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MITRAL VALVE BLOG

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Aortic stenosis is a condition that is growing as the U.S. population grows. Right now, it is estimated that 2.5 million Americans over 75 suffer from this heart valve disease, which accounts for 12.4 percent of the population.  Between now and 2050, the elderly population will more than double to around 80 million.

Aortic stenosis affects men more often than women. In fact, 80 percent of adults with aortic stenosis are male. What is aortic stenosis exactly? With this condition, the aortic valve’s flaps (cusps) have thickened or become stiff and could possibly fuse together, which narrows the valve. The valve’s opening becomes narrowed and blocks/reduces blood flow from the heart into the aorta and to the rest of the body.

A person with aortic stenosis will experience the following symptoms: shortness of breath, heart murmur, dizziness, fainting, chest pain, chest tightness, irregular heartbeat, and swelling of the ankles and feet.

The disease is often misdiagnosed and undertreated. A severe case of aortic stenosis can be fatal; some doctors refer to the disease as a “silent killer.”  It is a progressive disorder, and the onset of the symptoms and progression will vary from patient to patient. As a person gets older, the aortic valve disease will continue to progress, regardless of what the patient does or doesn’t do.

Since nothing can reduce the progression of this disease, patients are instructed to visit their cardiologist annually, and have an echocardiogram to evaluate is the disease is becoming more severe.  Aortic stenosis has three progression stages: mild, moderate, and severe.  As stated earlier, a person can experience an array of different symptoms with this disease. If a person is experiencing symptoms, it is often a sign of a progression of the degenerative process, and the person should have the doctor assess them immediately.

If a person gets to the point in which he or she needs an aortic valve replacement, they have more options for surgery than ever before. These days, there are less invasive approaches to aortic valve replacement such as transcatheter aortic valve replacement (TAVR).  TAVR is good for people who have been diagnosed with severe aortic valve disease and are at an intermediate or high risk for open heart surgery. Most people who have this procedure are in their 70s or 80s. In this surgery the doctor inserts a catheter in a leg or chest and guides it to the heart. A replacement valve is inserted through the catheter up to the heart.

Do you suffer from aortic stenosis? If you need an aortic valve repair or an aortic valve replacement, Dr. Mikhail is a cardiac surgeon based in New Port Richey, Florida, who specializes in heart valve surgery. To book a consult, click here or call 727-312-4844.

 


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About two months ago, Dr. Mikhail began performing TAVR at his New Port Richey, FL location. For those of you suffering from aortic valve disease, we would like to share with you some basic information on this surgical procedure. TAVR stands for Transcatheter Aortic Valve Replacement and it is considered a revolutionary, and still relatively new, heart valve treatment. TAVR is an alternative to open-heart surgery, which means it is minimally invasive. This surgery is performed through a small catheter.

This procedure is recognized as a big advancement in modern medicine since open-heart surgery was developed in the 1950s. In the last several decades, many patients, especially the elderly, were unable to undergo open-heart surgery for their aortic valve disease because the surgery had too many risks. Because they were unable to receive the surgery, these patients would unfortunately end up dying from the disease. With TAVR, patients do not need a sternotomy (chest cracked open) and do not need to be placed on a heart-lung machine. TAVR isn’t considered such a high-risk operation, so more people are able to receive this treatment.

In TAVR, the doctor will insert a catheter in the leg or chest and guide it to the heart. The replacement aortic valve is inserted through the catheter into the heart. If the valve isn’t expanding on its own, a balloon is often used to expand the valve. After the valve is implanted, the doctor removes the catheter from the blood vessel. With TAVR, there are three different approaches. The doctor will decide which TAVR approach is a good match for you. The approaches are:

  1. Transfemoral Approach – This is done through an incision in the leg.
  2. Transapical Approach – This is done through an incision in the chest between the ribs.
  3. Transaortic Approach – This is done through an incision in the upper chest.

 

Since TAVR is still a new procedure, it is recommended mainly for those suffering from severe aortic valve disease but who are at high risk if undergoing open heart surgery. A cardiologist, cardiac surgeon and imaging specialist will determine if a patient is in the high-risk category and eligible for this type of surgery. Some factors that make a patient high risk include older age, previous heart surgeries, lung disease, and kidney disease.

TAVR is considered a relatively safe surgery, but as with any surgery it comes with risks, including death, stroke, valve leaks, kidney failure and vessel damage. These complications are rare, and as TAVR becomes more widely used, the complications continue to decrease.

TAVR patients, for the most part, leave the hospital within a week following the surgery. Many patients will be placed on a blood thinner following the procedure.

If you suffer from aortic valve disease and think you may be eligible for TAVR or want to know more about this surgery, call Dr. Mikhail’s office at 727-312-4844 or click here to book an appointment. Dr. Mikhail is a cardiac surgeon who treats patients with aortic valve disease in the New Port Richey, Tampa, and Clearwater areas.


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If you’re experiencing symptoms of heart disease, there’s a good chance you’ve gone to see your doctor. Chest pain, dizziness, and shortness of breath are all red flags that should send you to your doctor immediately. If a doctor hears anything alarming through a stethoscope, he or she will suggest you have some testing done to confirm if you have heart disease. You will also need to make an appointment with a cardiologist. One such test you will have to take is a stress test.

A stress test can help the doctors determine if you have heart disease.  One type of stress test, and the one most often used, is the exercise stress test.  During an exercise stress test, you will either walk on a treadmill or pedal a stationary bike. The doctor will use the test to track your electrocardiogram, heart rate and blood pressure.

What does this test do or show? An exercise stress test will show a few things to the doctor, including:

  • If enough blood is flowing to the heart during activity
  • If there are any abnormal heart rhythms
  • If the heart valves are functioning properly
  • If you have coronary heart disease
  • If your symptoms (chest pain, palpitations, dizziness) are being caused by a heart issue
  • If your heart medications are working (if you’re on any) and how

Before the test, you cannot eat or drink anything except water for four hours prior to the test, and cannot have caffeine for 12 hours before the test. There are also certain medications your doctor will tell you that you cannot take before the test, – your doctor will advise you.

Before you begin exercising on the test, an EKG will be done to take your heart rate at rest. After the EKG, you will begin exercising. The exercising will gradually get more difficult to get you exhausted. You will be asked throughout how you are feeling and if you’re experiencing any symptoms. The test lasts about 60 mins, but you’re only exercising around 10 minutes.

If you’re experiencing any of the symptoms mentioned above, it may be time to talk to your doctor and see if a stress test is a good idea. Depending on the test’s results, you’ll want to see a cardiologist. If you’re looking for a cardiac surgeon, Dr. Peter Mikhail specializes in mitral valve and aortic valve surgery. To book an appointment with him, click here or call 727-312-4844.

 


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Dr. Peter Mikhail is a thoracic and cardiac surgeon in Tampa, Clearwater, and New Port Richey, Florida. Dr. Mikhail is Board Certified by the American Board of Surgery, The American Board of Thoracic Surgery and The Royal College of Physicians and Surgeons of Canada.

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