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Valve Disease (Drs. Griffin and Gillinov 3/14/11)

Monday, March 14, 2011 - Noon

A. Marc Gillinov, MD
Staff Cariothoracic Surgeon, Department of Cardiothoracic Surgery, Sydell and Arnold Miller Family Heart & Vascular Institute

Brian P. Griffin, MD, FACC
Staff Cardiologist, Cardiovascular Imaging Section, Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart & Vascular Institute


Heart valve disease occurs when one or more of the heart valves do not work correctly and cause the heart to pump harder to circulate the right amount of blood through the body. Left untreated, heart valve disease can reduce a person’s quality of life and become life-threatening.

More Information

Cleveland_Clinic_Host: Welcome to our "Valve Disease" online health chat with Dr. Griffin and Dr. Gillinov. They will be answering a variety of questions on the topic. We are very excited to have them here today! Thank you for joining us, let's begin with the questions.

Mitral Valve Disease

hs0212: Once you have been diagnosed with moderate to severe MVP with left ventricle arrhythmias & minor aorta regurgitation what type of tests are most appropriate and how frequently should these tests be conducted?

Dr_Brian_Griffin: Such patient should have an echo done on a routine basis - at least yearly and possibly more frequently.

Denise: I have a Mitral Valve prolapse.. found out a year ago. I get pain around my heart sometimes.. I’m 43yrs old. was told by the doctors not to lift anything heavy, not even my shopping...My work bag is heavy and I have been lifting light shopping, should that cause pain in my chest? WHY not lift?

Dr_Marc_Gillinov: Most people with mitral valve prolapse can lift normal weights like those associated with shopping.

Dr_Brian_Griffin: Lifting heavy weights in someone with MVP can cause the chords that hold the valve in place to stretch more - and may make leakage worse.

Janet: Can they do both mitral and tricuspid robotic surgery at the same time?

Dr_Marc_Gillinov: Yes. But it depends upon the person's particular anatomy and valve issues.

dricke: I have a rheumatic heart with mitral valve damage including prolapse. I'm 62 and have some trouble with shallow breathing at times, not life activity changing. I would like to know what "numbers" I should be asking my Doctor about to determine when it is time for minimally invasive mitral valve repair? Things like heart strength or pumping action, how wide the valve opens, how much blood is prolapse, etc. Can the heart be damaged if I wait too long?

Dr_Brian_Griffin: Rheumatic disease rarely causes prolapse - so mitral valve prolapse may be the issue.

We have a great tool to help patients know when surgery is necessary - see our website  to go through the tool - it will include info you can also ask your doctor.

The heart can be damaged if the valve leak is severe and you wait to long - this can be an issue. Basically the questions you need to ask is how severe your leakage is and what your ejection fraction (EF) is - if your EF is less than 60% and your valve leakage is severe - surgery is usually indicated.

hs0212: Is there a hereditary factor associated with MVP and if yes what steps would you advise?

Dr_Brian_Griffin: MVP may be inherited. There are three separate genetic loci that have been discovered - many of the family members with severe MVP have relatively mild abnormalities.

Currently we do not recommend screening of family members except as part of research studies.

Mitral Valve Surgery

vintal: Hello, I am in need of a mitral valve repair. I have been told there is a one in 100 chance for a stroke is this accurate? My choice for surgery is robotic, thanks

Dr_Brian_Griffin: It is less than 1 in 100 but there is a risk of stroke.

vanjeda: How much more difficult is it to repair an anterior as compared to posterior mitral valve, and are the chances of re-repair really higher for the anterior?

Dr_Marc_Gillinov: Anterior leaflet repairs are more complex and require a surgical team with experience in such repairs. Few surgeons can re-repair the anterior leaflet. We can.

Rubin: My wife has mitral valve prolapse with regurgitation. The anterior leaflet flails in a scalloping motion. Her left ventricle has become enlarged and she has had endocarditis twice in the past 8 years. Despite being otherwise asymptomatic, she has been recommended for open heart surgery by a specialist at NYU  to prevent damage to the heart and to avoid further complications and infections. He said that in her case robotic surgery (which he frequently performs) is not the safest smartest option and will not guarantee a perfect result. In my online research, I did not find much about any centers repairing the anterior leaflet robotically. Is this something you might recommend at your clinic or is open heart standard for the anterior repair? If it could be done robotically, would that avoid using the heart lung machine, or is that necessary regardless? Any answers you could provide would be most appreciated.

