Physical limitations with Leaky Valve

PS- I can’t tolerate nitroglycerin because I get migraines.

Whoops, sorry, I think that nitroglycerin comment ended up in the wrong place.

I’m a 75 year old guy who just had a stress echo that revealed a +4 mitral valve prolapse. The ventricals are normal in size and the ejection factor is 64%. I’m supposed to meet with a cardiologist soon but I was wondering if anyone has any experience with mitral valve repair surgery, conventional or robotic, or if they decided the MitaClip instead. Comments and suggestions welcome.
Lou

I can learn a lot from you, @susanejw. Thank you for your comment.

I am going to look a bit at discussions and see what I can find. In the meantime, if you haven’t already you can go to the box at the top of Connect home page and type words you want to search for. Also, here are resources I found:
- Mayo Clinic CMD treatment: https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/expanding-the-possibilities-of-treatment-options-for-patients-with-coronary-microvascular-disease/mac-20581614
- Small Vessel Disease Summary: https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/diagnosis-treatment/drc-20352123
- American Heart Association CMD Overview: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd

I have never heard of labile high blood pressure. This is the 2nd time in a couple of days. Would you check out this discussion https://connect.mayoclinic.org/discussion/labile-hypertension-how-to-improve-it/

I am interested to learn what you find out. I love you questions and will learn, myself. Will you come back and comment? Hopefully, @ficklefinn will have an update about pushing activity levels as well.

@neronel
I had mitral valve repair (minimally invasive, where the surgeon goes between the ribs rather than a sternotomy) about a year and a half ago when I was 69. The surgeon tried to also place a clip, but wasn't able to do so. The mitral valve repair was successful and I haven't had any problems and up to full physical activity - hiked 10 miles yesterday with 2,000' of elevation gain.
All the best!

@aard
Thank you for the information. Can you tell the degree of your prolapse, like +3 or +4? Also, were you diagnosed after a stress echo (treadmill)? What made you decide on the minimally invasive surgery?
Thanks,
Lou

I don't remember precisely, but I think it was in the +3 range. Diagnosis was not after a stress echo, but I had been getting echo-cardiograms on a yearly basis because of the prolapse to see if things were getting worse; they had been monitoring this for a few years after my EP heard a heart murmur (i.e., the leaky valve). The main reason to go with the mitral valve repair was because my afib, which had been controlled after my ablation, was popping up again. Mitral valve prolapse can cause afib.
Minimally invasive surgery was the decision of my cardio-thoracic surgeon. If it wasn't something he thought could be done with minimally invasive surgery, the alternative would have been a thoracotomy. Minimally invasive is apparently a bit more painful, but heals more quickly.
The only potential drawback was maybe not being able to place the mitral clip; he may have been able to do that if he did a thoracotomy, but that's speculation on my part.
If you do have the surgery, I would highly recommend getting into a cardiac rehab program afterwards; it will really help to figure out what you can and cannot do and get you back on your feet.

@aard ....oops, that should be "the alternative would have been a sternotomy," not thoracotomy.

@neronel, I had a mitral valve prolapse with severe regurgitation. I had no symptoms, other than a heart murmur, when I was examined for carpal tunnel syndrome.
One cardiologist told me to call him when I started getting short of breath, but a different cardiologist told me there were better outcomes when people had surgery before they went into Congestive Heart Failure. I took his advice and had open heart surgery, a repair, with a ring. I think I also had a Mitraclip. I was 69 at the time. I was in the hospital for two weeks after surgery with some complications, but I'm glad I had it done when I did.

@jlharsh Thank you for the links! I had already read some, but the hour-glass-shaped stent idea from the Mayo Clinic was new to me. Sounds promising, but I don’t really want to rush into another surgery, and I’ll have to see if the procedure is even done in this country yet. But it’s good to know about.
I don’t really see how it works, actually, because it’s still a constriction. But if it works to alleviate angina somehow, that’s great.
About @ficklefinn ’s questions, I should have also told you both that my cardiologist didn’t give me any advice about traveling in the Sierras. I just went by how I felt. At 6,000 feet I could walk a couple miles, same as normal, and at 10,000 I had to return to the car and ask that we descend before hiking. That was in 2023, before my coronary microvascular dysfunction had kicked in, which probably would have made it worse.