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Includes Expert Content

72 year old: whether to go for Mitral valve replac...

My Dad is 72 years old. Doctor recommends "mitral valve" replacement. We are unable to...

Posted by AshSri

My Dad is 72 years old. Doctor recommends "mitral valve" replacement. We are unable to decide whether to go for an operation or live with it. I am adding diagnosis here.I would like to get your opinion on whether to go for surgery or not. I also have pictures taken in the lab. Dont know how to upload them.

Primary illness: MITRAL VALVE PROLAPSE SYNDROME WITH SEVER MR IN SINUS RHYTM NYHA CLASS III.
Coronory angiogram: Atherosclerotic coronary artery disease with non — critical lesions.
Recommendation: Mitral valve replacement / repair
Associated disease: systemic hypertension & COPD: Emphysema.

Paraseptal, centriacinar emphysematous changes noted in both lung fields. Emphysematous bulla noted in subpleural region of posterior segment of right upper lobe. Coronary artery calcification noted. Mile thickening of lower part of the right side major fissure. Minimal fibrotic stands noted in basal segment of bilateral lower lobe. Subcentimeter right paratracheal and pretracheal lympnodes noted. No evidence of pulmonary collapse. No evidence of bronchiectasis / cavitation. Mediatinal position and contents including the trachea and its bifurcation, thoratic aorta, the main pulmonary artery and its branches appear normal. No bony destruction seen.

Both adrenal glands are normal. No abnormal soft tissue nodule / mass lesions seen. Visualized sections of liver and spleen normal. Paraseptal , centriacinar emphysematous changes noted in both lung fields.

COLOR DOPPLER ECHOCARDIOGRAPHIC REPORT:
Arotic value: AO:33.1mm. LA:39.9mm
Ventricular function: IVSd:12.7mm EDV:133.38ml, PWd:10.2mm ESV:39.21ml LVIDd:52.7mm EF:70.60% LVIDs:31.4mm FS:40.32%
Doppler paramters:
Mitral velocity (cm/s) : E 97, A 94, pulmonary 88cm/s aortic 148cm/s
Left ventiricle : normal LV systolic function. No Regional wall motion abnormalities.
Right ventricle: Normal right ventricle size and function.
Pericardium : normal
Mitral value prolaspse: Marked prolapse of both leaflet. SAM: nil. PML motion: normal. Thickening: nil, Clacification: Nil.
Aortic valve: thickening sclerosis. Flutter : nil, begetation: nil. Calcification: nil.
Pulmonary value : flutter : nil. Vegetation : nil.
Tricuspid valve: Thickening: normal. Flutter: nil.
Valve Regurgitation: mitral : mild. Aortic: trivial. Ricuspid: nil. Puilmonary: Nil.
Comment: No regional wall motion abnormalities. Normal LV systolic function. Marked prolapse of both leaflets.

Lab results:
BP: 140, Pulse : 76/mt . CVS: PSM (+)
ECHO: MVT syndrome, eccentric posterior wall hugging Grade II + MR present.
WBC count: 11900 cells/mm3. Neutrophil: 88%, lymphocyte:9%, eosinophil:3%, haemoglobin: 13.4gm% packed cell vol:44% blood esr:10mm fall at 30min,20mm fall at 60 min, RBC: 4.9mil/mm3, mcv:89.8fl mch:27,3pg, MCHC:30.5% Platelet count: 2.9 lakhs/mm3. Blood urea:30mg serum creatine: 12.mg%. NEE serum: clear Serum colestrol:183mg% . triglycerides:83 mg% HDL:42mg% non-hdl: 141mg% ldl:124%, VLDL:17mg% TC/HDL:17mg% TC/HDL:4.4

Medication given: Amifru 1/2, telma 40mg -1, strovas 10mg -1, serobid rotacaps 2 puffs twice daily.View Thread

Posted byAshSri

7 Replies | Reply | Watch This DiscussionReport This| Share this:72 year old: whether to go for Mitral valve replacement? My Dad is 72 years old. Doctor recommends "mitral valve" replacement. We are unable to...

Includes Expert Content

Reply: 72 year old: whether to go for Mitral valve replac...

Dr, I heard this morning that my "young dad" is walking and drinking juice . Looks like he...

Posted by AshSri

7 Replies | Reply | Watch This DiscussionReport This| Share this:72 year old: whether to go for Mitral valve replacement? Dr, I heard this morning that my "young dad" is walking and drinking juice . Looks like he...

Includes Expert Content

Reply: 72 year old: whether to go for Mitral valve replac...

Doctors operated my dad's heart on 10/8/12. He is in ICU still. Will be transferred out of...

Posted by AshSri

7 Replies | Reply | Watch This DiscussionReport This| Share this:72 year old: whether to go for Mitral valve replacement? Doctors operated my dad's heart on 10/8/12. He is in ICU still. Will be transferred out of...

Includes Expert Content

Reply: 72 year old: whether to go for Mitral valve replac...

Thanks Doctor. One question though. When you say "significant mitral regurgitation", are you...

Posted by AshSri

7 Replies | Reply | Watch This DiscussionReport This| Share this:72 year old: whether to go for Mitral valve replacement? Thanks Doctor. One question though. When you say "significant mitral regurgitation", are you...

Includes Expert Content

Reply: 72 year old: whether to go for Mitral valve replac...

His health is normal. He is still walking, going to the Bank, doing house hold work, helping...

Posted by AshSri

His health is normal. He is still walking, going to the Bank, doing house hold work, helping my mom etc. As of today, he is still active. During the past 12 months, three times, he blanked out completely and collapsed. Within few minutes he woke up and started his normal activities. After continuous 30 minutes of work, he gaps for 5 to 10 minutes. After that he seems to be OK. His dad had angina.

He worked on passenger diesel train engine for nearly 30 years. He is exposed to pollution and diesel smoke. He was a smoker too. He has occasional breathing trouble. He says, he is unable to walk for long distance and can't carry more than few 2 Kgs of weight.

Test report of "Helical plain CT study of the chest with HRCT study of the lungs" says:

-paraseptal centriacinar emphysematous changes noted in both lung fields.
-Emphysematous bulla noted in subpleural region of posterior segment of right upper lobe.
- mild thickening of lower part of right side major fissure.
- minimal fibrotic stands noted in basal segment of bilateral lower lobe.

Echocardiogrphic reports says:

- marked prolapse of both leaflets
- no regional wall motion abnormalities
- normal LV systolic function.
- Mild mital regurgitation
- no pulmonary hypertension
- no pericardial effusion
- aortic valve selerosis No AS / AR Trivial

Conclusion of full report says:
- COPD,
- systemic hypertension,
- dypsonea on exertion since 6 months,
- occasional angina and PND,
- serial ECGs : normal
- ECHO: MVPS, mild MR (diagonstic services)
- CVS; ESM
- CXR: Emphysema
- TMT: positive due to angina. Had hypertension on TMT.
- Echo rechecked: MVPS; ecentric post posterior wall hugging grade II MR.

======
Doctor recommends MVR (assuming MVR is Mitral Valve Replacement) to be done. He says, only when the heart is opened up, he will know the status and recommends presence of plumonologist. He says, lungs can't be revived and only medicines can help. Oxygen supply is weak and calcification is present in the lungs.

I really appreciate your opinion. All I am ( he is) looking for is his last peaceful days, that's where we are stuck and unable to take decisions.View Thread

Posted byAshSri

7 Replies | Reply | Watch This DiscussionReport This| Share this:72 year old: whether to go for Mitral valve replacement? His health is normal. He is still walking, going to the Bank, doing house hold work, helping...

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