Dr_Brian_Griffin: Someone undergoing valve repair will need to go on the heart lung repair whether this is robotic or not to insure there is no blood in the heart while the repair is being performed.  The anterior leaflet question is taken on a case by case basis and only after a thorough review of films - would this decision be made.

stacy72: Good morning. I have been diagnosed with a congenital malformed (cleft on valve) mitral valve. Since my last echo six months ago, my ejection fraction dropped from 62% to 51%. I would like to know what your opinion is on having a repair vs. a replacement. I would also like to know the chances of minimally invasive surgery. I look forward to hearing from you. Thank You, Stacy (CA)

Dr_Brian_Griffin: If the leakage is severe and the EF has dropped that much then surgery is likely indicated. Many times repair is feasible in this situation but this will depend on the site of the cleft and whether there are other abnormalities in the heart associated with it. The same would be true for robotic or minimally invasive surgery

RHowell: Dr. Gillinov is operating on me on April 21 (anterior leaflet of mitral valve). I have a problem with many pain medications especially Percodan/Percocet and related drugs; severe nausea, vomiting, dizziness, difficulty breathing, anxiety & palpitations. Given my situation, what pain meds. would you be able to give me post-op? Thank you

Dr_Brian_Griffin: We have a lot of experience in dealing with issues related to pain and nausea related to pain medication. We use a variety of different drugs - and we will be able to manage your pain post-operatively

Bobby: I require mitral valve repair. The doctor is waiting for me to set a time. I am 70 in excellent health as is my heart except for the Valve regurgitation and AFib. The operation would repair the valve and AFib. I work out 5-6 a week with swimming and weight training. I have had an Ischemic stroke 2 year ago with no apparent side effects. Due to my age and the valve problem, getting the operation now seems best. What side effects can I expect. I am also wondering how much of a risk the ICU care (24 hours) can be. I have read professional thoughts on ICU care but for longer periods of time. If you could respond, I would be better equip to make the best decision. Thank you Bobby

Dr_Marc_Gillinov: We operate on many patients like you. Our risk of major complications runs 1% or less. In addition, you may be a candidate for a less invasive approach depending on your anatomy and the ability of your surgical team.

Nutzy: I have rheumatic heart disease with severe mitral valve regurgitation. There is possible in my case a mitral valve repair or I need a mitral valve replacement?

Dr_Brian_Griffin: Difficult to determine without looking at the images of the valve with echo - in general mitral valve repair is more difficult in rheumatic heart disease and does not have as good long term results.

stacy72: If a patient can't make it to Cleveland, who would you recommend on the west coast for a mitral valve repair or replacement? What is the latest data for Cleveland Clinic Mitral Valve repair/success rate for Mitral Valve Repair? Thank You

Dr_Brian_Griffin: We have our outcomes listed on our website.

Sherry_F: So leaky valves should be fixed?

Dr_Brian_Griffin: It depends on how severe the leak is and the severity of heart function.

Aortic Valve Disease

bewildered: apical aortic conduit? percutaneous av repair? 64yr male.92 endocarditis.98 bovine aortic valve.nov 09 honogeneous graft at va.! jan 11 severe aortic stenosis.echo=gradient across av [43mmhg} peak=78mmhg.ejection fraction 60-65%.aortic valve area was not calculated. this would be third surgery.

Dr_Brian_Griffin: No indication for treatment currently if asymptomatic. However, follow up with your cardiologist should be done. We have performed third surgeries in many instances successfully. Perc AVR has not been approved for implantation in prosthetic valves as yet - although this is technically feasible in some patients.

adourian: For Dr. Griffin: I have an echo yearly for AVS. When I do get to the point when symptoms appear, will I need both a TEE and a cardio catheterization to confirm what type of surgery should be employed and if I have the surgery at Cleveland Clinic does it matter whether these procedures and done there rather than locally with the results sent to Cleveland Clinic.

Dr_Brian_Griffin: Typically we will need a heart catheterization to look at the coronary blood vessels but this can usually be done locally and the images submitted here.  A TEE is done as part of the operative procedure and in most instances is not required before surgery.

