### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Sir, i am 35 year old, arround 12 years back i was treated my mitral stenisis by balloon valvotomy, after that I was taking lanoxin and diuretic tablet and pencilline enj. Last year my echo show that now mitral valve is thick and fibrosed valve leaflet and I have moderate mitral stensis 1.58 cm2 with calcified tip. Along with this Aortic calve is also trileaflet, thickend and fbrosed with (moderate leakage) having Lt, Atrium dimension 35 mm and LA-Aorta (1.6).Left atrium dilated and left artrial overloaded. wall motion is normal and ejection fraction is 60 percent,.Sir here one doctor say that i have moderate heart failure and i need both valve replacement in near future, another says I can wait for few years.Now a days I am feeling palpitaion daily.I am taking 25 mg metopropal, dytor plus 10. how much time I can wait for valve replacement? both valve can be replaced at once?wtah would be the cost?and wahts is the expexted life expectancy after valve replacement? thanks

### output:

Hello Thanks for posting here. I have gone through your description. Your mitral valve area of 1.5 8cm2 is classified as moderate. Patients with Moderate MS with symptoms should undergo a valve replacement. Your symptoms are only palpitations. You must get an EKG done to see whether you have irregular heart beats called atrial fibrillation which is common in mitral stenosis. Treatment for atrial fibrillation can be given if required. Aortic valve also has moderate leakage so surgery not advice at this point. Your LA size and aorta size are normal so again no indication for surgery. I suggest you be on lanolin, diuretic tablets and other medications at present. Yearly 2d echo must be done to see the valve stenosis and to evaluate ejection fraction. You MAY require surgery at some point of time. But heart surgery is to be done only when it's the right time and not as a preventive thing. Yes both the valves can be changed during the same surgery. I do not know about the cost of two valve replacement abroad, in INDIA it is about 3-5 lack depends on where you are doing it. The life expectancy after a successful valve replacement is more than 20 years, but it has to be done at the hands of a good surgeon, so please don't compromise on the cost. REGARDS