My Wife's Bovine Pericardial Aortic Valve has only lasted 8 years!

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On the morning of Friday 14th March 2014 I had to call the Emergency Ambulance Service because my wife, Natalie, had a seizure at home.

No Warning.

The day started as normal without any warning of what was to come.

On returning home from the weekly trip to the local Sainsburys supermarket we put the shopping away and relaxed whilst we drank our mid-morning mug of milky coffee. After our drink we went upstairs to put a few toiletries away.

We were in the bedroom when Natalie said: “I feel dizzy, I think I'll sit on the bed for a minute.” As I turned to leave the room suddenly she suffered what seemed to be a seizure.

Her body went rigid; her back arched; her head tilted back; her mouth opened; her arms went stiff, stretched out at a forty-five degrees angle to her body; her eyes went blank and staring; she was moaning; she was having difficulty breathing; she was unresponsive. In a controlled panic I called 999.

Accident & Emergency.

After about five minutes, and at the same times as the LIVES (Lincolnshire Integrated Voluntary EmergencyService) volunteer arrived, Natalie started to return to some degree of lucidity. Within less than two more minutes the paramedic manned ambulance arrived.

She was quickly connected to an ECG(Electrocardiogram) machine to monitor her heart rhythm. Although the reading showed a regular heart beat the medics decided she needed to be taken to the Accident and Emergency department of Lincoln CountyHospital for further tests. Following her admission she had more ECG s, a blood test, an X-ray, and a CT (Computerised Tomography) scan of her head, in case she had suffered a stroke or fit with possible damage to her brain. The result of the scan was clear.

Inpatient.

The Doctor decided that as the cause of the seizure was not apparent, and because he could also hear a loud heart murmur, Natalie was admitted to the MEAU (Medical Emergency Assessment Unit) ward for further observation and tests.

The following morning (Saturday) the duty Consultant visited Natalie and reviewed the various test results available. He was of the opinion that the seizure type incident was probably an extreme reaction to a faint due to an insufficient flow of blood and oxygen to the brain. He was concerned about the loud murmur coming from her prosthetic aortic valve and therefore ordered an Echocardiogram (An ultrasound scan used to obtain a detailed image of the heart). This can often detect abnormalities with the shape and movement of the heart's valves.

The test was carried out on Sunday morning using a portable, therefore limited, machine as this was the quickest option. The preliminary results indicated that the valve is not opening correctly. A further test was requested on the main, more sophisticated, larger ECG machine so as to get better indications as to what is happening with the valve.

Natalie was transferred from the MEAU to a surgical ward at 22:00 hrs. on Sunday night.

The 'Echo' test was repeated on Tuesday morning. It confirmed that the artificial valve is not functioning correctly. It is not fully opening so the blood flow from the ventricle into the aorta artery is restricted. There was also concern that there could be some back-flow of blood into the heart chamber.

The Cardiologist, looking after Natalie, wanted her transferred to the Cardiac Unit ward as soon as possible, to make it easier to monitor her condition. She was moved on Wednesday evening.

Coronary Angiogram.

She was informed that it was necessary for a Coronary Angiogram (a type of X-ray that uses a special dye which helps the blood vessels of the heart show up clearly on an X-ray scan) to be carried out to ascertain the overall condition of her heart and arteries. The procedure was carried out during the morning of Friday 21st March, a week after her admission into hospital.

The results confirmed our worst fears. The Bovine Pericardial Aortic Valve (the Perimount Magna 3000 model, manufactured by Carpentier-Edwards), fitted in January 2006, has failed. It is suspected to be due to SVD (Structural Valve Deterioration). This could be as a result of calcification of the three leaves of the valve, or a tear in one of them.

She is suffering with severe aortic-stenosis (the valve opening is narrowed and obstructing a normal blood-flow through it) and severe aortic-regurgitation (the valve is leaking and a substantial quantity of blood is flowing back through it into the left ventricle) as the valve is neither opening or closing properly.

Open Heart Surgery.

The only remedial treatment is open heart surgery to replace the faulty prosthesis. A repeat of the operation Natalie went through just eight years ago.

The Consultant Cardiologist in Lincoln has sent a priority request to the Trent Cardiac Centre at Nottingham City Hospital for an operation. A report has been sent to the Cardiac Surgeon who carried out the first replacement operation. There is some surprise and concern as to the short period of time of the effective working of the current bovine-valve. The advice we were given in January 2006 was that we could anticipate a longevity of the bioprothesis of fifteen years, possibly more.

What of the future.

Natalie is to remain in hospital until the essential operation is undertaken because the severity of the valve malfunction requires constant monitoring of her heart's status. When will the surgery take place?

Not only does she have the fear of the outcome of another operation but she also has the worry as to which type of valve to have fitted this time. Should she choose a mechanical valve or another stented bioprothesis? Will she have a choice or will the decision be made by the surgeon based on the condition of the aortic root connection to her heart, as this will be the second Aortic valve replacement?

Follow-up article: Transfer to the Trent Cardiac Centre

© Elliot Sampford 2014