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MITRAL VALVE BLOG

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If a person has heart valve disease, it’s not uncommon to also experience other conditions or disorders at the same time, including atrial fibrillation and coronary artery disease.  Another disease that can affect patients with heart valve disease is an aortic aneurysm. What is an aortic aneurysm? An aortic aneurysm is when the walls of the aorta (the largest blood vessel in the body) begin to weaken and bulge. This aneurysm can result in a blood leak into the body if it bursts; however not all aortic aneurysms burst. Aortic aneurysms also can force blood away from organs and tissues resulting in heart attacks, kidney damage, stroke, and death.

Bicuspid aortic valve disease is often linked to ascending aortic and aortic root aneurysms. Patients with bicuspid aortic valve disease should also be evaluated for aortic aneurysms.

An aortic aneurysm can appear in the chest (thoracic aortic aneurysm) or in the abdomen (abdominal aortic aneurysm). Chest aneurysms often develop due to genetics, but other causes include high blood pressure, high cholesterol, plaque buildup, or a traumatic injury. With this type of aneurysm, the symptoms are often not present until the aneurysm is large or bursts. Symptoms that a person may experience can include chest pain, back pain, difficulty breathing and/or swallowing, and shortness of breath.

Often, there are no signs of an abdominal aortic aneurysm; however, some people may have back pain, deep pain on the side of the abdomen, or a throbbing sensation near the navel. If this aneurysm bursts, a person can feel sick and vomit, become sweaty, become dizzy, or feel extreme pain in the abdomen or the stomach. Doctors are not certain what causes abdominal aortic aneurysms but some things that may contribute to its development include hardening of the arteries, smoking, high blood pressure, and genetics.

In some cases, aneurysms can actually cause aortic valve disease or dysfunction. How? The aortic root is connected to the aortic valve and the stretching of the root can stretch the valve, which can lead to valve leakage or insufficiency. Patients with aortic aneurysms usually get checked for aortic valve problems, too.

Aneurysms often take years to grow, and they should be taken seriously. To prevent the development of an aneurysm, it’s best to maintain a good blood pressure and to avoid activities and exercise that require intense straining.

If you have an aortic aneurysm and aortic valve disease, talk to a valve specialist to determine a specialized treatment plan for your condition. Dr. Peter Mikhail is a cardiac surgeon who specializes in aortic valve surgery. To book a consult, click here or call 727-312-4844.


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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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Did you know the mitral valve is made up of five parts? The five parts are the leaflets, the annulus, the chords, the papillary muscles, and the ventricle wall. Together, these parts make up a suspension system for the leaflets to open and close properly. For this article, we will focus on discussing the mitral valve chord (or chordae).

The chordae look like chords and they connect the leaflets to the papillary muscles. These cords are responsible for the end-systolic position of the leaflets. There are marginal (primary) chordae, intermediate (secondary chordae) and basal (tertiary chordate). Marginal chordae function to prevent the prolapse of the margin of the leaflet. Intermediate chordae relieve valvular tissue of excess tension, and help preserve ventricular shape and function. Basal chordae connect the leaflet base and the mitral annulus to the papillary muscles.

The chords can malfunction by rupturing from an infection or prolonged elongation due to a possible collagen disorder. If the mitral chords rupture, they will leak blood, which develops into mitral regurgitation. Mitral regurgitation is a form of mitral valve disease or heart disease. The blood is leaking back into the left atrium of the heart. If left untreated, the heart could become enlarged, heart muscle damage could occur, or the person can develop congestive heart failure. If these chords rupture, a person may experience heart palpitations, shortness of breath, difficulty breathing during exercise, and fatigue as symptoms.

The mitral chords can be repaired by removing the damaged chords and the attached leaflet segments and replacing them with a mitral (annuloplasty) ring. If the mitral valve regurgitation isn’t severe, a patient can be treated with prescription medications.

