Opinions on Surgery

[Ashley]

Hi Everyone,

I haven't posted in some time, but have been reading through the formums and lurking around I saw my cardiologiest recently, and she sent me a follow-up letter with the following information:

Severve stenosis with peak and mean gradients of 64 and 37 mmHG respectively.
Aortic valve area of .61 cm2.
Trace AR.

Things seem to be getting worse as when I had a cath in May of 2005, my numbers were:

Peak gradient of 74 mmHG. Aortic valve gradient of 53 mmHG, and valve area of 1.067 cm2 (the echo I had just prior to this indicated an area of .68 and PG/MG of 85/40 mmHG).

Sorry for all the numbers. Just wondering if anyone has any thoughts - it's all a bit confusing.

Thanks!
Ashley

 

[Susan BAV]

Hi Ashley -

The cath numbers should be more accurate than the echo measurements. But it's clear that you are not getting better. What does your cardio recommend? Can she recommend an excellent surgeon for you to discuss these results with? Cardios and surgeons often seem to have different opinions as to when the valves need replaced. Are you symptamatic? Hopefully others will post more specific info for you to consider. Keep us posted and take care.

 

[Magic8Ball]

Theres not enough info on what your cardio suggests etc but i'd certainly be interviewing prospective surgeons now.

You don't want to wait for further test results and then be told you must have surgery soon and be all flustered thinking you don't have time to check everyone out.

Regards.

 

[tobagotwo]

If those valve area measurments are accurate, you should already have your surgery set up.

What on earth is your doctor waiting for? For you to collapse in his office?

Best wishes,

 

[the art den lady]

I couldn't find any peak value, but my mean gradient was 55 this year and 37 a year and a half ago. My valve size is at .98 cm2. I'm pretty sure my cardiologist at one time said .8 is critical. I'll be having my surgery next Friday.

Do you have any symptoms? Shortness of breath, fatigue???

-------------------------------------------------------

1995 - TIAs (mini strokes) started after birth of my daughter, Aspirin started.
1996 - BAV w/mild stenosis diagnosed.
2003 - PFO (hole in heart) fixed w/Amplatzer. 3 catheters up the legs.
2003 - FVL (clotting disorder) diagnosed, 10 mg daily Coumadin started.
2/16/07 - Surgery for BAV w/severe stenosis, Mechanical Valve, Dr. Suri, Mayo Clinic.

Expect the best. Prepare for the worse.

I intend to live forever -- so far, so good.

"Life is great, life is grand. Life is like a rubber band." - Jackie Beach

 

[ALCapshaw2]

Many Cardiologists and Surgeons recommend Aortic Valve Replacement when the Effective Opening Area is 0.8 sq cm or less.

Your gradients (the pressure drop across the valve) indicates that your heart is having to beat much harder than normal to pump blood to your body. I would expect that you may even be showing signs of ENLARGEMENT of your heart. Do you have all your old echocardiogram reports? If so, check your chamber dimensions for signs of enlargement (i.e. increasing numbers).

Bottom Line: You are MORE than ready for Valve Replacement. Continuing to wait only causes more damage to your heart muscle and walls, possibly becoming PERMANENT if you let it go too long.

I would recommend that you interview Surgeon(s) ASAP.

'AL Capshaw'

 

[Ashley]

Thanks so much everyone. I really appreciate all the great feedback. I am not sure what they are waiting for. I don't have any symptoms, and that seems to be the determining factor. I think because my cath showed such a different valve area to my echo they think the echo results are "false". Can they tell if a heart is enlarging from the echo? I hope that isn't the case.

Thanks,

Ashley

 

[ALCapshaw2]

Ashley,

"Old School" Cardiologists tended to be VERY Conservative in recommending Surgery. With the extremely HIGH Success Rates, Surgeons, and now even Cardiologists, are coming around to understand that there is GREATER RISK of Permanent Damage in postponing surgery.

Again, my recommendation is to start Interviewing SURGEONS and let the Surgeon determine WHEN to proceed. Waiting for symptoms only GUARANTEES that MORE DAMAGE is being done to your heart muscles and walls.

'AL Capshaw'

 

[Ashley]

Thanks Al. I am not sure how the American system works, but I am not sure if I get the option of talking to a surgeon in Canada. Maybe a Canadian can weigh in?

I think what happens is that they bring my "case" in front of a panel of doctors, surgeons (I hope) etc., and they all decide on a course of action. I belong to an Adult Congenital Heart Clinic.

My cardiologist seems to feel that they won't need to intervene until I decide to have children - as I wouldn't fair well to be pregnant in my current situation.

I think I'll ask her about talking directly to a surgeon.

I feel great - so it's hard to think that something is actually wrong, but I know the numbers aren't good.

 

[Adrienne]

Hi Ashley,

I live in Montreal. I know that each province's health system is slightly different, and I don't know what province you are in, but I can tell you that I spoke to a surgeon when I was looking for 2nd, 3rd and 4th opinions. The surgeon I spoke to is the surgeon that did my operation. He is the chief of surgery at the Montreal Heart Institute. It took me a while to get the appointment, but I did get one. O.K. I have to admit that one thing that helped me get the appointment was that my husband spoke to a doctor whose parents were family friends of my husband's parents and he kind of paved the way. In any case, I would sure try.