David John Cohen, MD

Your history of previous heart disease, age, diabetes, and possible hypertension related to stress are all significant risk factors. You need to be evaluated by your cardiologist as soon as possible. If you are having active pain, you need to go to an emergency room.

Yes, definitely. You may be having a new stroke or an extension of an old stroke. If this recently started, go to an emergency room immediately!

The answer to your question is not straightforward. Age, underlying medical problems, inability to take anticoagulants all influence the type of valve prosthesis used and its potential longevity. No valve is perfect and each has more and less desirable features.

In general, mechanical valves (made of metal and plastic components) last indefinitely unless they become infected or clot forms within them. They require life-long anticoagulation, generally with coumadin. Generally we recommend this type of valve in younger patients such as your son unless they cannot take coumadin, e.g. they have a history of bleeding ulcer, stroke, etc.

Tissue valves made from a pig’s heart valve or cow’s pericardium generally do not require life long anticoagulation unless there is another reason such as atrial fibrillation. They deteriorate over time and usually need to be replaced in 10-15 years. Unfortunately the younger the patient, the more rapid and severe the deterioration so that we don’t usually recommend them in younger patients under age 55-60 unless there is a compelling reason. They tend to be the valve of choice in older patients over age approximately 65. I don’t know what type you son had or why he needed it. There are complicated issues that can mandate a tissue valve in a young patient or a mechanical valve in an older patient, but the description above describes the thinking in a typical case. I hope that this helps.

You can live with one lung if the other lung has good function. Pre-operative pulmonary function studies are essential to know if you can tolerate a pneumonectomy (removal of an entire lung). Right lung is bigger than the left so removal of left lung may be slightly better tolerated than removal of the right lung.

Removing a hemothorax early before the blood turns to scar tissue surrounding the lung is straightforward and should not lead to major problems. If you wait too long and scar forms around the lung, it is more tedious to remove and you can have small air leaks on the surface of the lung requiring chest tubes to be left in place longer (several days). Either way you will do better long term if the blood is removed and the lung allowed to fully re-expand.

There are many types of heart disease. Some require just medicine while others might need a stent or a pacemaker. Still others need open heart surgery to fix coronary arteries or replace a heart valve. The bottom line is that a cardiologist would have to do tests to know what needs to be done.