Dear Ask The Doctor: My original aortic valve was bicuspid and early last year became infected and caused the valve to fail. The valve was replaced with a bovine tissue valve in April of 2009. My recovery was considered normal. This past week I went to the emergency room complaining pain in my left chest area when I took a deep breath. After I was admitted to the hospital several test were run including x-Ray, EKG, CAT scan, Echocardiogram and Transesophageal Echocardiogram. The diagnosis was Pericarditis. During the explanation of the diagnosis my cardiologist mentioned that the test showed that the pressures in my aortic ventricle are higher than normal. This high pressure was due to my newly installed heart valve, it is too small. Yes bells and buzzers should have gone off at the time but they did not. The ER doctor also mentioned that I had a higher than normal white blood cell count. I was prescribed Naprosyn twice a day and then sent home with a return visit in 60 days. After 24 hours of taking the medication the pain does seem to be subsiding. The cardiologist would like to watch it for a period of time. He did acknowledge that replacement is the only fix. He and i need to have a talk soon, but before i do i need to learn more. What are the implications of having to high a pressure in the aortic ventricle? What question should I be asking the doctor? Am I correct in assuming that the valve will not become smaller after use and the replacement valve was incorrectly selected?
Dear Patient: Having a high pressure in the left ventricle may result in thickening of the heart muscle (left ventricular hypertrophy) and symptoms such as shortness of breath. However this depends on how high the pressure is in the left ventricle, and this is one of the questions you should ask your cardiologist. The size of the prosthetic aortic valve is based on your body surface area and calculated at the time of your surgery. Severe aortic mismatch is rare, however can happen. I would ask your cardiologist the degree of mismatch between the prosthetic valve and your heart, the left ventricular pressures and whether they are elevated (mild/moderate/severe is usually a good description of the degree of elevation), what are the predicted short and long term implications and what is the future plan in terms of whether any further intervention is required at this time and finally what the follow up requirements are in terms of future echocardiograms.