WHY WE NEED VALVES

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

WHY WE NEED VALVES

Postby cheerleader » Wed Sep 21, 2011 12:17 pm

Dr. Schelling is concerned about the lack of valves and venous back jets due to valsalva manuever or thoracic pressure changes. We've discussed this at length.

Other doctors have expressed their concerns.
Internal jugular vein (IJV) is a main extracranial route for cerebral venous drainage. The jugular venous valves, which are located near the junction with the innominant vein, prevent the transmission of thoracic pressure and the reflux of venous blood into the cerebral circulation. Jugular valve insufficiency could result in retrograde jugular venous flow and back transmission of central venous pressure.

http://www.unboundmedicine.com/medline/ ... disorders_


Please read Dr. Chung's extensive research on transient global amnesia and valsalva manuever in those with internal jugular valve insufficiency. Venous reflux and incompetent valves are related to ischemic events and white matter lesions in the elderly.

We need working jugular vein valves. Unless you plan on never turning your head upside down, or sneezing, or straining on the john, or lifting something, or getting stressed, or having sex, or doing the myriad of everyday activities that causes blood to go back up the jugular veins and into the brain. The IJVVs are the only thing between the heart and the brain protecting from venous backflow...and we are JUST beginning to learn about their importance.

http://www.ncbi.nlm.nih.gov/pubmed/20800950

http://www.biomedsearch.com/nih/Pathoge ... 72657.html

Dr. Zamboni and his team are looking at ways to create new valves. Please, until there is more research, do not have valves disrupted, burst, popped, torn, whatever. There is just no science to back it up.

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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby Cece » Wed Sep 21, 2011 12:42 pm

I am not sure whether those of who have valve problems can ever have working valves. Mine were ballooned, not disrupted or torn. Based on my improvements in health, I am better off without the valves as obstructions, although maybe not as well off as I'd be if I had normal, functional valves. But normal functional valves may never have been an option for me! I agree that the disruption or tearing of valves does not have science to support it, nor to my knowledge is anyone who is doing this gathering data on outcomes. My biggest concern with it is that other doctors have said they have seen more complications in patients who have had their valves torn, compared to those who have had their valves ballooned. If there was anything that frightened me when going in for CCSVI treatment, it was the possibility of complications. You all had convinced me of the importance of jugulars and azygous veins and I did not want any damage done to them.
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Re: WHY WE NEED VALVES

Postby cheerleader » Wed Sep 21, 2011 1:18 pm

Cece--absolutely right. You would never have "normal" valves...and Dr. Sclafani dealt with your unique situation delicately and appropriately.
I am incredibly concerned that complete removal of valves could lead to TIAs, intercerebral hemorrhages and worse cerebral damage than MS, especially as these people age, and the veins become distended. Remember what happened to Ricci's right vein.
http://www.ncbi.nlm.nih.gov/pubmed/20800950
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Re: WHY WE NEED VALVES

Postby Luvsadonut » Wed Sep 21, 2011 1:21 pm

We need working jugular vein valves. Unless you plan on never turning your head upside down, or sneezing, or straining on the john, or lifting something, or getting stressed, or having sex, or doing the myriad of everyday activities that causes blood to go back up the jugular veins and into the brain. The IJVVs are the only thing between the heart and the brain protecting from venous backflow...and we are JUST beginning to learn about their importance.


sorry if I've missed something here, but I've been repeatedly told that 20% of the population don't have jugular vein valves and lead a perfectly normal life without them. Also, if indeed, it is proven to be correct that IJVVs are absolutely necessary to be working correctly, as nature intended, where does that leave the vast majority of CCSVI sufferers who have malfunctioning valves? The EHC (Glasgow, Scotland) have issued a newsletter stating that the vast majority of patients seen by themselves have malfunctioning valves. It all seems a bit 1 step forwards 2 steps back, so near yet so far...fairly heart wrenching.
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Re: WHY WE NEED VALVES

Postby cheerleader » Wed Sep 21, 2011 1:53 pm

closer to 90% of normals have at least one internal jugular vein valve. Those who do not, tend to be male. And there is no proof they lead perfectly normal lives...we just cannot say that with confidence at this point. How many of these people has strokes, or TIAs, or amnesia? We do not know. Valves are more often found only on the right side, in those who do not have both.

