Mitral valve repair

[masonje]

I wanted to relay my situation on the forum partly to hear from others who have had valve repairs or other types of open heart surgery but also it is simply therapeutic to discuss it.

A little background first. I am 40 years of age and in excellent health. I have rowed since 1984 and continue to be highly competitive. My most recent best 2K was a 6:36 at the St. Louis Indoor Rowing Championships and was actually the best overall time including the junior and collegiate categories. It's obviously not a blazing fast time, but I was pretty happy with it and was (and still am) hoping to improve on it. My main focus is the single scull but I love the erg both for training and to compete in indoor rowing. My most recent victories in the single were the Head of the Hooch and the Masters regionals in Indianapolis last summer. I was thrilled about this summer's racing season when I learned that I had to have my mitral valve repaired. By the way, the mitral valve is in between the left atrium and the left ventricle(the main pumping chamber).

I had no history of heart trouble whatsoever until Octer of 2005 when I had an episode of atrial fibrillation(AKA irregular heartbeat) that was converted back to normal sinus rhythm within a few hours after one dose of an oral antiarrythmic medication. I had an echocardiogram (ultrasound of the heart) to try to sort why I went into A fib and I had mitral valve prolapse with, at that time, moderate mitral regurgitation. I was completely without symptoms and my cardiologist cleared me to resume rowing but advised no heavy weightlifting. She also wanted a follow up echo in 6 months.

Since then, my lack of any symptoms continued and I was victorious at the Hooch and our local indoor regatta. Then I had my follow up echo in early May and I now have severe mitral regurgitation. Untreated, this will lead to heart failure within a few years and I would probably not live 5 years. This needs to be repaired and will be done next Friday (May 26) here in St. Louis.

I find this situation interesting (as well as obviously frightening) on a number of levels:

-I am otherwise in excellent health and am without symptoms not just at rest but while rowing! The evening prior to my echo I did 2 ten minute pieces in my single and felt spectacular.

-I am also a general surgeon and while cardiac surgery is not my specialty, during my residency I spent several months caring for cardiac surgery patients in the intensive care unit. This experience amazed me in that many patients of advanced age and with numerous medical problems absolutely sailed through heart surgery. This leaves me with great confidence that I should do fine. I also know, however , that sometimes things go wrong with no explanation. The human heart was not designed to be opened and repaired and when this is done, sometimes the unexpected happens.

Anyway, my goals are to:
1) Survive
2) Get back to work
3) Row again, hopefully at a competitive level. My cardiologist and heart surgeon both say that once I recover I can row as much as I want. My internet searches don't reveal many people who have had valve surgery and then continued to compete at at high level, either in rowing or other endurance sports. If anyone has a story to share either about themselves or someone they know, I would love to hear it.

[RowtheRockies]

John,

Wow for someone as fit and strong as you are (6:36 seems blazing fast to me!) this must be something very difficult to come to terms with. Your excellent fitness going into the surgery should make the chances of a complete and successful recovery very high. As you said there are a lot of very unfit and older folks that come through it very well.

It seem to me that there are a couple of posters on here that I have seen that have had open heart surgery of some form so hopefully they will chime in. I wish you the best of luck this Friday and please do let us know how you are doing and progressing. My thoughts are with you!

Rich

[Bob S.]

If anyone has a story to share either about themselves or someone they know, I would love to hear it.

John,

I was in the middle of a reply to your post and suddenly it disappeared from the screen. It was already supposed to be a brief summary, but I take it as a sign that I should be even more concise.

In a nutshell, I had a couple of age/wt class WRs a decade ago, but dropped out of competition, having slowed down as a result of stenosis of my aortic valve. In July of 2003, a porcine tissue replacement was installed along with 3 bypasses. Eighteen months later I reentered competition and qualified for a trip to the Crash-B, where I won another hammer (2/2005). By December, I had been selected to be on the USIRT and competed at the EIRC, setting a new M LWT 80-84 WR. In February, I broke the HWT record as well, and became the first octogenarian to go sub 8’ in an official competition.

If you are interested in more details, please send me a PM.

Regards,

Bob Spenger

[masonje]

If anyone has a story to share either about themselves or someone they know, I would love to hear it.

John,

I was in the middle of a reply to your post and suddenly it disappeared from the screen. It was already supposed to be a brief summary, but I take it as a sign that I should be even more concise.

In a nutshell, I had a couple of age/wt class WRs a decade ago, but dropped out of competition, having slowed down as a result of stenosis of my aortic valve. In July of 2003, a porcine tissue replacement was installed along with 3 bypasses. Eighteen months later I reentered competition and qualified for a trip to the Crash-B, where I won another hammer (2/2005). By December, I had been selected to be on the USIRT and competed at the EIRC, setting a new M LWT 80-84 WR. In February, I broke the HWT record as well, and became the first octogenarian to go sub 8’ in an official competition.

If you are interested in more details, please send me a PM.

