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Heart Valve Disease (Drs. Thomas and Soltesz 7/6/11)

Wednesday, July 6, 2011 - Noon

Description

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 "Heart Valve Disease" online health chat with James Thomas, MD and Edwards Soltesz, MD. 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.

Dr__Thomas: Thanks for having us.

Dr__Soltesz: Let's get started.


Valve Surgery General Questions

Imalucy2: How dangerous is the surgery itself and how long does it typically take?

Dr__Soltesz: Aortic valve surgery mortality is less than 1% in most individuals at the Cleveland Clinic. Surgery takes about 3 hours and recovery takes 3 - 7 days with one day being in the ICU. Repair or replacement of the mitral valve carries a similar low mortality. At the Cleveland Clinic, our mitral valve repair mortality has been zero.

roullac: Dr Thomas, I had Mitral Valve Repair (sternotomy) in August 2009. (I was an asymptomatic patient). My valve is working fine so far (with only trace regurgitation). During my last routine check-up my cardiologist noticed something different. Still trace regurgitation and the valve is fine but there is Paradoxal movement of IVS (which is a normal finding after heart surgery he says). The echo has also shown that there is a collection of blood behind the posterior leaflets (again he feels that this is post surgery related). What is your view on that ? How serious could that be and what treatment would it be required if any? What could have caused the collection of blood behind the posterior leaflets? I am really worried and very anxious as I thought that everything would be o.k. and I would be able to get on with my life after heart surgery.

Dr__Soltesz: The method of repair can sometimes create what looks like thickening behind the leaflets or a collection of blood - but this is normal. Paradoxical movement is also normal. If your cardiologist is not worried - then you should not worry.

Tomlinsonsd: Does breast size impact or influence incision site or type of mitral valve repair surgery (i.e. robotic) used? I understand that the location of the incision made creates a direct path for the tools used for the repair that allows the patient's heart to remain in it's normal location reducing the manipulation of the normal heart location.

Dr__Soltesz: No - usually not. the incision for a robotic surgery is the same location as a mini right thoracotomy. It does allow visualization of the heart. We have other options depending on the patient. If they have breast implants - they sometimes need to be removed and replaced after the procedure. The incision is actually under the breast in the fold.

Imalucy2: How long is the average recovery time from valve replacement surgery w/ CABG ?

Dr__Thomas: 5 - 7 days in the hospital. and 4 - 6 weeks before you can drive.

lynn1112: What would the percentage of mitral regurgitation have to be in order for you to recommend surgery. I also have DCM ,class111 and an ej fraction of 15-20%

Dr__Thomas: There are no absolute percentages that we use to make this recommendation. In general, the poorer your LV function, the more sensitive you are to any degree of valvular regurgitation. Whether the risk of surgery outweighs the benefits need to be determined on a case by case basis.

Consuelo: consuelo - how can we prevent calcification ?

Dr__Soltesz: Previously studies looked at statins to lower the risk of structural valve deterioration but recently randomized studies disproved this. We really do not have any proven methods to prevent this wear and tear on the valve.

JPP: Of the cardiac surgeons at Cleveland Clinic are there those who specialize in aortic valve replacement and reconstruction of the ascending aorta?

Dr__Soltesz: We all do - this is a very standard operation at the Cleveland Clinic and is performed by all the heart surgeons here.

GoldieSk47: have asked this question of the company that manufactures Pradaxa a couple of times and am still not certain if it is an anticoagulant I should consider taking. They tell me it is not for valve patients--those that have had valve repair as it has not been tested on that patient category. If I had a double annuloplasty repair at the clinic in February and not have atrial fibrillation, am I a candidate for taking Pradaxa because of the A-fib? (The repair was a wonderful success and I feel great; tachycardia is now controlled successfully with Metroprolol.) Because of the emerging osteoporosis, I would like to switch to Pradaxa from Coumadin. Thank you for your feedback on this.

Dr__Thomas: This is a rapidly changing area for this newly approved drug, and it has not been thoroughly test in this setting. However, since the primary indication for the anticoagulation is the AF, this would seem to be a reasonable choice for you and your doctor to make. The details of your heart and valve function are important here.

Tomlinsonsd: How much time does a patient stay on the heart and lung machine for robotic mv repair surgery vs non robotic with all variables equal?

Dr__Soltesz: At experienced centers like Cleveland Clinic with extensive and on-going experience with robotic cases, there is no difference in cardiopulmonary bypass or cross-clamp time.

