Too-tight heart valve needs replacement


DEAR DR. DONOHUE: I am 71 and have had aortic stenosis for 10 years. I have echocardiograms every year. I do not take medicines. 1. What echocardiogram measurements evaluate this condition? 2. What changes require valve replacement? 3. What amount of change is a normal rate of progression? 4. At what measurement is the problem considered dangerous? 5. Does a heart attack occur? 6. Is valve replacement similar to bypass surgery? 7. What valves are better, and what is their lifespan? — P.P.

ANSWER: Two weeks ago, I answered a question on leaking aortic valves. Your problem involves the same valve but a different process. Your valve is closing up — narrowing, stenosing. The heart has to beat with more force to get blood through the narrowed valve. The heart enlarges to produce enough pressure to accomplish that feat. With the passage of time, enlargement can’t compensate, and the heart fails. Death comes as a result of heart failure and not a heart attack. Or it can come from abnormal heart rhythms (question 5).

Symptoms indicate the severity of the narrowing. You have none. That’s a good sign. Serious symptoms are chest pain (angina) when active, shortness of breath on exertion and fainting spells. The echocardiogram at that stage shows an area of the aortic valve less than 1 centimeter squared. A normal aortic valve has an area of 3 to 4 square centimeters (questions 1, 2 and 4). That’s the time for valve replacement (question 2). On average, a stenotic valve narrows by 0.1 centimeter squared every year (question 3).

Valve replacement is similar to bypass surgery only in the approach to the heart. In bypass surgery, clogged heart arteries are replaced with grafts to re-establish blood flow to the heart muscle. The surgery takes place on the heart’s surface. In valve surgery, the heart is opened to expose the valve. The narrowed valve is removed and a new one is installed (question 6). Two kinds of heart valves are used — biologic or mechanical. Biologic valves are ones taken from pigs, cows or human cadavers. Mechanical valves are made from metallic alloys and plastics. Mechanical valves last longer, but they encourage clot formation, so they require anticoagulation (blood thinners). Biologic valves don’t require anticoagulation. Around 50 percent of them have to be replaced in 15 years, but newer materials are extending their life. These valves are used in older people (question 7).

The booklet on valvular heart disease explains the function and problems of the four heart valves. To order a copy, write: Dr. Donohue — No. 105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I read your article on canker sores hoping you would discuss Behcet’s disease. My daughter suffered for two long and painful years and went from doctor to doctor searching for treatment. Eventually we found a doctor who diagnosed Behcet’s disease. Please let your readers know about it. — R.R.

ANSWER: The distinctive signs of Behcet’s (buh-SETS) disease are painful oral ulcers that occur singly or in crops. The sores look like canker sores. Frequently, patients suffer similar genital sores. Eye inflammation is a third sign. Drugs that calm inflammation and rein in the immune system can contain the terrible pain of Behcet’s. This illness is something that should be considered in people with recurrent and persistent canker sores.

DEAR DR. DONOHUE: What is your evaluation of tattoos? Why is there no mention of removal? — R.T.

ANSWER: Tattoos are not my cup of tea, but I know many people who find them desirable. I also know quite a few who regret their decision to decorate themselves with tattoos. People should investigate the cleanliness of a tattoo parlor so they won’t end up with a tattoo and an infection. Lasers can get rid of tattoos. Different wavelengths are used for different colors. Black and blue are more easily removed than yellow and orange — a piece of information I just picked up.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from