Valve choice determines need for med

Dear Dr. Roach: Iama 70-year-old active female in good health, with the exception of mitral valve prolapse with two leaks. My cardiologist has advised me that I will most likely need to have the valve replaced. Would I have to be on blood thinners for the rest of my life if I elect to have this surgery?

R.Z.

Answer: Therearetwo options available to people who are undergoing mitral valve replacement surgery: mechanical and bioprosthetic valves.

Mechanical valves tend to last longer. They are recommended for younger patients, but require lifelong anticoagulation. Bioprosthetic valves can be made from animals, cadavers or the patient’s own tissues, and have no need for anticoagulants.

For mitral valve replacement, age 70 is a sort of cutoff. Any younger and mechanical is usually recommended; any older and bioprosthetic would be the choice. At your age especially, your personal preferences matter, and you should talk to the cardiologist — and the surgeon — about what you want.

Dear Dr. Roach: About two years ago I was hospitalized with amiodarone toxicity. My forearms and the backs of my hands became discolored to a brown, mottled color, and my skin would bleed at the slightest touch. A dermatologist prescribed hydroquinone cream, but my skin lightened only slightly. Do you have any suggestions?

M.J.

Answer: Amiodarone is a very powerful anti-arrhythmia drug that must be used judiciously, as there are several ways it can be toxic.

My discussion assumes you are off the amiodarone now. The timing of the discoloration strongly implicates the amiodarone as the cause of the discoloration.

The hydroquinone you were prescribed is a nonspecific bleaching or lightening agent. It, too, has problems when used for too long or in too high a concentration. If it isn’t working, you should stop it. You may have done so already.

Careful avoidance of the sun and consistently using sunblock are my best suggestions. Your skin may continue to lighten.

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