Tomlinsonsd: What complications can occur due to being on the heart and lung machine?

Dr__Soltesz: Cardiopulmonary bypass today is very safe. Complications that result are more a reflection of a patient's underlying medical conditions. For example, patients with extensive peripheral arterial disease are at higher risk for stroke during cardiac surgery; similarly, patients with renal impairment tend to be at higher risk for renal dysfunction. Complication rates are still very low, though, even in patients with significant co-morbidities.


Robotically Assisted and Minimally Invasive Valve Surgery

BobB: Do you have and are you using 'the Da Vinci Surgery' method yet and what is the success rate when replacing/repairing the Heart valves? I understand they are using this method in one of the Syracuse Hospitals at this time too.

Dr__Soltesz: We have a variety of minimally invasive surgical techniques for mitral, aortic and tricuspid valves for repair and replacement. For mitral and tricuspid valve repair and replacement we do use the DaVinci robot. We have a success rate of in excess of 98% at repairing valves that way with 0 mortality. If you are interested, please contact us and we can provide a surgical review.

hoffman72: Are there minimally invasive aortic valve replacement procedures available for younger individuals (38 yrs old)?

Dr__Soltesz: Yes - we perform min invasive aortic valve replacement as the standard. We require the fuller incision for more difficult cases. Patients derive a significant benefit for a mini invasive approach. There are techniques now in trials that are using a catheter to place a percutaneous valve but these are only reserved for the sickest and most unhealthy patients at this time.

Tomlinsonsd: What are the specific benefits and tradeoffs of use of robotics for mitral valve repair?

Dr__Soltesz: In patients who are candidates for it, it is certainly a fantastic option because it is truly mini invasive. It is as safe and effective as standard mv repair in the appropriate candidate.

Yvonne: I was told that the min invasive surgery means more time on bypass machine. Doctors around here would rather do the aortic replacement by breaking the chest. I feel that I would want the min invasive just want to know the facts

Dr__Soltesz: The standard minimally invasive aortic valve replacement involves a 6cm incision in the upper chest; the aortic valve can be easily replaced through a small incision in the breastbone. At the Cleveland Clinic, we consider this as the standard approach for all isolated aortic valve replacements (i.e., those valve replacements not needing other procedures such as bypasses).

Yvonne: where is the incision for min invasive in aortic valve replacement

Dr__Soltesz: It is a 6 cm incision in the upper sternum.

WB: Does "Da Vinci Surgery" (question from BobB) refer to percutaneous replacement of a heart valve, i.e. using a heart catheter procedure?

Dr__Thomas: No. Da Vinci Surgery uses a robot to assist a surgeon in repairing a valve. The catheter valve is entirely different (Transcutaneous Aortic Valve Insertion, TAVI), and is similar to stent implantation through the groin, just with an aortic prosthesis

Tomlinsonsd: What attributes could lead a surgeon to choose not to do robotic mv repair? Also, in the same vain what would lead a surgeon to not do minimally invasive mv repair?

Dr__Soltesz: Many factors go into the determination of whether a mitral valve repair can be approached robotically or even minimally invasively. For example, an extensively calcified mitral annulus may preclude robotic or even minimally invasive approaches.


Types and Choice of Valve Replacement

hoffman72: In a younger person, besides longevity of the mechanical valve, what other reasons would an individual choose that over tissue valve, considering they would have to be on anti-coagulants the remainder of their lives.

Dr__Thomas: That is the main reason why you would choose a mechanical valve to have less risk of having it replaced in the future. But it does carry the need of taking blood thinners.

Dr__Soltesz: It is a lifestyle issue. It will not overall impact your survival for either valve - but it does impact your need for anticoagulants for the mechanical valve vs. the need for replacement for the biological valves.

Henry: Four Questions: I am a 46 year old male that has a bicuspid valve that has become heavily calcified. I am an active person in sports (hockey, baseball, golf, and snowmobiling) and avid camper and fisherman. I am told that I will need my aortic valve replaced soon and am looking for your expertise on whether to replace with a mechanical or tissue. I am leaning towards a tissue valve because I don't want to be on blood thinners for the rest of my life.

Questions are:
1. which is the best tissue valve and it's life span? Are all tissue valve life spans similar?
2. what are the chances of having to stay on blood thinners, even I choose a tissue valve?
3. What are risks associated with a 2nd/3rd aortic valve replacement vs a mechanical valve and associated risks with blood thinners and blood clotting?
4. is there any progress being made of using an alternative to blood thinners with mechanical valves that would be less prone to blood clotting?