During a mitral valve chord repair, the surgeon ensures that the blood in the valve will be moving in one direction again. The earlier that mitral valve disease is caught the better a person’s chances are for a full recovery without damage to their heart or lungs.

If you suffer from mitral valve disease, it’s time to talk to a mitral heart valve surgeon about your options. Dr. Peter Mikhail is a mitral valve surgeon who specializes in heart valve surgery. To book a consult, click here or call 727-312-4844. He is based in New Port Richey, Florida, and treats patients in the Tampa and Clearwater areas.


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Heart surgery is major surgery, even when it’s a minimally-invasive procedure.  After such a major surgery, a person will certainly need lots of rest and relaxation to recover properly.  Although you know your heart was just repaired, it can be hard to exercise patience. Who doesn’t want to get back to their normal routine as soon as possible? Even though you asked the doctor endless post-op questions prior to surgery, you still begin to wonder when you’ll be able to return to your normal daily activities.

Recovery can be hard both physically and mentally.  Your recovery is unique because you are a unique individual. Every patient heals differently and at a different rate.

For the first week post op, you most likely will be in the hospital. You will spend one to two days in the ICU and then be moved to a regular hospital room for the remainder of the week. During your hospital stay you will be walking regularly and gradually increasing physical activity, so you will be able to walk and go up and down stairs before you head home.

Before sending you home, the doctor will give you recovery instructions, such as watching for any signs of infection, incision care, pain management, and post-op side effects. You will still be sore, but may no longer be on pain meds. The doctor will determine how much physical activity you can do, and will encourage lots of rest throughout the day. The doctor may recommend cardiac rehabilitation, as well as permanent lifestyle changes when it comes to diet, physical activities, tobacco usage, and stress management to promote healing and recovery. If something hurts, stop doing it. Focus on performing activities that don’t hurt you.

Around the fourth or fifth week post-op, you will be getting close to being back to your normal activities. You can be back to work, can travel and celebrate a holiday without feeling awful. Although you are still not 100%, you will feel significantly better now.

Looking for a cardiac surgeon to perform your heart valve surgery? This is Dr. Peter Mikhail’s specialty. Dr. Mikhail is a cardiac surgeon based in New Port Richey, FL, and treats patients in Tampa and Clearwater. He is considered one of the foremost authorities and specialists in mitral valve surgery and TAVR. To book a consult, click here or call 727-312-4844.


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Today, we are going to discuss a treatment method for aortic stenosis and aortic regurgitation – two serious conditions that affect the heart’s aortic valve – called Mini-AVR.

First, let’s talk about what those conditions are.

Aortic stenosis occurs when the cusps of the aortic valve become abnormally rigid and do not fully open. This narrowing of the valve creates resistance against the pumping of blood from the left ventricle to the rest of the body, and if left untreated, it can lead to heart failure.

Typically, this condition is the result of degeneration due to natural aging and health issues and calcium buildup on the valve cusps over time causes them to stiffen.

Aortic regurgitation occurs when the aortic valve allows blood to leak back into the left ventricle. It’s often caused by valve damage due to a recent infection or rheumatic heart disease, or it’s a congenital heart defect you were born with.

The symptoms of both conditions include shortness of breath, chest pain or heaviness, fainting or lightheadedness, decreased physical endurance during exercise, and swelling of the limbs.

The severity of aortic stenosis and aortic regurgitation will determine treatment. A Minimally Invasive Aortic Valve Replacement, or Mini-AVR, involves the surgical replacement of the aortic valve with a prosthetic valve. Its benefits include less trauma and pain, better cosmetic results, a shorter recovery time, and a potentially lower financial cost.

During Mini-AVR surgery, a small incision is made in the upper chest area, and a cardiopulmonary bypass machine is used to take over functions of the heart and lungs, so that blood continues to flow around the heart and the body’s oxygen levels remain stable. A surgeon will open the aorta (and, if necessary, remove any diseased valve cusps), measure the valve ring, and insert the prosthetic valve.

