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Triple bypass surgery after a heart attack, developed tricuspid and mitral valve regurgitation, now has edema. Survival possibilities?

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Cardiologist, Interventional
Practicing since : 1996
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My wife had a heart attack in January 2011. She underwent triple bypass surgery and we thought everything was moving along fine. She has never regained her strength and we found out that she has tricuspid and mitral valve regurgitation, apparently not noticed during the triple bypass surgery. Doctors don’t seem to want to fix this problem even though she is experiencing edema in her abdomen and legs. She recently had 40 pounds of fluid removed using BUMEX. How long can she continue to have these leaking valves and live?
Posted Wed, 18 Apr 2012 in Valvular Heart Disease
Answered by Dr. Raja Sekhar Varma 14 hours later
Thank you for your query.

I have gone through the details that you have provided. Before I can give you a specific answer, I would like some clarifications from you.
1) What was the nature of the heart attack?
2) What treatment was given for the heart attack?
3) How long after the attack was the surgery done?
4) Can you upload a recent ECG to this website?
5) Can you tell me the findings on ECHO (all findings including measurements, Doppler values, etc)?

While mitral and tricuspid valve regurgitation can cause symptoms, so too can depression of cardiac ejection fraction as a result of the muscle damage sustained during the heart attack.

Diovan (Valsartan), Aldactone (spironolactone), Bumex (Bumetanide) and Toprol XL (Metoprolol) are all drugs that can improve the efficacy of the cardiac pumping and reduce the symptoms due to valve regurgitation.

Unless the degree of valvar regurgitation is extremely severe, it may not be advisable to consider a second major operation (a prosthetic valve is never equivalent to the natural valve and can have major complications).

The edema may also be secondary to depression of the muscular pumping function of the heart and the regurgitation may be secondary. In such cases, attention is to be paid to improving the cardiac function rather than the regurgitation per se.

I can give you a more specific reply after hearing from you.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Triple bypass surgery after a heart attack, developed tricuspid and mitral valve regurgitation, now has edema. Survival possibilities? 2 hours later
My wife was seen at an emergency room and was rushed to the local heart hospital where a XXXXXXX was performed. She had 90% blockage of the anterior descending coronary artery. She was rushed out of the XXXXXXX lab in to the operating room where the triple bypass was performed. She was in cardiac ICU for 9 days on the ventilator. A lung collapsed during surgery. No treatment was given for heart attack because she was operated on immediately. The echo shows about 40 percent ejection fraction but it did go down to around 15 percent. She continues to have fatigue problems. I only have the recent lab report to send.
Thank you
Answered by Dr. Raja Sekhar Varma 17 hours later
Thank you for the reply.

From the reports that you have given, it appears that CABG was performed on an emergency basis for the severe triple vessel disease in the patient with acute anterior wall myocardial infarction.

Since the ejection fraction has improved to 40% from a low of 15%, it appears that there has been considerable improvement.

Fatigue is due to the lower than normal ejection fraction. It is also possible that there may be some fatigue as a side effect of some of the medicines. However, the medicines that you have reported are absolutely essential for the improved function of the heart and cannot be stopped. You can discuss this with your treating physician and see if the doses can be titrated to achieve an improvement in the patient's symptoms.

It is not possible to comment any further on the valve regurgitation without the details of the echo report, the measured values and the estimates of the severity of the regurgitation.

Generally, intervention is needed only if the degree of regurgitation is very severe and is causing hemodynamic disturbances. Till such time, medical management will have to be continued. Some fatigue, breathing difficulty on exertion and palpitations may trouble her. Improvement in symptoms will occur with time, natural healing, optimization of drugs, appropriate diet, regular exercise and cardiac rehabilitation and physiotherapy. Your physician can direct you to specific cardiac rehabilitation programs available in your area.

I hope this answers your query. Feel free to get back to me for further clarifications.

Wish your wife a good health.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
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