I believe that the mortality rate at the Cleveland Clinic is the best when completing aortic valve replacement......is this a true and if so, what is it? Is the risk greater for a 2nd/3rd aortic valve replacement? Thx Henry

Dr__Thomas: Many questions! Given your lifestyle, a bioprosthetic valve would likely be the best option, and you should get 10-15 years of service from it (though sometimes they deteriorate earlier). Risks of 2nd and 3rd operations are only marginally higher than 1st time unless there are other complicating factors (I’ll let the surgeons comment on specific risks). You would only need anticoagulation if you had atrial fibrillation or problems with clotting. There are new alternatives to Coumadin (Dabigatrin), though it is not yet approved for use in valve cases. Also, in a few years, we may be able to implant a percutaneous valve inside a deteriorating bioprosthetic valve. Hope this helps! I’d encourage you to come to the Cleveland Clinic to have a fuller discussion of your case.

Sept14: Hello, thanks so much for sharing your time and expertise. For a 35 year old male bicuspid aortic valve patient in need of valve replacement, could you please compare the risks involved with both valve types (mechanical and tissue). For example, if a mechanical valve is chosen, what is the risk per year of stroke and hemorrhage (assuming anti-coagulation therapy is under good control)? Does a tissue valve have a stroke risk as well? If the tissue valve route is chosen, what reoperation risk rates would you quote for a 2nd and 3rd surgery? For all these questions, please assume a patient in otherwise good health. I'm aware that there are many others factors that also go into the mechanical vs tissue decision, but just trying to get a good framework for evaluating risk over time with a mechanical valve versus reoperation risk with a tissue valve. Thanks for any guidance you can give.

Dr__Soltesz: This is a very complicated question.

Dr__Thomas: This depends so critically on so many factors. In a healthy patients - the risk of stroke or major bleeding is about 1% per year given the person doing normal activities. If you have a physically active lifestyle there may be increased risk of bleeding. Your particular circumstance would need to be evaluated to provide you with an answer.

Dr__Soltesz: The risk of bleeding and the risk of mortality of the bleeding over the lifetime, balances out with the risks of reoperation. You are actually weighing about at the same risk for both. For the situation you describe, the risk of redo aortic valve replacement would be less than 1 %.

Sept14: How do currently used tissue valve replacements compare to those used 20 years ago? Is any significant progress being made in improving overall longevity? Any predictions (no guarantees obviously) for the future, based on current studies?

Dr__Soltesz: Yes there is significant improvement in the tissue valves we presently use - mainly in the anti-calcification treatment that we use - this results in a presumed longer longevity of the valves. We will not have the data for another 25 years - but it appears very promising.

WB: What does "stented bioprosthesis" mean with reference to aortic valve replacement surgery?

Dr__Soltesz: It is a type of a valve. A stented bioprosthetic valve is the standard valve. A stent less valve is a type of valve that was popular several years ago but has fallen out of favor except for special circumstances.

Yvonne: When the onyx valve comes out of trials would you recommend that over a tissue valve?

Dr__Soltesz: At the present time, the trials have not been conclusive as to whether this valve requires full anticoagulation or not. Patients should make this decision based on that these patients will need anticoagulation through life.

WB: Could you please address the pros and cons of the different types of aortic replacement valves for someone undergoing aortic valve replacement surgery.

Dr__Thomas:
Mechanical valve:
Pro: most durable (though a significant percentage will still need redo surgery at some point in their lives).
Con: Need for life-long anticoagulation (AC)

Bioprosthetic valve:
Pro: good hemodynamics and no need (usually) for AC.
Con: need for redo surgery, though this is almost as safe as the first surgery

Homograft:
Pro: good hemodynamics and best choice in setting of complex infection.
Con: will likely need redo surgery, which can be more difficult than that for a bioprosthetic valve


Valve Repair

einstein: what are the advantages, disadvantages of aortic valve repair--as opposed to replacement? what are the criteria for repair? how long does repair last ? bill

Dr__Thomas: Repair is most often possible in patients with AR with little calcification in the valve. It is not as common as mitral valve repair and needs to be handled by a very experienced surgeon. The repair may last as long as 10 years or more.

Horace_P: How do you determine if a bicuspid aortic valve is suitable for repair? What is the success rate of repair on BAV, and percentage of reoperation?