In particular, we assessed the presence, morphology and competence of valves at their ostium. Unilateral jugular vein valves were present in 406 cases (88%), mainly on the right side. The most frequently observed morphology (75%, 305 cases) was the two-leaflet valve, and jugular vein valves were incompetent in the huge majority of cases (365 cases, 90%). Our findings confirm the anatomical variability predicted from classical anatomical studies but, unluckily, do not provide additional evidence on the possible role of jugular vein valves in physiology and pathology. Further studies are strongly needed to determine whether these valves actually play an important role in counteracting chest venous pressure and in preventing reflux towards the brain.


Indeed, further studies are needed to evaluate whether there is a real increased prevalence of jugular vein valve absence or incompetence in patients with transient global amnesia or, more likely, whether the presence of at least one competent valve acts as a protective factor from cerebral venous engorgement in the case of increased chest venous pressure. Some authors suggest to concentrating on valve motion instead of competence, being this aspect complex and various, and probably the real index of valve function (Morimoto et al., 2009).

http://ejour-fup.unifi.it/index.php/ija ... /9073/8407

Dr. Schelling is especially concerned with this increased thoracic pressure in MS.

Dr. Zamboni found several truncular venous malformations, including atresia (missing veins) hypoplasia (small veins) webs, septum and malformed valves. There is no one answer. There is only each unique, complex case of CCSVI. And not all can be repaired with venoplasty. This is why Dr. Zamboni's team is now surgically replacing veins and working on mechanical valves. Because if a doctor tells you he understands CCSVI 100%, please, please, be wary.
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http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby David1949 » Wed Sep 21, 2011 2:14 pm

I've often wondered if a valve can become inverted as a result of a sudden surge in pressure downstream of the valve. This could happen as a result of a sudden blow to the chest area or if the individual was involved in a car accident while wearing a seatbelt with a shoulder harness. The shoulder harness can exert a great deal of force in the area of the heart and the superior vena cava.
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Re: WHY WE NEED VALVES

Postby cheerleader » Wed Sep 21, 2011 2:20 pm

The competence of the IJV valve is crucial in maintaining the transcranial blood pressure gradient during cardiopulmonary resuscitation with closed-chest compression.(7) This valve also prevents a sudden increase in the IJV pressure during coughing or during positive pressure ventilation and may thus protect the brain from acute increases in intrathoracic pressure.(8,9) This feature is unimportant in neurologically normal patients, but may be important in patients with compromised cerebral perfusion (e.g.,after head trauma or neurosurgery) .(10) At the same time the functional or morphological incompetence or absence of the IJV valves may cause cough headache, cerebral morbidity after positive end-expiratory pressure ventilation and some types of cerebrovascular diseases.(6) Transient mesiotemporal ischemia induced by venous congestion may be a potential cause of transient global amnesia (TGA).(11) In 1998, Lewis originally proposed the venous congestion hypothesis for TGA.(11) which is primarily based on the observation that the onset of symptoms is often correlated with prior Valsalva-like activities, which in turn may lead to venous reflux through the IJV. In anatomical studies, aplasia is reportedly present in as many as 16% of non-selected patients but in these studies valve competence was not assessed.(12) In humans approximately 90% of internal jugular veins have a valve.

http://ejour-fup.unifi.it/index.php/ija ... /9073/8407

We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage.

http://www.jmedicalcasereports.com/content/4/1/225

Several (not necessarily mutually exclusive) pathophysiologic processes may cause or contribute to cough-related syncopes, including Valsalva-induced decreased cardiac output, increased intracranial pressure, cardiac arrhythmias, stimulation of a hypersensitive carotid sinus, cough-triggered neural reflex-mediated hypotension-bradycardia, laryngospasm, augmentation of left ventricular outflow obstruction, impaction of a brainstem herniation, decreased cerebral blood flow, internal jugular vein valve insufficiency, and rarely seizures.

http://www.medlink.com/medlinkcontent.asp


Transient global amnesia (TGA) is associated with an increase in the prevalence of jugular insufficiency. Valvular insufficiency may lead to increased venous pressure transmission during a Valsalva maneuver and thus contribute to venous ischemia in TGA. The association of valvular insufficiency and longer reflux times with the occurrence of a trigger event further suggests that cerebral venous congestion is an important etiological factor in transient global amnesia.

http://ukpmc.ac.uk/abstract/MED/15999232
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby David1949 » Wed Sep 21, 2011 2:34 pm

When I was a kid we used to do something that was probably dangerous but we didn't know it. We would take a few deep breaths then hold the last one. A friend would put his arms around your chest from behind and squeeze. It would cause you to pass out for a few seconds. We thought is was neat but most likely it was a really dumb thing to do.

