“Are Pleural Effusions Common After Heart Valve Surgery?” Asks Jan

I too, experienced a pleural effusion after mechanical valve replacement.. My surgeons colleaque would come in the morning and tell me I was not using the spirometer enough and they were worried about pneumonia.. about 5 days after surgery, they finally called in a lung specialist and after a quick ultrasound, pronounced I had fluid on the lung. It turned out to be blood, not water.. over 1 liter had completely collapsed my left lung. He stated it was a fairly rare event that would not repeat and thus far he is correct. Once they drained the blood, I could finally breath a decent breath in the sprirometer.

I had fluid building up in my abdomen to the point of bloating, taught skin, and discomfort. They put me on a mild duretic and the problem subsided.

Hi, I had descending aortic valve and aneurysm repair on December 2, 2008 at the Cleveland Clinic. I returned to my home in Arizona and was feeling great upon my return, but shortly after New Years, I developed extreme pain in my left shoulder and under my rib cage. I could not get up from my recliner and no matter what I did the pain would not go away. I awoke at 3 a.m. thinking I was having a heart attack. I immediately called for help and was taken to the hospital near my home, It was determined that I had pleural effusion and the new cardiologist attending me wanted to drain the fluid. I explained that the fluid was around my heart when I was discharged from the Cleveland Clinic. I also asked that they call and request my surgical history. The cardiologiist in Cleveland told the cardiologist in Arizona what type of medication to place me on, which is normally given to Gout Patients but which also helped me to got rid of the fluid fairly quick. I felt 100% better within just a few days. I can surely understand how scared pleural effusion is to a patient and caregiver, but as it was mentioned by Adam, it’s very common after heart surgery and usually goes away by itself.

I developed both pleural effusion and effusion around the heart. Both were drained and I felt much better.

One week after surgery to replace my aortic valve, I developed cardiac tamponade. A pericardial procedure was done to drain over a liter of fluid from around my heart. My understanding is that an effusion can develop into tamponade. I remember doing a lot of breathing treatments and other excercises to keep fluid from building up on my lungs.

I too had a left pleural effusion after about 10 days. I had been recovering very well and it was like I had hit the wall. I had 800ml drained to no effect and diuretics which also did nothing. After a frustrating week I saw my surgeon who said I should ignore the previous advice to take things easy and really push the exercise until I was well out of breath – it cleared up within a few days!

My experience was very similar to one of your other responders. I had aortic valve replacement (bovine) on a Tuesday morning. In recovery the doctor explained that they almost had to take me back to surgery for excessive bleeding. After a transfusion they finally got the bleeding to stop. On Wednesday they gave me another transfusion. They were concerned that I still required some oxygen by Saturday night so a pulmonary doctor did a sonogram and said my right lung was collapsed due to fluid. He did a thoracentesis and removed 1 liter of blood. I was off all oxygen by the next afternoon and discharged on Monday.

I also experienced a pleural effusion after mitral valve replacement in July or 2000. I was readmitted to the hospital, a drainage tube inserted and stayed for a week while draining litre upon litre of fluid. The fluid added 35 to 40 pounds of very uncomfortabel weight. Fortunately I left the hospital and my cardiologist took over my care and eliminated that problem along with other complications. This is the first I’ve heard that this is pretty common after the surgery. I have aortic stenosis now and hope I will not need another replacement. Isn’t there some way to prevent the chance of a pleural effusion?

4 weeks after my triple bypass on sept 1 they removed a quart from my chest cavity. thinking I had pneumonia they kept me in hospital for three days and then sent me home. they tried to culture the fluid but no bacteria materialized. for three days they loaded me with cypro anf other anibiotics. the thirty something doctor was convinced I had pneumonia no matter the lab results. I was saved by my cardiologist who intervened and basically told the other doctor that this was normal for heart patients. it has been a month sice this happened and the fever has not returned and I have a small amount of fluid around my left lung. I was told this may or may not go away.

