mg etc.

Try the website for ONX

onxlti.com

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Thanks so much for your reply, it really is invaluable to find out what life on Warfarin is like! And also good to hear the On-x is used in the Midlands, not too far from where my cardio dept is based. If it's okay to ask, are you happy so far with choosing the On-x, and not having to worry about re-operation? Does your valve make a noticeable sound or do you not notice it anymore?

I am so far completely unsure whether to opt for a tissue valve and aspirin or a mechanical valve and warfarin - there may also be the option for a repair, but I'm told this is not done so often and long-term results not so well known. As I'm 40 I'm being strongly recommended a mechanical, which makes sense in terms of how long they last, but the thought of internal bleeding e.g. if I bump my head, scares me somewhat (and of course the potentially distracting internal metronome!)

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I onli had tissue valves and would recommend them they last a long time if u look after ur heart and if not can be replaced often (up to every 3 years of needed). Trust me I kno I’ve had them replaced often but my bloke’s gdad had one for over 20 years.

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Thanks very much for your reply! So how many surgeries have you had to have so far? I've been told that each time you have open heart the risk goes up, so that alarmed me somewhat! And have your tissue valves lasted quite a long time or did some of them fail quickly? That's brilliant news that tissue valves can sometimes last 20 years! Do they give you advice on how not to wear your tissue valves out? I hear they wear out because of 'calcification' but not sure what that means!

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If u clean ur teeth and get dental work done wen needed u are less likely to infect the valve which is wat I’ve done. I’ve had tons of valve surgeries but my last open Heart surgery I was 4. I’ve had the rest via keyhole surgery.

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Thanks, I will be sure and look after my teeth! Have you had an aortic valve replacement done via keyhole surgery?

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Yea. They go into ur breastbone if it keyhole surgery.

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I will listen out for Mozart's Sonata for piano and valve! :)

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Ha ha, this is a great idea - a musical heart valve organ could be a very useful new instrument!

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I know three professional musicians (sadly one departed in December 2016) that have had numerous heart encounters, all were able to carry on with their careers. So take a look at the experiences of Rick Wakeman, Malcolm Jones and the late Rick Parfitt (to name the three)

Should put your mind at rest and going forward offer great confidence.

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Thanks, they do all seem to have coped with heart problems really well! And thanks again for your support, it really has helped talking to you :)

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I had a mechanical valve 4 years ago, there are times when I'm stressed I can't hear myself think. I have heard other people talk about their valve with fondness but I can't agree. Whilst I am grateful for it keeping me alive - I hate the noisy little thing.

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Thanks very much for your reply, really sorry to hear you're finding the mechanical valve so difficult to live with. I've decided now to go for the tissue valve, although when that wears out I'll have to have a mechanical valve replacement, which I am not looking forward to! Is your valve a St Jude? Are you having difficulties sleeping with the ticking?

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