The surgery typically takes about 2 to 3 hours. Several recent studies have shown that a Mini-AVR procedure is potentially safer than a conventional AVR procedure with a full sternotomy, which calls for much larger incision.

It’s important to talk to your doctor about the best treatment options for aortic valve conditions. In some cases, medication may be effective treatment for aortic regurgitation. However, receiving timely surgery is often advised because a significant delay could lead to congestive heart failure.

Dr. Peter Mikhail is a cardiac and thoracic surgeon based in New Port Richey, Florida, who treats patients in the Tampa and Clearwater areas. For more information on his practice or to schedule a consultation, visit Mitral Valve contact page or call 727-312-4844.


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Keeping tabs on your health in today’s digital age is easier than ever before. But did you know that when it comes to monitoring your heart rate, a wrist-worn device isn’t as effective as one that’s strapped to your chest?

PC Magazine recently offered a review of 10 wearable heart monitors, and four out of the top five personal devices used chest straps to record heart activity. The magazine noted that chest-strap models, which use an electrical pulse to measure heart rate, are more accurate than wrist-worn devices that employ optical technology.

That finding is backed by a March 2017 report by the Cleveland Clinic, which tested five wrist-worn fitness trackers and came to the same conclusion – that monitors worn across the chest are more accurate at measuring heart rate while exercising.

Heart monitoring during sustained physical activity is especially important for individuals with heart murmurs and mild-to-moderate mitral valve regurgitation (MVR).

Here’s a list of the top chest-worn models (prices may vary):

Wahoo Fitness Tickr X Heart Rate Monitor: “The Wahoo Fitness Tickr X is the best heart rate strap you can buy. It’s so much more than just a heart rate monitor, and yet it costs the same as other excellent chest straps that don’t offer nearly as much. It doubles as a run tracker. You can use it with or without your phone.”

$99.99 MSRP; $79 at Amazon.com (http://amzn.to/2wCvvb1)

Polar H7 Heart Rate Sensor: “Polar users in need of an accurate HRM can’t go wrong with the H7, but it’s also good for anyone looking to add heart rate data to their run-tracking using one of the five supported apps. And if it works with your home or gym fitness equipment, all the better. The price is right, too. The Polar H7 is one of the most versatile and accurate HRMs available.”

$79.95 MSRP; $62.99 at Amazon.com (http://amzn.to/2gD39nJ)

Polar H10 Heart Rate Sensor: “If your current H7 chest strap is showing some wear and tear, you might want to think about upgrading to the H10. The extended battery life and built-in memory make it a solid investment, especially if you have or are thinking of getting a Polar fitness tracker.”

$89.95 MSRP; $89.95 at Amazon.com (http://amzn.to/2wCXrvr)

Garmin HRM-Run: “For runners who want a plethora of data, the Garmin HRM-Run gives you advanced stats including cadence, oscillation, ground contact time, ground contact balance, stride length, and vertical ratio. It makes for a pricey bundle when paired with a compatible tracker, but one worth considering.”

$99.95 MSRP; $83.74 at Amazon.com (http://amzn.to/2w3jkAu)

Dr. Peter Mikhail is a cardiac and thoracic surgeon based in New Port Richey, Florida, who treats patients in the Tampa and Clearwater areas. For more information on his practice or to schedule a consultation, visit Dr. Mikhail’s Mitral Valve and Aortic Valve website or call 727-312-4844.


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This is a heart condition that affects a very small percentage of the U.S. population, and its symptoms may include irregular heartbeat and chest pain.

Mitral valve prolapse, also known as click-murmur syndrome, Barlow’s syndrome and floppy valve syndrome, occurs when the mitral valve flaps do not close smoothly or evenly as the heart beats; instead, the flaps bulge, or prolapse, upward into the left atrium.

In most cases, it’s harmless and most people aren’t even aware they have it.  However, some cases require treatment; for instance, when a prolapsed valve allows a small amount of blood to leak backward, a heart murmur may occur. For some, MVP is genetic, but for others, it’s caused by other health issues, such as progressively weakening connective tissue.