I had a bovine aortic replacement at the Cleveland Clinic on October 30,2009 and returned to my home in Florida about 1 week later. I developed a severe cough and was hospitalized for a large pleural effusion and underwent a thorosentesis which drained about 1 liter of fluid with blood, Between mid November and mid Dec. I had 2 more pleural effusions which were draided on an out patient basis. Each procedure drained less and I have had no further prolems with this since De. I was told that pleural effussions are commom post aortic replacement and occurs at some level in >60% of patients. I was told that this hyper fluid response is caused by the lungs being deflated during the surgery and can sometimes recur up to 1 year post surgery.

I was just reviewing my medical records from surgery to repair my mitral valve two months ago. I was startled to see a report of “bilateral pleural effusion” and a bit relieved that it appears to be somewhat common after heart surgery. I have no symptoms that seem to be consistent with pleural effusion, but will follow up with my cardiologist to make sure that this is nothing that I need to have monitored.

I had aortic valve relacement surgery in November, 2008. Surgery and recovery were successful and quite uneventful EXCEPT for recurring pleural effusion and 3 thorocentesis (drainage) procedures. I have significant shortness of breath upon stair-climbing, walking any distance or exerting most physical activity. Pulmonologist is still trying to come up with some beneficial treatment. A definite downer that no one mentions PRIOR to surgery.

Hi Adam
I’m experiencing pleural effusion of about 550 cc’s or 1 pint of fluid. I believe it showed up on day 3 after surgery and included the right chest pain and nagging cough. I was slated for an aspiration but then my surgeon decided to put me on diuretics to see if that would help. I was sent home and told to have my family physician monitor the progress. I’ve been home a week now and today notice my cough has lessened a little and perhaps I’m turning a corner. Let’s hope tomorrow is better. I was also sent home with a Flovent prescription which may have helped. While in CCU one other valve patient underwent an aspiration procedure which didn’t look to be too pleasant. I’m really thinking that is the source of the acute pain in my right back.

I asked my family physician today to double check on my right lung and she couldn’t really understand why I was asking. I’m going to monitor how I feel myself and perhaps tomorrow if I can’t definitely see improvement, will insist she see me. I’d rather be safe than sorry. Perhaps I’m not explaining the symptoms correctly but I know that is what is noted on my discharge papers including the request for family physician follow-up and x-ray.

I don’t mind discomfort but I would worry if there were any dangers involved that I should be aware of.
Cheryl, Ontario

Adam,
I had my aortic valve replaced with an On-X mechanical valve July 16, 2009. I am a 50 year old male born with a bicuspid aortic valve. About 2 weeks after surgery, I was starting to feel a little “off” even though my recovery was going well and I had been keeping up with my walking. Late one night I asked my wife to drive me to the ER to get checked out. Something wasn’t right but I had no idea what was wrong. Providentially I had an aggressive ER doc at the Lehigh Valley Hospital, Allentown PA who fortunately found the problem: Pericardial Effusion. They admitted me right away and was back in the OR by 11 am that day. I did have the pericardial cavity drained and they put another chest tube in. I was in the hospital for another 4 days. So I lost about a week on my recovery schedule. My suggestion to your readers: if your not feeling right and you’re not getting answers or not getting a response from your medical care givers, be politely persistent. I am 13 weeks post op and feeling great. Jim

Adam, I had plureal effusion after my aorta valve replacement in Feb. 2009. I had a lot of difficulty breathing and severe pain in my back shoulder blade area on the right and a cough I could not shake. The home nurse diagnosed it before any of my drs. agreed finally. Once the chest x-ray came back I had to go and have the effusion drained, which was relatively painless and fast to my surprise and relief.
I was told that this is very rare after cardiac surgery. I ended up with the effusion again about 3 wks. later but not enough to drain. Ended up clearing on its own this time. I was surprised to get this due to I was constantly up moving after surgery and during my recovery at home for 6 wks. I am only 48yrs. old.

hi, ive just two months ago underwent bypass surgery to repair two blocked arteries, two weeks afte released from the hospital, i had to go in and have fluid drained from both lungs,,,there was close to a qt. of fuild in each side,,,i felt so much releaf, then two weeks later i had to go again,,,not as much fluid in the right lung but still close to a qt on the left lung,,,now this is three weeks after the last time and ive got to go in and have the fluid drained again,,,they told me friday that i only had the left side with fluid, the right has none…im wondering if this will stop or am i in for this every two or three weeks…

I had a very sucessful mitro valvue repair 30 days ago and have developed plureal effusion. I have already been drained 3 times. This is an extremely painful experience.
How long does this last? Are there any alternatives?

