Re: Symptomless leaky heart valve more dangerous than previously thought
From: Howard Homler (howardhomler_at_netscape.net)
Date: 03/06/05
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Date: Sun, 06 Mar 2005 12:31:39 -0800
On 3 Mar 2005 08:45:03 -0800, "MrPepper11" <MrPepper11@go.com> wrote:
>Associated Press / March 3, 2005
>Study urges timely surgery for symptomless leaky heart valve
>
>People with severely leaky heart valves that cause no symptoms, a
>situation thought to be relatively harmless, actually are in danger of
>dying and should consider surgery to get the problem fixed right away,
>a new study suggests.
>
>Such people are five times more likely to die of a heart problem or
>develop heart failure or an irregular heartbeat than those with mild
>leakage, researchers at the Mayo Clinic reported in today's New England
>Journal of Medicine.
>
>Their study involved the mitral valve, which connects the upper left
>chamber with the heart's main pumping chamber. If the valve's two flaps
>don't close tightly, blood can leak back into the upper chamber when
>the heart contracts.
>
>Most people don't feel anything, but if it gets worse, they can develop
>shortness of breath, fatigue, dizziness, and palpitations.
>
>Doctors can detect the condition by listening to the heart, but usually
>don't recommend surgery to repair or replace the valve unless it causes
>symptoms or damages the heart itself.
>
>The Mayo researchers used a relatively new ultrasound technique to take
>measurements of the hearts of 456 patients who had leaky valves but no
>symptoms. They found that the size of the hole in the valve was the
>strongest predictor of how the patient would fare. Without surgery,
>those with bigger holes, about the width of a pencil, did the worst.
>
>"When it's severe, it's fixable. And we can determine when it's severe
>now with new techniques," said Dr. Maurice Enriquez-Sarano, who led the
>study.
>
>Of the estimated 2.7 million Americans with notable leakage, about
>600,000 are probably candidates for early surgery, Enriquez-Sarano
>said.
>
>Study participants were enrolled between 1991 and 2000. All had leaky
>heart valves without symptoms and no other heart problems. Their
>disorder was classified mild, moderate, or severe based on the volume
>of their leakage and the size of the valve hole.
>
>Participants were monitored and treated independently by their own
>physicians. Updated information on the patients was collected by the
>researchers in 2002.
>
>Their findings showed that age, diabetes, and the valve hole were
>strong predictors of survival.
>
>Catherine Otto, of the University of Washington in Seattle, said the
>study is a big step forward, because physicians can use the measurement
>to tell patients what to expect if they have a valve problem. But she
>said the measurements are challenging to make, and the data apply only
>to those without any other heart problem.
I've read their article and spoken with cardiologists about it, too.
I've got many patients with significant mitral valve regurgitation who
have not had (or wanted) surgery and they've been doing great. I
think that these results should be kept in an appropriate context of a
facility that serves as a referral point for selected cases. I would
not jump on the bandwagon for surgery in asymptomatic people with
mitral regurgitation without seeing data from many other cities and
universities. H2
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