Health professionals can typically detect a murmur during a routine examination, especially if a patient has experienced heart palpitations (sudden rapid heartbeats), chest discomfort and fatigue. For those without symptoms, physicians may use an echocardiogram or magnetic resonance imaging (MRI) to look for issues.

Mitral valve surgery may be required if symptoms appear to be getting worse, the left ventricle of the heart is enlarged or heart functions are worsening. While mitral valve prolapse rarely becomes a serious health condition, it can cause arrhythmias – when the heart beats too fast or slow – that are potentially life-threatening, according to the American Heart Association.

Physicians typically recommend treating the symptoms of MVP with regular exercise, over-the-counter pain relievers and relaxation/stress reduction activities, while avoiding caffeine and other stimulants. Beta blockers, or medications that slow the heart, may also be used to treat heart palpitations.

Experts recommend that individuals with mitral valve prolapse should see their doctor regularly, and a cardiologist every 2 to 3 years. Those with moderate symptoms should get an echocardiogram every 6 to 12 months.

Dr. Peter Mikhail is a cardiac and thoracic surgeon based in New Port Richey, Florida, and treats patients in the Tampa and Clearwater areas. For more information on his practice or to schedule a consultation, visit the Tiny Scar Valve Surgery contact page or call 727-312-4844. To learn more about this disease, visit Dr. Mikhail’s Mitral Valve Disease page.


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Blood pressure and heart health go hand in hand. Your blood pressure reading reflects two numbers, systolic pressure and diastolic pressure. Your systolic pressure measures the pressure of the blood against your artery walls when the heart pumps blood out during a heartbeat, while your diastolic pressure measures this pressure in-between heartbeats when your heart is full of blood. Ideally, your blood pressure should read below 120/80. One in three American adults suffer from high blood pressure.  One thing you can do to keep your blood pressure in check is to eat a balanced diet. Certain foods are known to increase your blood pressure.  We suggest you avoid the following foods or limit them in your diet to keep your blood pressure in a good range:

  1. Soda/sweetened beverages – Sugar-loaded drinks can quickly lead to weight gain; excessive weight on the body can raise a person’s blood pressure.
  2. Processed meats and other foods – Deli meats like turkey or ham are loaded with sodium, which can raise a person’s blood pressure. Lots of packaged foods contain high amounts of sodium, e.g. canned soup, frozen meals, tomato sauces, canned vegetables and bread. These foods have a lot of sodium, because this ingredient is used to preserve the foods.
  3. Baked goods – Cakes, doughnuts, muffins, cupcakes, cookies, pies and more are loaded with sugar, but also contain a lot of saturated and trans fats. Both these “bad” fats are known to increase blood pressure.
  4. Candy – When you eat a piece of candy, you’re basically consuming empty calories and a lot of sugar; candy can spike your sugar levels and can lead to weight gain.
  5. Alcohol – Excessive use of alcohol can lead to weight gain and dehydration both of which can lead to an increase in blood pressure.

Each day, you should aim to keep your sodium intake to less than 2,300 milligrams; sugar should be limited to 37.5 grams per day for men and 25 grams per day for women. It’s best to avoid or limit the above foods and opt for water, 100 percent fruit juices, fresh meat, fruit, homemade (healthier) desserts, nuts, legumes, vegetables, and whole grains.

If you currently have high blood pressure or heart disease, it’s wise to discuss with your doctor the best meal plan for you. If you suffer from mitral valve disease or aortic valve disease and need surgery, Dr. Peter Mikhail is a cardiac surgeon treating patients in the Tampa, Clearwater and New Port Richey areas of Florida. To book an appointment, click here or call 727-312-4844.