Dr__Thomas: To some extent this determination can be made from the echo and is best if there is no calcification in the valve and there appears to be excessive valve tissue. However, the final determination can only be made at the time of surgery and depends critically on the skill of the surgeon.

Dr__Soltesz: Success rate of BAV repair is over 95 % but those are of patients who are ideal patients.

Tomlinsonsd: What does "success rate" mean? Does that mean repair vs. replacement and/or need for rehear within a certain amount of time?

Dr__Soltesz: Success of aortic regurgitation repair means the success of the repair at discharge. The long term success of the repair depends on many factors but it is well over 85% at 10 years. The 95% success quoted is success of patients leaving the hospital with a successful repair of the aortic valve. For the mitral valve, the success rate is far better -near 100%.


Percutaneous Heart Valve

Yvonne: Do you feel that the surgery that is being used for high risk, feeding the valve thru an artery, will be the way valve surgeries will be done in the future? If so, it is down the road several years?

Dr__Thomas: You must be talking about TAVI - it will be one of the ways we handle our sickest patients with aortic valve disease and in the future standard surgery will still be the best option for the majority of patients.

Dr__Soltesz: despite popular rumors, standard surgical replacement of the aortic valve carries a very low mortality rate - sometimes far less than 1%. This is better than many other non cardiac procedures. There is a lot of myth surrounding the risk of cardiac surgery. At this time we have very safe methods to repair or replace valves.

genodoc: Rush University of Chicago is in a Cobalt Chromium Valve clinical trial for percutaneous insertion. How is it stabilized, are you in the study? General use ? Ever for Aortic. Insufficiency?

Dr__Thomas: We will likely be involved in it and so far no percutaneous aortic valves have been studied for aortic insufficiency yet.

lynn1112: Is there a non invasive surgical repair of a heart valve available?

Dr__Soltesz: There are many different minimally invasive approaches to repair or replacement of various heart valves. At the Cleveland Clinic, we tailor the approach to each individual patient's situation.


Reoperation

Regina: My mom had open heart surgery in 1999 aortic valve replacement. A bovine valve was used. Now for her last two dr. appts the valve is narrowing and this time when we went it was considerably worse. Her bp is running in 120s to 130s over 80s. Is there anything that can be done for her. She is 87 and has had12 great years. What is normal life span for these valves.

Dr__Thomas: This is around the time that these valves tend to deteriorate. If she is otherwise in good shape and mentally alert, then she may be a candidate for repeat surgery. In addition, we are close to having the FDA approve new valves that can be implanted through a catheter. There have been a few cases where these valves have been implanted inside a deteriorating artificial valve. She would need to see a specialist to determine her eligibility.


Symptoms of Valve Disease

dukefan55: I am a 56 yo female with a bicuspid aortic valve with an area of 1.1cm.I've been experiencing alot of lightheadedness. Is this a symptom of my stenosis worsening?

Dr__Thomas: I would say it could be and it certainly needs to be evaluated with an echo and clinical exam. Normally a valve area of 1.1 square cm does not cause severe symptoms such as you are describing - so it may be related to other issues and you need to be carefully evaluated.

Clara: My mitral valve had changed to mild / moderate and the tricuspid is now mild / severe. I have had open heart surgery to replace the aortic valve and grafts 5 years ago. The last 2 years I have had 4 DES stents put in. I seem to have developed SOB. Could this be due to the valves changing?

Dr__Thomas: It could be from the valve changing, but it could be from many other things, including new coronary blockages, damage from prior heart attacks, and lung disease. It could also possibly be from constrictive pericarditis (thickening of the lining of the heart), which can occasionally occur after surgery. You need a thorough evaluation for this.


Diagnostic Tests and Follow Up

JMG9620: JMG: With an EF of 63% and an aortic insufficiency measured at 3+ would the “cardiac output” be equivalent to an ejection fraction of 33% in a heart with normal valves?

Dr__Thomas: No. With AR, the ventricle enlarges, so that 63% is actually pumping a larger volume than usual, and the net output is likely around normal.

JPP: 51 yr M, non smoker, not overweight, NBP. A few dizzy spells, had a cardiac echo. I was found to have a bicuspid aortic valve, moderate regurgitation, 4.8 ascending aortic dilitation, effacement of the sinotubular junction and a PFO. I am told this is all from a genetic process from birth. I have no symptoms like SOB or fatigue. I do get fleeting light headedness. Left ventricle upper limits of normal. Is it best and less risky to do surgery now without symptoms or heart enlargement? By waiting how great is my risk for dissection or rupture of the aorta? Could this genetic defect from birth have effects on other arteries, organs?