I had mitral value repair 6-29-09,and had 3 pleural effusions,afterwards,my surgeon explained to me,was probably due to my small stature.95 lbs.5’3″,he expected me to have some complications going in,however I was not prepared,for everything that I had to go through ad 58 years old.

I am 11 weeks post mitral valve repair; about 15 days postop developed plural effusion. Went to ER due to pain level and was admitted for 3 days on medicine therapy (no aspiration). Dr. has since treated with Colchicine (gaut RX also used for this problem), ibuprofen 600 mg daily and finally a diminishing dose of Prednisone. Very discouraging, as it returned about a week after the Prednisone was completed. Am headed back to the doctor ths morning. Hope I don’t end up back in the hospital!

I have post operative infusion and returned to the hospital a week after going home with extreme pain and inability to breath. For 3 days I was very frustrated because I felt no one was taking my pain seriosly. It was not until I started running a fever that they began action. I also felt like no one was giving me any answers. I went for a tap to remove some fluid to make sure it is not a bacterial infection but there was not enough to withdraw safely. I wish that more had been done to educate me and my family about this possible complication since it seems to be fairly comon. We would not have so worried and scared.

I had double coronary artery bypass surgery five weeks ago. I am experiencing some pleural effusion. Have been on lasix 20 every day but it doesn’t seem to be helping much. This morning I awoke with pain under my left breast and to the left that increased with deep breaths. The pain went away when I stood up. I am an RN so listened with my stethoscope and can hear a definite friction rub. I know these are usually benign and eventually reabsorb, but this is worse than before which concerns me. I had an echocardiogram done yesterday but didn’t have the pain then, so don’t know if it showed or not. I see the Dr. tomorrow. Should I wait and see or call him now?

Im almost 3 weeks post op for mitral valve repair. Three days ago I went to the ER for sharp pains under my right lung and a fever. I have 500 cc of fluid on my right lung and just a little on my left. It was very frustrating because I felt like I was slowly recovering and then all of a sudden I felt as bad as post op day 2. They put me on motrin 600 mg twice a day and zpack antibiotics. I was told that walking, avoiding sodium and drinking tons of water will help clear it. So far the pain is almost gone but lying down my lung still feels gurgley and my temp has been up to 99.6 once in a while. I hope it goes away soon. I also found out I’m anemic. I didn’t mentally prepare for the after math of surgery like I did for the surgery itself so I feel emotionally more vulnerable to these set backs.

My wife aged 72 years went into surgery for the replacement of aortic valve in a DELHI hospital, in August 2008. After about 30 days she was detected having pleural effusion of the pericardium and lungs. She was taken back to the same hospital. Pericardial effusion was removed by a special catheter, and it was about 800 grama, it was something like puss It did not stop and carried on slowly. The pleural effusion was not removed. The doctors prescribed certain medicines, and discharged her, and declared she had some infection pericardial effusion did not stop so a window was opened , she could not recover and died after 20 days due to sepsis and DIC. She was given a lot of blood and platelets transfusions. I believe she died due to unavailability of the required treatment. What do you say?

I had my aortic valve replaced with a bovine valve Jan. 2005. I had a pleural effusion in my right lung post surgery and had some difficulty with pain and breathing for a few days. I was given a diaretic and got rid of the fluid naturally in two days. I did not need to have it drained.

Hi Adam,
I’m frustrated and looking for answers. I had valve replacement and bi-pass surgery almost a year ago and for the third time I’m experiencing pleural effusion and will probably have to have it drained again.
Does anyone have any answers or suggestions to prevent this?
Thanks so much.
Bill

P.S. We appreciate your book.