Regards,

Bob Spenger

Thanks, Bob. Your story is certainly an inspirational one and very nice to hear as I'm getting ready for this. It's one thing to be told by my docs that I can exercise again but I don't think they understand the demands of rowing and my addiction to competition and performing at a high level. I not so concerned about the safety of vigorous exercise but rather my ability to return to competitive form. I'm actually quite optimistic that I will be able to and hearing your story only assures me further. Thanks again.

John

[DavidA]

My father had quintuple by-pass surgery, and 4 months later we were biking across the country. While that is biking fast, it is very strenuous, day after day, and he didn't have any trouble.

David

[Cole]

I am 38 years old and was in awesome physical condition. I used to run marathons and competed in the Eco challenge in 96'. In June of 04 I came down with a terrible infection that clogged up my sinuses and came out my nose and on to my face like an out of control cold sore. I went in and was put on antibiotics and cleared it up but at the follow up a murmur was detected. My ejection fraction went from 85% to 65% in a matter of weeks so I had to do the repair. I had mitral valve repair done last year, Jan 05 and I am in the military. Within a couple of months I was back to conducting Physical training and parachuting. I had a very small stroke two days after being released and was put on blood thinners for a couple of months. I still have some chest pains but have been checked out thouroughly and was told that it takes a while for the sternum/nerves to heal. I just had a tooth pulled and developed a dry socket and would rather go through surgery than that. Mentally the dry socket will do. I am still in the military and am heading to alaska in june to continue my career. You will be fine.

Cole

[masonje]

Thanks for your reply, Cole. It's certainly good to hear from another "youngster " who has gone through this.

A brief update of my situation. I had a cardiac catheterization Friday to check my coronary arteries and also my right heart pressures. Because I am 40 and having my valve repaired, my surgeon wanted to assess my coronaries and, thankfully, they are pristine.

The right heart pressures are fine (a good thing) implying the leaking mitral valve is recent and no pulmonary hypertension has developed. I also have a moderately leaking tricuspid valve that will be repaired at the time of my mitral repair.

Surgery is this Friday (may 26) and I will have the two valves repaired as well as a Maze procedure to prevent future atrial fibrillation. I will plan on chronicling my recovery here with the goal of getting back to (eventually) competitive rowing.

[Alissa]

John,

My very best wishes for you on Friday, and as you recover. I look forward to hearing your "reports"!

Alissa

[LJWagner]

I had minor mitral valve regurgitation from an infection 4 years ago, that caused severe shortness of breath and some chest pain. Cardiologist thought it minor, so with rest it got better and I went back to light training after four months. How you could work out at your level with mitral regurgitation, in my experience, is amazing. I discovered it walking stairs. I used to walk 54 flights in 15 minutes twice a day effortlessly. Suddenly I had pain and short of breath. Of course it could be you aggravated it with your training regimen. My GP friend said do more warm-ups.

March 2005 I had a strained mitral valve, determined by stress echocardioram. Doctors said ignore it, but I could hardly breath the first two weeks. A General Practioner and Weight Lifting author I know recommended 3-4 months off then resume training gradually. I did and it worked out well. I was not in your kind of condition, but I was doing very well until last December. 10:30's on 3x2K twice a week being careful to control my HR. Of course it could be you (we) aggravated the mitral valve with your training regimen. My GP friend said do more warm-ups.


Suddenly, big chest pain walking any slight hills, then from less and less activity. I had two coronary arteries 99% blocked, a 3rd 80% in many locations determined by angiogram. Triple bypass the next day. The DOCTORS were scared for me. My exercise over many decades gave me unusual secondary circulation for my heart. You no doubt may also have that.

You are incredibly fit, so once healed, won't really notice a bit. I went back to work after two months, and I'm less fit than you are. The first week after surgery will be pretty uncomfortable; you won't want to breath full in your chest, laugh, cough or sneeze without your clutch pillow. But a few weeks in, you'll feel pretty good, and be able to do most of the same things within 4 months. I just did a 9:30 2k the other night, and had not done that in years (I should be training harder, I know). I'm 53.

[masonje]

I came home from the hospital yesterday and am doing well, although I am pretty wiped out. They were able to repair my mitral valve without replacement which is great news as I avoid long term anticoagulation and the heart functions better with it's own valve. Things went as smoothly as they could have but I hope I don't have to go through this again.

As far as my rehab, I will begin a walking program over the next 6 weeks and I can row again 8 weeks post op. I am not sure when I will compete again and I have many hurdles to clear before that's even a consideration. At the same time, the thought of competition helps keep me motivated and inspired through this recovery.

I greatly appreciate the thoughts and kind words of all who posted. I will continue to document my rehab.

[RowtheRockies]

masonje,

That's great news! Glad everything went well. Please do keep us updated on your progress.