Sept14: What are other related conditions (if any besides aortic aneurysm) that can result from or are connected to bicuspid aortic valve disease? Is intracranial aneurysm one such condition, and if so, how pervasive in BAV patients? What recommendations are there for BAV patients to screen for this condition, if so, or any other related conditions that may exist?

Dr_Marc_Gillinov: Most people with a bicuspid valve have a bicuspid valve.

Dr_Brian_Griffin: In approx. 30% of patients, they also have aortic aneurysm - but a certain percentage of patients will have coarctation (which is a narrowing of the descending thoracic aorta) which causes high blood pressure.

Bari aneurysms may occur with bicuspid valves but this has not been adequately studied. None of the national guidelines state that screening for bari aneurysms should be done with BAV.

Cole: I was diagnosed with severe aortic regurgitation in 2008 but have no symptoms. How do you know when is the right time to have surgery and is it a mistake to wait until symptoms appear?

Dr_Brian_Griffin: It is often appropriate to hold off with surgery in aortic regurgitation even if it is severe as long as the patient is being followed closely. This involves seeing a cardiologist and having an echo every 6 months. Symptoms often appear later and the driver for surgery may be the change in the size of the heart or in its pumping power. That is why close follow up with echo is needed.

Aortic Valve Surgery

adourian: For Dr. Gillinov: I have AVS but no other apparent heart issues (mitral ok, coronary arteries clear). When it comes time for a valve replacement my current desire is to go with a bioprothesis to avoid the need for coumadin. Please take me through your evaluation process for selecting the best surgical approach....sternotomy vs minimally invasive and if minimally invasive would it be a mini sternotomy or a port access and would it be with robotic assistance or not?

Dr_Marc_Gillinov: If the coronary arteries are fine, we can almost always offer a minimally invasive approach through a 2-3 inch incision. The robot is not used for aortic valve surgery as it does not have the correct tools.

Paul: I have been advised I should have an aortic valve replacement. I am 72, otherwise healthy, all tests to date show no blockages or other heart conditions present. I am quite interested in the minimally invasive and/or robotic assisted surgery. What are your general parameters to be eligible for this type of surgery?

Dr_Marc_Gillinov: If a person needs isolated aortic valve surgery without bypasses (the coronary arteries are ok) we can almost always perform a minimally invasive operation and speed recovery.

einstein: dr gillinov, i am a 58 year old active man who would like to have my bicuspid non-stenotic aortic valve repaired, instead of replaced. am i correct in wanting repair, not replacement? after av repair, if the intra-operative tee shows residual insufficiency, would you immediately redo the repair? once? twice? or go immediately to tissue valve? pig or cow?

Dr_Brian_Griffin: The repair of a bicuspid regurgitant valve can be a very effective treatment but it is individualized. The surgeon would need to review the images of the valve as calcification of the leaflets even in the absence of stenosis can make repair impossible

Natacha: Hello - I was reading online about your Robotically Assisted Technique for hear valve repair. My 77 year old father has Heart (Stenosis of aortic valve + Regurgitation of Tricuspid Valve) and Kidney Failure (20% function). Does this procedure require contrast? We were told that the dye could seriously damage the kidneys and that he could either die during the procedure or require dialysis for life. Does the Cleveland Clinic offer a procedure that can be done without Diagnostic cardiac catheterization with dye? I would appreciate your response as we are running out of options. Thank you so much! Natacha

Dr_Marc_Gillinov: This sort of procedure can often be done minimally invasively without contrast. But he would require a cardiac catheterization to examine his heart's arteries before surgery, and that does require contrast dye.

robert: I had an aortic valve replaced with a bovine valve 7.5 years ago at Cleveland Clinic. Dr. Cosgrove used the minimally invasive technique. The valve is now malfunctioning and stenotic. Main symptom is shortness of breath. Should I have it replaced with a mechanical valve (I am 66 years old) or another bovine? In either case, is there anyway this can again be done less invasive?

Dr_Marc_Gillinov: You should choose whichever type of prosthesis that you wish. Usually such an operation requires a standard sternotomy. But results are excellent and risk is very low.

Katharina: I am a 79 year old white female with moderate aortic stenosis. What is the possibility of replacing the aortic valve using minimally invasive surgery (off-pump)?

Dr_Marc_Gillinov: When your aortic valve is severely stenotic, we can replace it minimally invasively.

