Pulmonary Valve Replacement

As most of my readers know by now, I am awaiting a pulmonary valve replacement surgery in the next 3-5 years. Naturally, I myself am curious of all the ins and outs of such a procedure. Being that I never knew or imagined I would need another surgery up until two years ago, I have never thought to study the surgical procedure. I've spent my life studying the heart and my conditions and all of my defects but never have I ever considered to delve into the details of valve replacement surgeries.

In my case, at this point in time, I will be needing a pulmoary valve replacement. Possibly later down the road I will also need a tricuspid valve replacement.

I do not currently have a pulmonic valve. I have a stent in which the blood flows through to the lungs.
 My tricuspid valve is ruptured and does not open and close.
Therefore, I have a significant amount of regurgitation of blood in my heart. This makes my heart have to pump so very much harder to force that blood through the valves since the valves themselves do not push it as they should with the opening and closing mechanisms. This has also caused my entire right side of my heart to enlarge significantly.

I also have a repaired atrial septal defect for the record but that is neither here nor there for the intents and purposes of this blog.

What I have learned in my last visit on the academic level of my condition in regards to the pulmonic valve are several interesting and informative pieces of material.

** It is uncommon to have a pulmonic valve replacement in adults with the exception of patients like myself with congenital defects of said valve.

** There are several options in valves to be chosen for replacement and the selection of the one I get is contingent upon several factors such as my age, anatomy of my heart, and the prognosis of my condition.
       a.) Biological Valves: These valves are engineered from tissues of either bovine, swine,        equestrian, and human heart. These are ideal for 20 somethings and child bearing age. This is not as durable as a mechanical valve, however; blood thinners are not needed for these such materials. These valves usually last 10-15 years before needing to be replaced.
   
       b.) Mechanical Valves: These valves are engineered from synthetic materials like plastic or    metal. These valves will require long time anti-coagulation methods such as taking warfarin. This is to ensure that blood does not clot within the workings of the valve and flows well and safely through the valve. They are much more durable and have a longer lifespan than tissue valves.

As I was last told, I am currently a better candidate for a tissue valve at this time. This is contingent, again, on my anatomy and my age and my vivaciousness. This will be determined though when the time does come.

I however, was told two years ago when this all initiated, that there is a transcatheter biological valve made of bovine material by Medtronic called the, "Melody Valve." At this time, I am not a "perfect" candidate for this valve, though I did not inquire as to why. Oh but I do pray for a transcatheter valve replacement versus a sternotomy incision.

picture: "Melody Valve"

If Eric and I (God willing) have a baby before the surgery is needed, I will obviously have a baby without a man-made valve and will have my own God given...nothing?? Haha! I don't have one!! (Gotta have a sense of humor!) Therefore, I would quite likely have the surgery sometime in the very near future after having a baby and would quite likely be given a Mechanical valve. But again, that will be decided upon all factors considered when necessary. This also likely means that if Eric and I were to wait to have a baby after surgery, I would have a man-made valve in my heart. This would quite likely be a Biological valve as I would still be in my 20's and child bearing age. It is not the best option to have a baby after surgery. Experiencing a pregnancy is hard on every woman. My conditions present greater risks for me and my baby. Therefore, it is better to put the strain in my un-repaired heart. It will help to make my future repaired valve more sustainable and strong to have a baby before a repair. However, if God does something miraculous and crazy and has us have another baby after the repair, I will trust in His plans and not worry! I will not worry anyway. He has always had this planned. He already knows it all and I just need to sit back and wait and trust.

The surgery can also be performed through minor incisions, but it may also be done through a sternotomy. Again, this is one of the details that will be decided based on what valve we choose as well as my anatomical factors. I am praying for minor incisions as my scar on my chest has already been cut open three times. It is very sensitive and at times painful. But if I am raw and honest, just as much as the discomfort bothers me, I also do not want to have a thicker, darker scar along my chest. I know this is vain. I have to remind myself this is a beautiful mark God gave me to symbolize His glory, His healing, and His miracles. I know that trumps it all!

I am attaching a link to those interested of an open heart method to this procedure of a 25 year old woman. She has Tetrology of Fallot. This is different than my condition.I have Epstein's Anomaly, Pulmonary Atresia, and an Atrial Septal Defect. But the idea is much the same.  Follow the link below to see:

https://www.youtube.com/watch?v=oPoCslAHFK8#action=share
Figures in the video first appeared in the article "Adult Congenital Pulmonary Valve Replacement: A Simple, Effective, and Reproducible Technique" (Congenital Heart Disease, 2: 314–318. doi: 10.1111/j.1747-0803.2007.00118.x) John Wiley and Sons hold the copyright.

I do ask that if you are a prayer warrior you pray for Eric and I. I want you to pray that God would be glorified through this time and through these happenings and conditions. I will deal with this the rest of my life. This gives me an amazing opportunity to share Christ all throughout my life as He heals me and uplifts me with peace that only comes from above. And please pray for my sweet Eric's heart as his is so much stronger than mine for loving me so well with all of these challenges. God is Savior!! He is Savior!!

Love, Emily Gladden :)