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Question:
Should I seek a second opinion about my endocarditis and valve disease?
I recently had endocarditis. Although I had no known heart conditions before becoming ill and am otherwise healthy, echocardiograms now show that I have moderate to severe mitral valve regurgitation, mild tricuspid regurgitation, a moderate-sized vegetation on my mitral valve, and moderate pulmonary hypertension. A stress test was normal. The heart surgeon has said I will need a mitral valve replacement but wants to wait until I am 60 so he can use a tissue valve rather than a mechanical valve. He says regulating the coumadin necessary with mechanical valves is tricky. I'm now 56. I have two questions: 1) should I wait or seek a second opinion, and 2) is anybody researching techniques which might lead to repair of valves damaged from endocarditis?
submitted by Ellen from Ohio on 11/13/09
Answer:
by Texas Heart Institute cardiovascular surgeon, Joseph S. Coselli, MD
By in large, the problem you described concerning your mitral valve necessitates operative intervention, sooner rather than later. I do not believe that it would be in your best interest to wait 4 years until you are 60. It is true that if you have your mitral valve replaced with a mechanical valve you will have to take Coumadin. Many people have to take Coumadin for other reasons and since I'm uncertain of your entire medical history, you may have or will develop one of those complications regardless. Consequently, to answer your question about waiting or seeking a second opinion, I would suggest you seek a second opinion.
Concerning repair of damaged mitral valves for endocarditis, in many cases when endocarditis affects only a portion of the mitral valve, even if there is vegetation, it is still repairable. The benefit of this is that you won't have to take Coumadin and generally, it's definitive. There is a greater incidence of mitral valve replacement in patients with endocarditis and the situation you described than there is mitral valve repair. All of the above assumes that your endocarditis has been cleared; you no longer have active infection and are off antibiotics.
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Updated November 2009