My mum has recently had aortic valve replacement 3 days ago, she is out of ITU today whith breathing difficulties, a chest xray today showed fluid on the lung. A few days ago while in ITU she had problems breathing and was told that her right lung had deflated. She is also very hot and sweaty and cannot complete a sentence as she is so breathless, she is currently on 4 litres of oxygen. What is her prognoses of recovering?
Regards Karen.

My father underwent triple bypass with Mitral Valve Replacement in October. He has since been drained twice(both within a fortnight of the surgery) and has since been asymptomatic though the most recent xray still shows pleural effusion. Fingers crossed on how things are going to unfold.

On May 20th 2010, I had a mechanical aortic valve replacement, my mitral valve repaired & one bypass. I went home one week later. I returned to the hospital the following July & had to have chest tubes in both sides> They drained a total of 2500 ml from both lungs> I am now at home with Pluerx chest tubes that i have to drain at least once a day. I get anywhere from 600 to 1200 ml off each side daily! The doctors say this could go on for a year!

Thanks to everyone for sharing your stories! I don’t feel so alone now!

Hi Donna
I had a tricuspid repair and a bovine mitral valve surgery almost a year ago. Two weeks after surgery and after severe shortness of breath I had a thoracentesis as an outpatient and almost one gallon of fluid was removed from one lung cavity. Several days later I had a quart removed from the other lung cavity. I used my incentive spirometer several times a day after that and did that for a couple of months. The fluid never did return and was told this was not an unusual post op complication. There have been several people on this site that have had this same problem but am not aware that they have permanent tubes in place as you do. Did you have lung issues going into the surgery? Were you told to use your spirometer? Hope they are wrong and this will clear up a lot sooner than predicted.

Hello all,

I am a 28 year old female and I underwent open heart surgery on March 14, 2011 at UCSF. I had my aortic valve replaced with a bovine valve. I used my incentive spirometer more than most patients according to the nursing staff and I even took it home and used it for weeks in fear of lung complications. I too experienced a pleural effusion after surgery in my 3rd week post op. I was having difficulty breathing and an old rib injury was really flaring up because of it. I didn’t know what it was until they took an x-ray and found the fluid. They sent me home with a diuretic and potassium pills to dilute the water retaining sodium. I took those and drank little water for a week and dehydration pulled the fluid out. No drain tubes. It reocurred in my 5th week post op, so I called in to get more diuretic and potassium pills. This time it cleared up in around 3 days from pure dehydration. I guess when dehydrated other areas of your body need the fluid so it pulls it right out. I was told to stay hydrated after surgery, so I was surprised of this treatment but it worked and was way better than tubes 🙂 Hope this helps!!

Hello,
I had my mitral valve repaired in Sept. 2009 at age 57. I am very active, work out daily and was in great shape. My symptoms were shortness of breath and extreme fatigue and they came on quite suddenly. I recovered fine and went back to working out. About 6 months later I passed out in a store and had to be taken by ambulance to the ER. They said everything was fine. Since then, I am still short of breath on exertion with chest pressure and still get that extreme fatigue sometimes. Not just tired but the extreme fatigue a cardiology patient gets. I have had every test on me they can do including going to a pulmonary doctor. Everything is fine. My valve is fine.
I feel my life has totally changed since my surgery. I can no longer work out. When the fatigue hits I get out the 5 hour energy drinks since the doctors say there is nothing wrong with me.
Does anyone have any suggestions?
Linda

My mom had her aortic valve replaced in October 2011 and has had two pleural effusions with thoracentesis. They have now placed a pleurx catheter in her which we will drain at home. Has anyone had any experience with this complication following open heart surgery.

