AVR- Valve too small

[Harrysgran]

I had my AVR 3 years ago and was told that the porcine valve they had to fit is very small due to my small anatomy. As a result i am suffering from pre- syncope which means i am breathless and dizzy on excertion and lightheaded on a daily basis. This is down to “ poor perfusion”. A recent TOE shows the valve is functioning ok.Anyone else out there have these issues ?

[Fortepiano]

Do you know what size valve you have? They vary according to the size of your aortic annulus - the smallest is 19mm and some surgeons don't like to use this because it doesn't give good blood flow. It's a problem that mainly affects small women.

I was lucky enough to avoid this myself, but I do sympathise. It's so frustrating to end up with what is basically another stenotic valve.

If you are at all overweight it can help to lose weight since the less your BSA the less blood flow you need. But don't be underweight!

If you need a replacement valve - if what they call your Patient Prosthesis Mismatch is severe - it might be worth going to a specialist cardiac hospital which does congenital cardiac surgery. This is because children's cardiac surgeons are both very used to doing repeat surgery and they are also very used to doing annulus enlargement to put in a larger valve.

I myself had a small annulus of 21mm and eventually chose a more complex operation called a Ross to get better hemodynamics, but my backup was an annulus enlargement and my surgeon said he thought he could enlarge it enough for a 25mm valve.

All the best

[Harrysgran in reply to Fortepiano]

Thank you so much for your reply .I have a 19 mm sorin valve .yes i am a “ small woman” at 5ft 1. I am not overweight as im aware of the effect this may have. My consultant has painted quite a frightening picture of having annulus enlargement , and warning of a high mortality rate so your advice and experience has given me some hope and encouraged me to ask more questions ( there is very little information out there) Can i ask you which hospital treated you ? I am in Leeds.We do have a Childrens specialist cardiac service so i will speak to my cardiologist next month at my appointment.

I hope you are doing well , may i contact you again if i need to ? X

[Fortepiano in reply to Harrysgran]

I'll send you a Private message. Yes of course you can contact me!