Dr__Thomas: We would need to know more to recommend you in particular. But certainly aortic size is getting close to the range of getting repaired. When one has a bicuspid aortic valve we recommend 5 cm for repair. You need to have this followed very closely - at least every 6 months with a CT scan and echo. As for the AR, this also needs careful evaluation to quantify the severity. We would be delighted to evaluate you at the Cleveland Clinic.

lynn1112: Does a "leaking" mitral valve have anything to do with the ejection fraction

Dr__Thomas: The biggest issue is that you may receive false reassurance by having a normal EF while much of that blood is being ejected backwards through the mitral valve. Your cardiologist needs to carefully evaluate your echo to assess the true pumping function of your heart.

Yvonne: do all bicuspids need to be replaced? I am 57 old female, with valve area of 1, ejection fraction of 55% and no symptoms of fatigue, or lightheadedness. I am being monitored...what is your opinion, hoping to hold this off as long as possible and let technology advance more

Dr__Thomas: It seems to me that you are being well managed and I agree that you can continue to monitor this situation with your doctor and await either the development of symptoms or more severe narrowing of your heart valve.

kent1954: At my last dr. visit I was at 2.75 out of 5 for aortic valve regurgitation. I have developed body swelling and stiffness. Could this be related to my valve? Thanks, Kathy

Dr__Thomas: These are not the typical symptoms of AR particularly since yours sounds to be in the moderate range. I would suggest a careful evaluation by your internist and cardiologist. JMG9620: JMG: If the mitral valve is a 1+, the aortic valve is a 3+, and the ejection fraction is measured at 63%, how does one calculate the “net blood volume flow” into the aorta? The cardiac output?

Dr__Thomas: Sounds like you should attend one of our echocardiography courses, as this is an excellent question. In the case of mixed aortic and mitral regurgitation, we would measure forward flow through the pulmonic valve, (Note that in this case, 1+ MR may be so small it can be ignored).


Valve Disease and Associated Medical Conditions

carol: Had a heart attack 4 yrs ago and ended up having to have mitral valve replaced. Previous to this I was told my mitral was leaking and needed to be watched.....have always wondered...which came first...my having a heart attack and that damaged valves even more. Or could the valve itself become so damaged that it caused the heart attack? Curious because at the same time I was also told my tricuspid valve needed to be watched and I just want to make sure I don't have a repeat of previous problems. Thanks for all you do at the Clinic!!

Dr__Thomas: Impossible to know from this information, but in general, it is hard for a leaky mitral valve to “cause a heart attack”, which occurs when a coronary artery becomes occluded. There are several different kinds of mitral regurgitation (MR), and it is possible that you had a leak from one cause (mitral valve prolapse, for example), but the heart attack caused some tethering of the mitral valve leading to more regurgitation. As for the tricuspid valve, regular follow-up seems the best approach for now.

dmf840: My mother, who's 78, has been diagnosed with Aortic Valve Stenosis and will be having valve replacement surgery sometime in the next couple of months. Additionally, her Cardiologist detected a thickening of the walls of her heart chamber which will also have to be addressed during the valve replacement surgery. This came to our attention during preparation for hip replacement surgery which is now postponed until the heart valve replacement surgery is performed. My question to you is, how long after open heart surgery can she have hip replacement surgery and when will we know she's ready?

Dr__Soltesz: There is not a hard and fast rule to this. We give patients typically 4 weeks after surgery for recovery for any additional major surgery - however again no rule.

Dr__Thomas: This sounds like purely elective surgery - so I would allow 4 - 6 weeks for recovery. If it needs to be sooner, this should be discussed with her doctors.

JMG9620: JMG: What effect does an increase in blood pressure have on AVI? Does it increase aortic valve insufficiency?

Dr__Thomas: Aortic insufficiency (AI) is caused by a hole or gap in the aortic valve. Increasing blood pressure causes more flow through this valve, so good BP control is important to reduce AI.

Elizabeth: Does having 3 mildly prolapsed valves contribute to SVT?

Dr__Thomas: There has been an assoc between MVP and arrhythmias but these also can occur coincidentally together.

rspence: I and a 35 y.o. woman and have a moderate mitral valve prolapse. Does this increase the risk of developing valve disease?