Jackie: At what point is valve replacement surgery necessary.? My husband has a bicuspid aortic valve that has leakage. He was told by his cardiologist in Akron, Ohio, he is not at the point where the surgery is necessary but eventually will have to have surgery. His leakage is at 3% right now. He also has atrial fibrillation and has had several ablations. The last ablation was at Cleveland Clinic. Does the leaky valve have anything to do with his continuing afib problems, and at what point do you recommend valve replacement

Dr_Marc_Gillinov: He should have valve replacement only when his leak becomes severe. His atrial fibrillation is not related to the valves.

neffwords: I've lived with moderate insufficiency of the aortic valve (bicuspid) for over 7 years. I also have mild insufficiency of the mitral valve. My last echo showed biatrial enlargement (LAVI 41cc/m2; no ventricular enlargement). Is this related to the valve problems? If I get the valves fixed, will the atria return to normal? What happens if I don't get the valves fixed?

Dr_Marc_Gillinov: You should only get the valves fixed when they are severely dysfunctional (broken). Your atrial enlargement will remain after fixing the valves, but is not an indication for surgery.

fjgolfer: Recent echo indicates critical valve stenosis, mean gradient 53, valve area 0.5 cm2, ef of 60-65%. Otherwise, fit & in good health. Mild/moderate breathing symptoms. Change in 1 year in valve was 0.8 to 0.5. Can i put off surgery for 5 months? Frank

Dr_Marc_Gillinov: Symptomatic severe aortic stenosis should be operated on in a matter of urgency - 5 months is a long time.

BJobling: I have a 90 year grandmother who has aortic stenosis. Otherwise she is in good health. What should we do as far as treatment?

Dr_Brian_Griffin: Aortic stenosis in a 90 year old who does not have symptoms should just be followed. Highly symptomatic active individuals may be candidates for surgery or the experimental percutaneous valve replacement.

stacy72: At 39 years old, if a repair can't be done and a replacement is a must, how do you decide on a pigs valve or mechanical, what is the best? Thank you.

Dr_Brian_Griffin: There are a number of considerations in making this decision and the patient's input is vital. Mechanical valves will likely last much longer than biological (pig) valve but require the use of long term blood thinner - whereas the biological valve does not.  The decision on what valve to use must be individualized based on patient's circumstances and to some extent on their occupation and lifestyle.

Percutaneous Valves

mbt13: I have been evaluated for the new percutaneous aortic valve procedure and am awaiting instructions on the next step. In December I was told that I do qualify and need one more test before the final decision. Can you give me an update on how the trail is progressing in general and if there is any more positive or negative news about the procedure. I am hoping that as more procedures are preformed the more data is available on its success. Thank you for taking the time to answer my question.

Dr_Brian_Griffin: The second stage of the trial will be presented next month. The original group presented a number of months ago and suggest that in patients who cannot have aortic surgery, the percutaneous valve procedure is life enhancing. There are other trials underway. It will probably be sometime before we fully understand the appropriate situations where percutaneous valves should be used.

John: Since the MitraClip procedure involves placing a metal clip in the heart, would the patient be on blood thinners post-surgery?

Dr_Brian_Griffin: Blood thinning with warfarin is not usually required unless there is another reason for being on it - such as atrial fibrillation.

Biagini: My inquiry is for my 92 year old father. He has asymptomatic mod- severe AS. In 2006 he had both a cerebral hemorrhagic stroke, presumptive amyloid angiopathy,and 1 month later a DVT. He has some memory loss, and constant dizziness from bilateral vestibular hypofunction disorder. Recent testing revealed a positive lupus anticoagulant, elevated D-dimer. He is on 81 mg. ASP alternate days. We are told anticoagulation is very risky because of the amyloid angiopathy. He is also a mouth breather and always had spinals for prior hernia surgeries. He has some memory loss and other cognitive deficits subsequent to the stroke. He also sustained a DVT one month after the hemorrhage. What procedures, if any, are available for a 92 yr. old man with aortic stenosis and It seems valvoplasty is palliative and has similar risks to TAVi. Other there any other options? He still gets on the treadmill daily!

Dr_Brian_Griffin: Given his co-morbidities - it sounds like he is doing terrific. Intervention should only be considered if he becomes symptomatic from his aortic valve.

radiation_1: I am 55 and have severe AS and AI (symptomatic), stage 3 diastolic dysfunction, Afib and flutter, pacemaker, CAD (3xCABG and 3 stents) and previous radiation to mediastinal area. Since surgery is only a last resort, is TAVI a possible solution for me? If so how soon could it be available outside of the current trials?

