Managing Severe Tricuspid Regurgitation After Mitral Valve Replacement: Options?

After mitral valve replacement, there is now severe tricuspid regurgitation. Is surgery necessary?

I am 40 years old.
In 2013, I underwent surgery for severe heart failure and had my mitral valve replaced with a bioprosthetic valve.
Since then, I have been regularly following up with my doctor.
In previous visits, pulmonary hypertension was noted, but I have not experienced any inconvenience in my daily life.
Recently, I have been experiencing severe chest pain and facial swelling.
After returning for an echocardiogram, my doctor suggested that I undergo tricuspid valve repair surgery.

Question 1: Is my body able to handle another surgery just three years after my last heart surgery?
Question 2: Since I have a bioprosthetic valve, will I need to have it replaced again in ten years?
Question 3: My doctor has prescribed diuretics for me to take whenever I experience swelling.
Will living this way have other effects on my body, such as on my aorta?
Question 4: If I choose not to have surgery now, can I wait until my mitral valve needs to be replaced to have the tricuspid valve repaired at the same time?
I am really worried, especially since my children are still young.
Hearing that I may need another surgery during my follow-up appointment was shocking, and I didn’t have the chance to ask my attending physician.
I sincerely seek your advice.
Thank you.

Wu Tou Cang Fei, 40~49 year old female. Ask Date: 2016/11/12

Dr. He Dongjin reply Cardiology

Hello, without more complete medical records, I cannot advise whether surgery is necessary.
I recommend scheduling a time to visit the outpatient clinic to discuss your condition with the physician.
Alternatively, obtaining a medical summary to discuss in person with a cardiac surgeon at a medical center would be advisable.
Changhua Hospital cares about you.

Reply Date: 2016/11/12

More Info

Managing severe tricuspid regurgitation after mitral valve replacement can be a complex issue, especially considering your medical history and current symptoms. Let's address your concerns one by one.

1. Surgical Feasibility After Recent Surgery: It is understandable to be apprehensive about undergoing another heart surgery just three years after your mitral valve replacement. However, the decision to proceed with tricuspid valve repair largely depends on the severity of your symptoms and the findings from your echocardiogram. If your tricuspid regurgitation is significant enough to cause symptoms such as chest pain and edema, surgery may be warranted despite the short interval since your last procedure. The heart can often tolerate multiple surgeries, especially if they are performed by experienced cardiac surgeons. Your overall health, the presence of pulmonary hypertension, and the functional status of your heart will also influence this decision.

2. Longevity of Bioprosthetic Valves: You mentioned that you received a bioprosthetic mitral valve. Bioprosthetic valves typically have a lifespan of about 10 to 15 years, depending on various factors including the patient's age, activity level, and overall health. After this period, it is common for these valves to calcify and become less effective, potentially necessitating a replacement. Your cardiologist will monitor your valve function regularly, and if you are asymptomatic, you may not need immediate intervention.

3. Long-term Use of Diuretics: Diuretics are commonly prescribed to manage fluid retention associated with heart failure and can help alleviate symptoms such as edema. However, long-term use of diuretics can lead to electrolyte imbalances, dehydration, and potential kidney issues. It is crucial to have regular follow-ups with your healthcare provider to monitor your kidney function and electrolyte levels, especially if you are relying on diuretics frequently. Your doctor may adjust the dosage or suggest alternative treatments if necessary.

4. Deferring Surgery: While it is technically possible to delay tricuspid valve surgery until the time of your next mitral valve replacement, this approach carries risks. If your tricuspid regurgitation is causing significant symptoms or leading to further complications, postponing surgery could worsen your condition. It is essential to weigh the risks of surgery against the potential deterioration of your heart function if left untreated. Discussing your concerns with your cardiologist will help you understand the best course of action tailored to your specific situation.

In conclusion, it is vital to maintain open communication with your healthcare team. They can provide personalized advice based on your echocardiogram results, overall health, and specific symptoms. It is also important to consider the emotional aspect of your situation, especially with young children at home. Seeking support from family, friends, or even counseling can help you cope with the stress of your medical condition and the decisions you face. Remember, you are not alone in this journey, and there are options available to manage your heart health effectively.

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