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“Do Asymptomatic Patients Really Need Heart Valve Surgery?” with Dr. Richard Lee

By Adam Pick on January 27, 2012

Following our last post about watchful waiting for patients with moderate heart valve disease, I received several emails from asymptomatic patients. While each email was unique, most patients were curious to know if patients without symptoms should undergo heart valve repair and heart valve replacement procedures — for conditions including aortic stenosis and mitral regurgitation.

Luckily, during my recent tour of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital in Chicago, I was fortunate to discuss this topic with Dr. Richard Lee, an associate professor of cardiac surgery. The video below contains the highlights of our discussion. (For the hearing impaired members of our community, I have provided a written transcript of this video below.)

Thanks to Dr. Richard Lee for taking the time to share his clinical expertise with our community. To learn more about Dr. Lee, please click here.

Keep on tickin!
Adam

P.S. Here is the transcript to my discussion with Dr. Lee:

Adam: “Hi everybody, it’s Adam, and we are answering your questions that were put up at HeartValveBlog.com. Today, I’m thrilled to be at the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital in Chicago, Illinois. I’m with Dr. Richard Lee, a cardiac surgeon here, and we’ve got just a great question for Dr. Lee, and I hear it all the time. And the question is: Adam, I feel great. I don’t have any symptoms, but I’m being told that I need to have heart valve surgery. Do I really need surgery if I’m asymptomatic?”

Dr. Richard Lee: “Well the answer is, it depends. But, I’d say the first thing you need to do is talk to your family members. So many times, we see this all the time, where there is a husband and he comes in and he says he doesn’t have any problems, and his wife says wait a second, you get short of breath now much more than you did before. So I’d start with really taking a thorough history and physical, and seeing if there are symptoms or not. But even if there are no symptoms, sometimes the answer is still yes. There are different conditions of the heart, as you know. There is four different valves, and the valves can either be tight or leaky, and there are really three conditions, of those valves, that probably merit consideration for operating on asymptomatic patients.

The first one is mitral regurgitation, that’s a leaky heart valve on the left side of the heart. If you have a leaky in valve on the left side, mitral regurgitation, the answer is yes. Even if you are asymptomatic, you should get a heart operation. And why is that? Well we know from many studies that if you don’t fix that problem early on, you’ll get worse and worse and worse and actually have, not only symptoms, but a lower survival. If you fix the problem before those other problems occur, and prevent those larger problems, you’re survival is just the same as yours or mine. So, for mitral regurgitation, if you go to a center, with a very low operative mortality, and a very high repair rate, meaning keeping your own valve and just fixing it, then you definitely should get repaired for asymptomatic mitral regurgitation.
For some of the other conditions, like aortic stenosis, we know if you have a tight out valve on the left side, more and more data are emerging suggesting that if you don’t take care of that problem, even when you don’t have symptoms, you will have symptoms. You will go on to need an operation or it will cause you some harm. So, I think over time, we support that, if that valve is causing problems, we should at least watch it very closely and maybe down the road, even if they’re asymptomatic, getting that taken care of. We also know if you have a tight valve, out valve, on the left side, at the time of regular cardiac surgery, it needs to be replaced. To learn more about aortic stenosis, click here.
And the last condition is tricuspid insufficiency. It’s the in valve on the right side of the heart. Well, if you’re asymptomatic, you shouldn’t go to the operating room, just for that. But more data is suggestion that if you have a leaky in valve and you’re going to heart surgery for another reason, you probably should get that fixed as well. Because we know it probably doesn’t go away when you correct the other problems, and we know that if you don’t take care of it, at the time of surgery, it’s much harder and patients do much worse. So those are really the three main conditions that patients should consider surgery for, if they don’t have any symptoms. For all the rest of the valve problems, really probably very close monitoring with your cardiologist is a better route.”

Adam: “Great, well Dr. Lee thanks so much for answering our question and all of the great clinical work you are doing here at Northwestern. We really appreciate it.”

Dr. Lee: “My pleasure.”

Written by Adam Pick
- Patient & Website Founder

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Bob Kropfli says on January 27th, 2012 at 4:14 pm

Dr. Lee described my situation exactly. As a 69 year old male I had been closely monitoring my bicuspid aortic valve for decades. It was slowly deteriorating and constricting, but it always seemed that surgical intervention was a few years away. I had no symptoms whatsoever. I had exercised vigorously all my life with long bike rides, skiing and hiking until, at the end of a strenous bike ride a year and a half ago, I passed out on the bike. Strangely enough, I felt pretty good just a few days afterward so somehow the heart compensates even though it might have a serious defect. I did get the message loud and clear, though, and three weeks later I had a new bovine aortic valve. Now, fully recovered, I do everything I did before surgery and am so glad to have it all behind me.

Rakesh Pandey says on January 27th, 2012 at 10:16 pm

Thanks Sir, for your valuable suggestions.

Rakesh Pandey says on January 27th, 2012 at 10:17 pm

We all really love to here new things regarding the heart

George Trevor says on January 27th, 2012 at 11:53 pm

I could not agree more with Dr. Lee. Persons saying they are asymptomatic are many time just not willing to admit what is really happening. As has been said many times, it is human nature to ignore that river in Egypt. I was diagnosed with moderate aortic stenosis at 52 from a bicuspid value. We did the standard monitoring and in 2009 Cardiologist said let’s do the echos every six months and think about doing an angiogram. I pushed it out and ignored his advice — just thought I was getting old when I had to catch my breath during rigorous activity. Fact was I was symptomatic for at least a year before my surgery in February 2010. Thank you Dr. Guadiani and his team at CPMC in San Francisco. Doing great now –skiing and biking and don’t get short of breath. Its called denial folks and we all do it.

Claudia says on February 6th, 2012 at 11:24 am

How did you decide on the tissue valve versus a mechanical valve?

stephani8769 says on May 25th, 2017 at 1:08 pm

I have mild mitral valve regurgitation and moderate aortic valve regurgitation. I do have symptoms. I am out of breath when I lay down or when I do anything physical. Even walking from room to another. I am extremely tired. I am dizzy and lightheaded when I do any physical activity. My pulse races and I can feel it beating in my head when I do any physical activity. I am 48 years old and female. Can this be helped?

Aquarama says on January 8th, 2019 at 4:59 pm

I have moderately severe, class 3+ mitral valve regurgitation and the left atrial cavity is severely dilated.I have not been referred for surgery or medication. I am asymptomatic. I just finished a seven mile bicycle ride with 300 feet of climbing and I feel fine. I fear that this dilation is further damaging my atrium and would have deleterious effects even if I had surgery some day.