Dr_Brian_Griffin: TAVI has not been approved for use as yet and the conditions for entry to the clinical trials are stringent and the determination of whether TAVI is feasible is an option needs to be made on an individual basis.

Symptoms and Diagnosis of Valve Disease

Duane: In 10/09, at the age of 50, I received the shock of my life when my doctor detected a heart murmur at a routine physical. Severe MVP, severe MR. I am a physically fit runner with no family history of heart valve disease. In 1/10 I had a mitral valve repair via median sternotomy. 2 days later I suffered a cardioembolic stroke. After my bumpy early recovery, I have done great and have resumed running. Last month, I had a surprise repeat of pericarditis/pericardial effusion, 1st time in a year. The new echo showed much change since the previous 1 year ago. My aortic valve (tri-leaflet) has gone from mild regurgitation to moderate plus (the prelim echo reading called it severe). There are lambl's excrescences on the non-ventricular side of the valve. My tricuspid has gone from trace regurgitation and leaflets thin and pliable to mild regurgitation with the leaflets thickened and/or calcified but open well. When he repaired the mitral valve 13 months before, the surgeon said everything else looked good. Any ideas as to what's going on with my heart or why? Any advice? Does it look like I'm definitely heading for repeat opening heart surgery?

Dr_Brian_Griffin: my advice would be to have a second opinion as to what is going on and if there are questions regarding the severity of the valve lesions - a TEE (transesophageal echo) may be required. If you are having ongoing fevers you should have blood cultures to exclude the possibility of infection.

amanda: I went to the doctor last Friday and he found that I have Dyspnea and Palpitations and put an order in to have testing done to rule-out Valvular Disease on the 15th of this month. I don’t know what is going on with me but I do know that I don’t feel like myself and every time I go to the E.R they never tell me anything, they don’t even do tests or anything...I am very dizzy and lightheaded by the end of the day, I feel winded even when I lay down. I have the chills mostly all day, my abdomen looks bloated and I have gained at least 7 pounds in a very short time. I am also finding that everyday it is more difficult to catch my breath. sometimes it will feel like my breath is being taking away. My hear pounds so fast most of the time and I wont even be doing anything a fluttering sensation also. I am scared. I have no energy and am sooo tired most of the time...I can barely keep up with my 3 year old or do the things I would normally do...Just want to know what’s going on, and just want someone to actually CARE and LISTEN to me!

Dr_Brian_Griffin: The echocardiogram seems to be an appropriate test - if there is an abnormality on that you should certainly see a cardiologist. A 24 hour or 48 hour monitor would also be an appropriate test to assess your palpitations.

KarenJ: I had a coarctation repair at age 12. At age 30 I had my aortic valve replaced with a St. Jude Valve and aortic root replaced at Methodist hosp. in TX. I am now 53 and have been very tired and at time short of breath. My Cardiology Dr. (who I work for) tells me that I am fine. Should i get another opinion?

Dr_Brian_Griffin: It would seem appropriate for your piece of mind to get another opinion to see that there is nothing new going on with the valve and/or coarctation.

clara: I have had the aortic valve replaced, and now the mitral valve had changed from mild to moderate plus the Tricuspid valve is now moderate / severe. Both valves have changed. I have noticed increasing shortness of breath and fatigue. What are the symptoms that these valves could cause. I was told a year or more ago that they regurgitate. I was told to watch for changing symptoms. I don’t know the symptoms.

Dr_Brian_Griffin: Shortness of breath and fatigue could relate to both the mitral and tricuspid valve. Please check with your cardiologist for further follow up.

arae27: What is a Cardiac Doppler?

Dr_Brian_Griffin: It is a measurement of speed of blood flow through the heart valves. It is a very accurate way of measuring the function of the valves in terms of their opening or closing.

jpolevy: John asks: What does EF actually measure? What is the norm for a person with a healthy heart?

Dr_Brian_Griffin: The EF is the percentage of blood pumped out of the heart with each beat. Normally it is 50 - 70%. The heart always has to have some blood in it to have it primed for the next beat.