 


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Get up, and get moving! Exercise is essential to heart health. However, you don’t have to be overly athletic or a marathon runner to reap the benefits of exercise. According to the American Heart Association, a person can improve his or her overall cardiovascular health by participating in at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise (or a combination of both) per week. Exercise comes in many different forms, from running and lifting weights to Zumba class and walking. For this article, we focus on the benefits from one particular type of exercise, Yoga.

Yes, yoga. This form of exercise is much more than a bunch of funny-looking body positions. People have been practicing yoga for more than 5,000 years to help rejuvenate the body and help themselves live a longer life. Yoga has been shown to have numerous benefits including helping reduce stress and bring clarity and peace to a person’s mind. Recently, a new study published in the European Journal of Preventative Cardiology said that yoga may help lower a person’s risk for heart disease in the same way as walking or another conventional exercise.

In this study, people of all ages and health conditions saw improvements in their health while participating in yoga. These people lost weight, lowered their blood pressure, and lowered their LDL (“bad”) cholesterol levels.

Yoga is physical but it also involves a lot of breathing exercises and meditation. These activities can all have positive effects on the heart and body.  Yoga’s impact on muscles and the mind can help control blood sugar, lower blood pressure, and calm the nervous system, which can reduce stress in the body.  Yoga can also help increase a person’s aerobic capacity, and has also been known to help people with atrial fibrillation have fewer episodes.

Yoga classes are available for people of all experience levels. If you have a health condition or aren’t in great shape, a beginner class is a great way to learn all the moves in a slow, controlled way that isn’t intimidating.  Hatha yoga is good for beginners, while Vinyasa yoga is better for those individuals who are more experienced and physically fit. Bikram yoga or Hot yoga, which is yoga in a room with a temperature of more than 105 degrees, is not recommended for people with heart conditions like heart disease.

If you currently have heart disease, talk to your doctor about taking a yoga class. If you’re a candidate for heart valve surgery, Dr. Peter Mikhail performs mitral valve surgery and aortic valve surgery in the cities of Tampa, Clearwater, and New Port Richey of Florida. To book a consult, click here or call 727-312-4844.

 


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During your annual physical, a doctor will listen to your heart with a stethoscope. If the doctor hears anything troubling or odd, he or she will recommend that you have an echocardiogram done on your heart. What is an echocardiogram? An echocardiogram (echo) will show doctors the size, structures, and movements of the parts within your heart. Through this test, a doctor will be able to determine several things, including: the size of your heart, the state of your heart muscles, heart valve problems, problems with your heart’s structure, and signs of blood clots or tumors.

During an echo, a technician will place three electrodes which are attached to an electrocardiograph monitor (ECG or EKG) on your chest. You will be asked to lay down on your left side. He or she will place a wand (with gel on the end) on your chest; the wand is a sound-wave transducer. You may have to change positions a few times during the test, so several areas of your heart will be photographed. Echos are safe and you should feel no discomfort.

An echo lasts for about 40 minutes; you can return to work or other daily activities immediately following. You can eat, drink, and take any medications normally before this test.

There are several different types of echocardiograms and your doctor will determine which one is right for you. Here are brief descriptions of the types of echocardiograms:

Transthoracic echocardiogram – This is the basic echo and is like an x-ray (minus the radiation).
Transesophageal echocardiogram – In this echo, the transducer is inserted down the throat into the esophagus, because the esophagus is close to the heart.
Stress echocardiogram – This echo is taken while the person exercises on a treadmill or stationary bike.
Dobutamine stress echocardiogram – This is a stress echo but without the exercise; the stress is obtained through a drug that makes the body think its exercising.
Intravascular ultrasound – This ultrasound is performed during cardiac catheterization, and the transducer is threaded into the heart blood vessels through a catheter in the groin.

If you’ve had an echo or other stress test, this can help the doctor determine if you are currently suffering from heart valve disease. If you found out you have mitral valve disease or aortic valve disease and need surgery, Dr. Peter Mikhail is an experienced cardiac surgeon who specializes in mitral valve surgery and mini-AVR. To book an appointment, 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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