I've lost touch with those friends but I know two of them are deceased.
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Re: WHY WE NEED VALVES

Postby Jugular » Wed Sep 21, 2011 6:56 pm

I was told after having my RIJV valve and azygous valve treated by Dr. Arata to discontinue using my inverter board and so I have. Apart from that I haven't had any ill-effect whatsoever with weightlifting, swimming (including turning), bending over, coughing, sneezing, or (recently) skydiving. What I have had though is a major sustained reversal in my MS.

We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage.


Did anyone think to congratulate him.
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Re: WHY WE NEED VALVES

Postby Billmeik » Thu Sep 22, 2011 7:47 am

so given the choice between stents over you valves and valve destruction I chose the latter. No ill effects so far. I think my malformed valves already didn't work so it all seems normal.
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Re: WHY WE NEED VALVES

Postby dlb » Thu Sep 22, 2011 8:54 pm

Cece wrote:I am not sure whether those of who have valve problems can ever have working valves. Mine were ballooned, not disrupted or torn. Based on my improvements in health, I am better off without the valves as obstructions, although maybe not as well off as I'd be if I had normal, functional valves. But normal functional valves may never have been an option for me! I agree that the disruption or tearing of valves does not have science to support it, nor to my knowledge is anyone who is doing this gathering data on outcomes. My biggest concern with it is that other doctors have said they have seen more complications in patients who have had their valves torn, compared to those who have had their valves ballooned. If there was anything that frightened me when going in for CCSVI treatment, it was the possibility of complications. You all had convinced me of the importance of jugulars and azygous veins and I did not want any damage done to them.



That is exactly the same story for me. All of my problems: LIJ - 90%, RIJ - 70% & Azygous - 50%, were valvular. I too was ballooned by Dr. Sclafani rather than disrupted/torn. But I do wonder what exactly has happened to those valves now... how is ballooning less destructive than anything else, except with the use of IVUS, the treatment was pretty optimal for the size of the different veins. I had 18 mm balloon in my RIJ & only a 12 mm balloon in my LIJ. Regardless, this is now my new "normal" and so far it's treating me pretty good in comparison to pre-CCSVI treatment!
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Re: WHY WE NEED VALVES

Postby CindyCB » Sun Sep 25, 2011 3:57 am

How about child birth? The pushing involved in that must cause a valsalva maneuver?
Thyroid disease, Vitamin D deficiency, hypermobility, 'ME/CFS', CCSVI (stenosis both sides and assymetric malformed valves), TMJ - No MS but many neuro symptoms.
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Re: WHY WE NEED VALVES

Postby cheerleader » Sun Sep 25, 2011 8:40 am

CindyCB wrote:How about child birth? The pushing involved in that must cause a valsalva maneuver?


yes, you are right, Cindy. Childbirth is major valsalva time. What's interesting is that during pregnancy, the body has double to amount of blood, and many women feel great and have remission from MS, but after giving birth, the blood levels drop back to normal, hormones shift, and women have progression of MS. Maybe the act giving birth is part of the picture, too?
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Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby CindyCB » Sun Sep 25, 2011 8:51 am

I wondered how it would figure because I am yet to have children so was thinking that giving birth may somehow have an effect on the valves/veins and would Caesarian be a better option etc.

There are members here that have had angioplasty and then gone on to give birth, aren't there?

I'm also friends with some people with ME/CFS and one of them gave birth and instantly lost all her symptoms, felt perfectly normal and has not relapsed after 3 years. She states that literally within minutes of giving birth her energy was back - makes you think doesn't it. Perhaps there's something about the process that opens stuck valves (even if yiu didn't know you had them).

People within my own family have had spontaneous resolution of hemiplegic migraine after child birth.
Thyroid disease, Vitamin D deficiency, hypermobility, 'ME/CFS', CCSVI (stenosis both sides and assymetric malformed valves), TMJ - No MS but many neuro symptoms.
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Re: WHY WE NEED VALVES

Postby Cece » Sun Sep 25, 2011 9:03 am

I gave birth three times (no caesareans) but still had 99% and 80% blocked jugulars due to valves. It didn't pop them open in my case! :)
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