I had mitral valve repair Feb 2 2012. On the 4 th day my drainage tubes were removed and I began to bleed internally. On Feb 7 I had a second surgery where they discovered a tear or cut on my left mammary artery. At least two pints of blood were removed. Four days later a large pleural effusion was discovered around my left lung and a drain was inserted in my left side. I remained in the hospital until Feb 28 when it was finally determined that the amount of fluid was small enough to finally send me home without a diuretic or a drain. My breathing did not improve at home nor did the effusion shrink so now I am back on LASIK and feeling better. After reading all of the comments I am going to try to increase my activity in the hopes the effusion will shrink.

My cardiologist doesn’t seem worried and told me to go ahead and plan for an out of county trip in September. I’m a bit worried that the effusion , after it does go away,will return.

I’m a 62 year old female and this is my second repair. The repair itself seems to have been very successful although I still,have a small amount of atrial fib so am on Coumadin. My cardiologist is optimistic the atrial fib will go away.

I had mitral valve repair September 2009. The surgery went well. Months before when I had my cath I was given an aspirin 325 mg. and broke out in a rash. After surgery they gave me an aspirin 81mg against my better judgement saying the benefits were best for me. Well, I broke out in a full blown, head to toe rash with fever and terrible itching. They could not treat the rash until they determined that there was no infection in my heart. So after days of cultures, pic line, dermatology consults, I laid there and itched. I ended up being in the hospital for 11 days! Most of that time I laid there and itched while my heart healed. My cardiologist would say “your heart is healing fine it is just this rash”
So for about 2 years now I am short of breath on exertion, chest pain and pressure with exertion. It feels like an elephant is sitting on my chest when I walk. I have passed out twice. Once taken by ambulance to the hospital.
I have had every test done to me to find out why. Echos, Stress test, EEG, Methacholine test, CT chest (with and without contrast), sleep test, lab work. I have see my cardiologist who has brought me up to his board, pulmonary doctor. Everything is normal…but still I can not walk, exercise or live a normal life like I did before surgery.
My primary care recently found the problem! She was examining me and when she touched my ribs I had extreme pain. She sent me to rehab. After different tests they found out that my chest was full of adhesions. Probably from not moving after surgery for 11 days. So when I exerted my lungs could not expand and I would become short of breath and would get dizzy until I passed out. So they did “rib rolls” over my chest. They pulled the skin off the adhesions. If was very painful but worth it!
I have my life back. I can now exercise, walk, climb stairs and enjoy life. I am sharing this because while in rehab I was their first cardiac patient. Cardiologist don’t think of muscular skeliton. They want to make sure your heart is functioning properly. I hope this information can help someone else.

I had pleural effusion that needed to be drained. Immediately I breathed better. Sometimes it needs to be drained more than once.

I had aortic valve replacement and mitral valve repair a year ago (July 2011). I was home for a week, and returned to the hospital by my cardiologist for treatment of pleural effusions. After 3 thoracentesis procedures and the removal of 3.5 L of fluid, I wish I could say that I was “cured.” I have continued to take diuretics all year in hope of resolving the remaining small pleural effusions. This month the situation blew up on my left side, and I had 800 ml of fluid removed in another thoracentesis procedure, which resulted in a collapsed lung (pneumothorax). This was treated, but the effusion has returned and is occupying about 1/2 of the chest space on my left side, resulting in breathing difficulties. I am of average weight and I do not have congestive heart failure; these effusions are a side effect of the valve surgery. I am seeing a thoracic surgeon next week to discuss surgical procedures to resolve these effusions (thoracoscopy or thoracotomy). Has anyone gone through anything like this? I’m getting desperate to resolve this situation!

I had aortic valve replacement and tricuspid valve repair on August 1. I was doing fine when I hit what others have described as a wall, caused by pleural effusion. I had 600 ml of fluid drained on August 1 and 825 ml on September 10. The relief is instant but doesn’t last, as I am once again breathless upon mild exertion. I see my cardiologist on Friday to find out what’s what. Glad to know I’m not alone!

