Dr. John M. Mckinney, M.D.

The necessity for surgical therapy would depend upon the cause of the enlarged heart. In your age group, there are several possible reasons for enlargement, including both "surgical" and "medical" causes. All of these are collectively known as "cardiomyopathies". Among the "surgical" causes include leaking valves, blockage in the coronary arteries (with damage from heart attacks), and some congenital abnormalities which involve improper development of the heart before or shortly after birth. The medical reasons can involve viruses, alcohol, and some other reasons that lead to what is known as a dilated cardiomyopathy for which surgery can do little to help. In any event, tests in addition to a chest x-ray are required to determine the reason for your enlarged heart, which will lead to a recommendation about which types of therapy might be of benefit to you.

I do not know of any significant advantage in giving up coffee, so I would continue to enjoy it (in moderation).

Valve repairs are generally limited to either the mitral or tricuspid valves, both of which are "inlet valves" leading to the main pumping chambers of the heart (ventricles). Repairs can be accomplished in about 90% of situations where the mitral valve is leaking, and almost always where the tricuspid valve is leaking. A surgeon can look at a preoperative echocardiogram and determine whether a repair will be likely. A repair is favored as it is often more durable than an artificial valve, it preserves the heart's geometry and ability to pump efficiently, and can help avoid the use of blood thinners after the operation.