Rich

[masonje]

I had minor mitral valve regurgitation from an infection 4 years ago, that caused severe shortness of breath and some chest pain. Cardiologist thought it minor, so with rest it got better and I went back to light training after four months. How you could work out at your level with mitral regurgitation, in my experience, is amazing. I discovered it walking stairs. I used to walk 54 flights in 15 minutes twice a day effortlessly. Suddenly I had pain and short of breath. Of course it could be you aggravated it with your training regimen. My GP friend said do more warm-ups.

March 2005 I had a strained mitral valve, determined by stress echocardioram. Doctors said ignore it, but I could hardly breath the first two weeks. A General Practioner and Weight Lifting author I know recommended 3-4 months off then resume training gradually. I did and it worked out well. I was not in your kind of condition, but I was doing very well until last December. 10:30's on 3x2K twice a week being careful to control my HR. Of course it could be you (we) aggravated the mitral valve with your training regimen. My GP friend said do more warm-ups.


Suddenly, big chest pain walking any slight hills, then from less and less activity. I had two coronary arteries 99% blocked, a 3rd 80% in many locations determined by angiogram. Triple bypass the next day. The DOCTORS were scared for me. My exercise over many decades gave me unusual secondary circulation for my heart. You no doubt may also have that.

You are incredibly fit, so once healed, won't really notice a bit. I went back to work after two months, and I'm less fit than you are. The first week after surgery will be pretty uncomfortable; you won't want to breath full in your chest, laugh, cough or sneeze without your clutch pillow. But a few weeks in, you'll feel pretty good, and be able to do most of the same things within 4 months. I just did a 9:30 2k the other night, and had not done that in years (I should be training harder, I know). I'm 53.

Thanks for your story. As far as mitral regurgitation and exercise my heart surgeon and cardiologist (both experts at their field with years of experience at Washington University in St. Louis) felt that aerobic exercise was fine even preoperatively but strongly urged avoiding heavy weightlifting. Heavy weight lifting dramatically raises blood pressure and can severely worsen MR at least transiently. I have queried numerous cardiologists and heart surgeons and aerobic exercise (even vigorous) should be fine once the healing has completed from mitral valve repair. I'm not sure about your comments about warming up. While I am a firm believer in a good warmup, I'm not sure that lack of warming up would worsen MR. Nor do I believe my training worsened it. At least in my case, this was a congenitally abnormal valve that finally had a portion give out. I hope the repair lasts awhile...

[LJWagner]

My doctor friend, across the country, believes lack of warm-up causes the little valve operating muscles to be less well prepared for heavy pumping duty and valve closing under high pressure. Do it too much, and a strain can occur. My strain happened during an action movie. They make my heart pound. Did it again Sunday, too. Hit 147 HR, and I had numb fingers on one hand for two days.

I see my cardiologist Thursday, and will ask him about that Dr. El-Hewie's theory on that.

At any rate, I can do far more 4 months after bypass and my home rehab of the strained valve than I was doing before the bypass. When you start breathing really hard during exercise, you are not meeting oxygen demand, in the heart as well possibly. With two valve incidents, I remember the uncontrolled rapid breathing too well.

I also wear my HR monitor while lifting weights. The hr shoots up faster with more weight, but does adapt over the weeks when I work gradually at low to moderate poundages. I now set the audio alarm to 145, and spend most of the time below that. A set is a group of reps until the alarm sounds for a few seconds. Many people when lifting weights don't breath in a regular pattern and hold their breath a lot. That is the major problem in raising the blood pressure.

As aggressively competitive as you describe yourself, this amateur with a similar problem continues to say do throough warm-ups. For me, any sense of hard breathing is a stern warning that I'm not really ready.

Mind you, on my last hard 2K, I did the last minute at an hr of 173, and was in control of my breathing. So I am not babying the workouts too much, considering I had the old chest cracked in January, and a strain the year before.

I always do a good 10 minute or so warm-up on the erg, first few minutes at 40-45% HRR, then going up another 5% each minute until I am around 135-140, which is 70% HRR for me.

I've also gotten to where I can tell my BP is high or low by the force of the pressure of the beats against my fingers. When it up, it is quite a pounding. BP can also be raised by dehydration, or heavy sweating, so a glass of water and a break will ease it down some.

[SlugButt]

Thanks to all for sharing experience and for your extremely informative comments. I've recently learned I have some mitral valve leakage. Aside from being careful to warm up and avoiding heavy wieghts (I almost never do them anyway), are folks aware of other factors or cautions I might want to keep in mind?

David

[LJWagner]

My first leakage was from an infection so the leaflets were fat and like three basketballs together, with a gap between them. Second time was the mitral valve strain,and the leaflets just stood open under any exertion. Each time my doctors said there was nothing to do for them since they were not major problems.

It was just really uncomfortable to do anything and be gasping for breath. So I took it easy, and as I felt better, started a rehab program.

Knowing my training habits the last 40 years, I think my doctor friend is right. The heart is really tough, and tolerates incredible abuse by athletes. I'm curious as to the statistics of athletes vs. non-athletes with MR.