My 87 year old mother had open heart aortic valve replacement surgery @ washington Hospital Center. Now after several weeks of relapses in Georgetown it appears that fluid build up in the lungs could be the culprit. She was relatively healthy for a 87 year old but with complications from shortness of breath and irregular heart beat she is fighting a courageous up hill battle. What can I tell her for any reassurance ? Hang in there? I feel better having read comments from other patients..

my 84 year old mother-in-law is 4 days post-op for mitral valve replacement and the resection of a dissecting anneursym of the aortic arch. She seems to be recovering well but for a pleural effusion that is currently being treated with Lasix for pleura l effusion

My mother had mitral and tricucspid valve repair and PDA ligation! She developed bilateral pleural effusion! She had right pleural effusion preop and had thorax enteric twice before undergoing surgery! Post op she developed bilateral effusion worst on the left lung that requires initially aspiration of bloody drainage( INR was elevated at around 8) that’s what the surgeon had explained why its bloody! After 2 days post aspiration, pleural fluid built up again and now she has a Blake more tube connected to JP drain to her left chest! Right lung pleural effusion resolve on its own!The 2 d echo post op shows mitral and tricuspid valves are working ! She has the left blakemore tube on her left lung for a week now and continue to drain at least 300 cc for 24 hours! Need your opinion on what’s going on! Thanks

why pleural effusion post heart valvular surgery occurrence frequently although treated with pleural tap or drainage?

I had aortic valve replacement (mechanical valve), and an ascending aneurysm graph in Jan. 2014, Recovery was going fine but last week 04/10/2014 I developed a productive cough I could not shake it and a fever ensued, went over to my regular doctor and she prescribed some antibiotics and sent me over to check my INR because of my Coumadin and while I was there she order a chess x-ray stat! I went home after picking up prescriptions at the local pharmacy. After a couple of hours she gave me a call and inform me that she could not make it out, but there was ether an enlargement of the heart or fluid buildup in the pericardial cavity! She sent me to the ER and after an echo cardiogram it was confirm that there was a substantial amount of liquid in my heart cavity! I did have the pericardial cavity drained of over a litter of liquid and they put another chest tube in. I was in the hospital for another 3 more days. Now the matter is getting my Coumadin levels back to 2-3 INR and hope that this does not happen again. My fever is gone I can breathe much better but I still have that horrible cough, hopefully it goes away in couple of days then maybe I can enjoy my life and family once again!

I had open heart surgery in Sept. 2013, and I just had my pleura effused Fri. April 18,2014. They look a liter out and my lung was partially collapsed due to this fluid.

I still don’t feel any better, just pain from the effusion.

It seems there is a lot of pleural effusion despite this doctor’s blog that says it is rare. Interesting – comment after comment after comment, yet it’s rare! My Mom is currently 2 weeks post op for a valve replacement and all signs indicate pleural effusion, yet the post-op doctors and rehab people aren’t calling it that. I am hoping they will diagnose that, drain it before she has to leave rehab for home. The fluid doesn’t seem to be leaving, first it was edema, now shortness of breath a day or so later, which upon reading all tehse comments sounds like this pleural effusion.

Dear Adam,
My son who has just became 2 years old on the 3rd of August 2014 made his 3rd heart surgery (Fontan) on the 31st of July and now he has a pleural effusion with two tubes in each lung to drain the excess water out. Luckly the left lung dried up after 2-3 days and now the tube is out. The right lung is still draining fluid until today, the first first tube was blocked and they had to change it with another one, and the second one seems that it is getting blocked soon. All I hear from the hospital is that we have just to wait and it shall dry out alone, but I would appreciate if you can explain for me your experience about the case and it there any information that I need to know and the doctors are not saying.

Thanks
The father

Thank you for taking the time to post this! Every post helps me to better understand what might be going on with my Dad! Thank you again!

“Most of these effusions develop as a consequence of the surgical procedure itself and follow a generally benign course.” … what does “a consequence of the surgical procedure itself” mean ?

Please elaborate.

I am 2 months post open heart, I had a repair of the mitral and tricuspid valves, septal myectomy ,double by pass, and a atrial clip……I was told I had a bit of fluid around my left lung, by was advised that it would resolve its self. I continue to have shortness of breath along with extreme weakness intermittently … will this pass ?

How are you now? My mom is in this situation draining at home