Abnormal Heart Rhythm and Valve Disease

tyted777: I had min invasive mitral valve prosthesis 3-24-2010.I had a MAZE procedure at that time. Since then I have been in a-fib with HR of 120. The 1st drug was amiodarone &3 cardioversions. The Amiodarone put me in hosp for 3 weeks so ill I could barely function. During that time I had a very long pause which brought the crash cart team to my bedside. I also have Rt bundle branch block. atriums somewhat enlarged and pulmonary hypertension R. lung only. They said things should calm down in a year. One dr wanted to do an ablation . I do not think I should do anything to jeopardize the valve. I have been told not to exercise which is making me worse. The mitral stenosis was congenital. Do you have any answers? I am only 52 and I can not work as a nurse due to physical toll and lifting. Is there hope? Thank you

Dr_Brian_Griffin: We would be happy to evaluate you for a second opinion. These are pretty complex issues that would be best approached by seeing a cardiologist experienced in valve disease.

rbrint: Good Morning. Drs. Gillinov and Griffin - You performed a mitral vale re-repair on me 11/2008 at the time of discharge I developed a-fib and was sent home with amiodarone. As of most recent checkup valve still has a mild leak and I'm still taking 200mg of amiodarone daily. I've read about toxicity of this drug and am wondering if it's safe to take long term. I am not in afib now.

Dr_Brian_Griffin: Amiodarone in higher doses may be associated with unwanted affects - although it is very effective in treating atrial fibrillation. It may be possible to discontinue this - but you should check with your cardiologist.

Midnight01: Can a patient function without restriction for long term with a non contracting atrial chamber

Dr_Brian_Griffin: Yes. Many patients have atrial fibrillation and are completely unaware and unrestricted as a result.

Multiple Valve Disease

GoldieSk: Following repair of both my mitral and tricuspid valves in Feb. with annuloplasty, how long can I anticipate that this repair will be effective?

Dr_Marc_Gillinov: Usually such repairs last a lifetime. You need to get an echocardiogram once a year.

After Surgery and Recovery

ezaidman: I exercise daily for one hour. I had four Dressler episodes in the firs two years and none so far. My question is: How many years do you think I will be able to keep my valve before replacing it again? and can heavy exercise wear my new valve?

Dr_Marc_Gillinov: Exercise does not wear out your valve. Such valves usually last at least 10 years and sometimes last 20 years.

ezaidman: The two questions above are by the same 67 year old MD, I exercise daily, my lab numbers are great and my yearly echo is great. I have two small grand kids and I like to live to be at least 90 and exercise. I was operated at CC minimally invasive technique. Can I do anything special to have my valve last longer?

Dr_Brian_Griffin: We have a lot of research underway to understand this - but no specific medications have been proven to make the valves last longer.  Being on a statin may help - but this isn't proven. Keeping fit and healthy is important.

NanaBear: What form of exercise is beneficial prior to valve repair sexual intimacy OK for the heart prior and how long after surgery?

Dr_Brian_Griffin: I would recommend, depending on how severe the lesion, the appropriate form of exercise may vary - so check with your cardiologist.  Usually sexual intercourse is not contraindicated in patients after valve repair.  Typically patients can resume sexual intimacy after the sternum is healed and your doctor will discuss this with you.

gadapea: How often is it necessary to have a stress test, echocardiogram, and carotid ultrasound done following a successful mitral valve repair ?

Dr_Brian_Griffin: Usually the only required testing is an echo on a yearly basis.

jpolevy: I am a 77 yr old athlete, diagnosed with mitral valve regurgitation, if I have it repaired , will I be able to continue and how long would it take to recover?

Dr_Brian_Griffin: Repair should not prevent continuing with activity. It will take a minimum of 6 - 8 weeks before light athletic activity - We have a web chat coming on May 2 related to the cardio-athlete - you may be interested in participating.


dricke: Pradaxa has been praised by the media as THE medicine of the 21st century. With a bad mitral valve and afib do you think I will ever be able to use it?

Dr_Brian_Griffin: Pradaxa has been approved by FDA for anticoagulation in treatment of atrial fibrillation. There is less information about its use in patients with valve disease and I would recommend you check with your cardiologist to see if it would be a good medicine for you.

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Griffin and Dr. Gillinov is now over. Thank you again for taking the time to answer our questions about valve disease

Reviewed: 03/11

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