Dr__Thomas: There is an increased risk you may develop mitral regurgitation in the future but this is not certain. You need to have periodic cardiac exams with echocardiograms and stay alert for the development of symptoms like shortness of breath


Atrial Fibrillation

GoldieSk47: As a surgical patient at Cleveland Clinic in Feb. 2011 for annuloplasty repair of my mitral and tricuspid valves, I developed tachycardia and A-fib following surgery. A -fib requires me to take the anticoagulant Coumadin to prevent blood clots which could cause heart attack or stroke. At age 64, I have moved from having osteopenia to beginning osteoporosis and don't want to take the Fossamax-like drugs. As the use of Coumadin requires that I not ingest Vitamin K or greens (the major binder of Calcium in the bones), what other anticoagulant options do I have? Prescription Omega-3 Fatty Acids or what else? Thank you.

Dr__Thomas: This is a complex question that you need to speak to your physician about. There are possibilities of cardioverting or alternative coagulants to coumadin that may be appropriate. I can't comment on the calcium issues as that is not my field and suggest you speak to an endocrinologist or rheumatologist about this

DianaM_1: I had successful mitral valve repair Aug 2010 but have developed A Fib. & A flutter. Am taking Multaq & Pradaxa. Cardiologist wants to do ablation to stop the flutter, although he says I'll still have to take the drugs "forever." So, how would I benefit from having the ablation done?

Dr__Thomas: You may benefit from the ablation itself although your doctor has noted, this does not guarantee that you can get off your anticoagulation.


Valve Disease and Genetics

Sept14: I've seen a few isolated studies indicating that first degree relatives of bicuspid aortic valve patients with aortic aneurysms may be at heightened risk of aneurysm themselves, even if they don't have the bicuspid condition. Is an echo recommended for all first degree relatives, and assuming there is no initial evidence in a sibling, for example, how about rechecking in the future? Thanks.

Dr__Thomas: It is probably not an unreasonable recommendation. Having a relative with bicuspid aortic valve increases your risk about 10 fold of also having a bicuspid valve. There may be similar risks for the aortic dilation. it seems prudent to check an echo in early adulthood and perhaps every 10 years or so.

JPP: Can the genetic defect that will cause a bicuspid valve to form or to form a connective tissue disorder of the aorta have effects on other vessels, arteries, or organs?

Dr__Thomas: Generally the effects of this genetic change are confined from the aortic valve to the proximal descending aorta, but it is certainly possible that there may be some effects elsewhere, and a careful physical exam and appropriate testing may be reasonable


Infection, Endocarditis, Rheumatic Fever and Valve Disease

tractorgirl: I recently had a severely regurgitating mitral valve repaired, and have been informed of the importance of antibiotic prophylaxis for any invasive procedure (dental work, colonoscopy, etc) . Previously my dentist told me that prophylaxis for mitral valve disease had been downgraded and is no longer thought necessary. Is a repaired (valve at higher risk of infection and now properly functioning) valve at higher risk than a diseased unrepaired valve? If so, why?

Dr__Thomas: Both situations are at very low risk for infection. But - because the annuloplasty ring represents foreign tissue in the body - it is still recommended you take antibiotics before dental work for a period of time after surgery. The American Heart Association has detailed recommendations on this. Learn more about endocarditis at my.clevelandclinic.org/heart/disorders/valve/sbe.aspx.

orvilleor: what is the main therapy of rhuematic fever?

Dr__Soltesz: For acute rheumatic fever - we recommend penicillin and the long term ramifications are on a case by case basis because it can present itself in many ways. It would be treated like any other valve disease.

adamblog: What valve option do you prefer for aortic endocarditis? Does it vary depending on if it is active or not? native endo vs prosthetic endo? What if the infection has progressed beyond just the leaflets?

Dr__Soltesz: In Prosthetic valve endocarditis we would most likely recommend homograft valve replacement. For native valve endocarditis that only affects the leaflets, we would recommend valve replacement. There is also a chance of treatment with antibiotics. If there is extension of the endocarditis beyond the leaflets we would then recommend a homograft valve replacement. We have the largest experience in the country with endocarditis valve treatment and have had great success.


Cleveland_Clinic_Host: I'm sorry to say that our time is now over. Thank you again for taking the time to answer our questions about Heart Valve Disease.

Dr__Thomas: Thank you for having me today.

Dr__Soltesz: We will try to answer some additional questions off line.

Reviewed: 07/11


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