The Heart of the Matter

As I mentioned in my last video post, the appointment with my cardiologist on Friday went very well. The news was great and I was told that my heart was in perfect condition.  This all took place after I had an echo to see the progress my heart has made.

 If you have not had an echo before, I will fill you in on a secret, they take some time and if you are like me, the best way to kill time is by chatting it up.  My echo technician and I had a great conversation about my valve and after discussing my blog with her, she pointed me in the direction of some reference materials to learn more about it!  Our conversation revealed that prosthetic valves, bio-prosthetic valves in particular, are quite complex and there are many options out there.

The entire conversation was sparked when she pointed out that my new mitral valve had three leaflets instead of the two in normal mitral valves.  I did not expect there to be such a difference in the valves.  As we continued discussing the new addition to my heart I realized the complexities that go into creating a bio-prosthetic mitral valve and into the decision process as there are many different types to choose from.

Since our discussion I have followed her advice and looked a bit deeper into the world of prosthetic heart valves and while it did take the use of a scientific dictionary, I learned lots that I will share here!

Firstly, there are many different models of bio-prosthetic valves each varying in size, material, leaflet number, etc.  These factors play into the varying sizes of their hosts and their hosts hearts, as well as blood flow (if you decide to research yourself, this is a simplified definition of hemodynamics) age, ability to use coumadin and the list goes on.    One diagram I found intriguing and helpful with relation to the types of valves shows different models of valves and the materials that go into them.  It is provided by the American Heart Association's website: http://circ.ahajournals.org/content/119/7/1034/F1.expansion.html and inserted below:

As per the website above: 

"A, Bileaflet mechanical valve (St Jude); B, monoleaflet mechanical valve (Medtronic Hall); C, caged ball valve (Starr-Edwards); D, stented porcine bioprosthesis (Medtronic Mosaic); E, stented pericardial bioprosthesis (Carpentier-Edwards Magna); F, stentless porcine bioprosthesis (Medtronic Freestyle); G, percutaneous bioprosthesis expanded over a balloon (Edwards Sapien); H, self-expandable percutaneous bioprosthesis (CoreValve)."

My valve is made from the cows heart (it is a bovine valve).  Interestingly, it is made from tissue of the cows heart, but not its actual valve, unlike the porcine valve which comes from a pigs aortic valve. The companies that create these prosthesis use the biological materials and enhance them with man made features including stents and special coatings which ensure the longevity and strong function of the valves.

The surgeon and his team analyze the options for each patient, increasing the chances for a successful replacement. Thrombogenicty (blood clots caused by the new valve) and PPM (prosthesis patient mismatch) are two of the main concerns when choosing a valve, and the person must fit well with the choice in order to decrease these risks.  Because of our amazing doctors and the incredible advances in technology, this is something managed very well today and should not be a major worry.

If you are interested in learning more about bio-prosthetic heart valves, I recommend the following websites which were able to provide helpful information to me as I researched this topic:

• http://emedicine.medscape.com/article/1971075-overview#aw2aab6b3  (A general overview, with different  bioprosthetic valve production companies referenced)
• http://circ.ahajournals.org/content/119/7/1034.full#sec-1 (An overview of the different types of prosthetic heart valves)
• http://circ.ahajournals.org/content/119/7/1034/F1.expansion.html (A helpful chart included above)