harleygirl528
Well-known member
Hi there,
I have my first surery consult yesterday with Dr. Teply at Swedish Medical Center in Seattle. It was a very tired, day-long excursion as it turned out. I live on the other side of Puget sound and so my husband and I took the ferry across to seattle and then a cab ride to the hospital. We ended up waiting 2.5 hours just to see the surgeon, which was fine because as it turned out he was in the middle of a surgery and I realize that comes first! They were fitting me in and it wasn't normally his day for consults so I appreciated that. My sister, who is a nurse in a cardiac cath lab, went along for support which was great.
Anyway, here is what he said: My aneurysm is actually right at 5 cm according to angiogram CT...not 4.8 cm. He does do aneurysm repairs involving the root and the arch...he says he does about 10 a year...but said for some reason this year he had done more, probably 10 in the last month. In fact, the surgery he was getting out of involved a lady with a 7.8 cm aneurysm.
He said that I do meet the criteria for surgery if I wanted to do it now but that it would be completely appropriate to take a "wait and watch" approach, get a ct in 3 months to see if it has grown and then every 6 months after that. He says that I am at a lower risk of rupture because he has me on blood pressure medicine (toprol 25 mg). He seemed to be very calm, cool and collected. He took us in and showed us the aneurysm on CT...and also noted a couple of congential abnormalities with my heart...something to do with my coronary arteries being almost fused together and enlarged...and my heart is enlarged which he says there is nothing that can be done about that.
We talked about my valve and replacement options...my aortic insufficiency is mild and he felt that there was a 80% chance of sparing my native valve for now. He feels that there is a 95% chance that aortic valve replacments will be done percutaneously ...without going through the sternum, etc. within the next 5 years. He felt that tissue valves work better then mechanical and since the future is bringing less invasive procedures for replacements that might be a viable option for me to consider...makes sense to me if they don't have to open up my chest! If I opted for mechanical he felt St. Jude's was best option...I asked him about On-X...he said they haven't been around as long and don't have the track record of success yet so he didn't recommend. I know lots of you have had this valve so I am sure there are advantages to it.
He did feel fairly confident that I have a bicuspid valve and said I present with classic results of that....the aneurysm involving root and arch. He said it looks like the aneurysm of the arch only involves one of the coronary valves so he wouldn't have to reimplant all three.
I don't know if doing 10 of these a year really makes me feel totally comforable...he was referring to aortic aneurysm repairs involving root and arch...I am sure he does a lot more valve replacments without aneurysm.
My dilemna is two-fold: Is doing 10 of these a year really enough to make you an expert in this field? Also, is this "wait and watch" approach desirable just because I am on blood pressure medicine? What would be the advantages to waiting? I realize that timing is important and I am relieved that he isn't whisking me in tomorrow...I want to get things situated at home...I have a 9 year old daughter...it would be great to do it on a school break or something.
The hospital itself is really beautiful....Swedish has several different buildings..this particular "wing" is dedicated solely to cardiac and neuro surgery and care. It looks to be recently renovated and is immaculate and clean smelling with modern furnishings ammenities...there is a Starbucks right across from the family waiting room...which lit up my sister's eyes!
Also, he said that in terms of the ventilator, I may only have to be on it for 3 hours...he would be cognizant of the fact that I am terrifed of this...and I may even be off it before I leave recovery.
I did send all of my records off to the Cleveland Clinic and I will be curious to hear what they have to say. Turns out there are quite a few out of pocket expenses involved in just having them review your records...almost $1000! My insurance won't cover since I am living in the tricare west region...yikes...Maybe I should just tell them to hold off on review? I did call my insurance company and told them I want to get a second option asap...
Thanks in advance for sharing your thoughts on these issues...sorry for being so wordy!
I have my first surery consult yesterday with Dr. Teply at Swedish Medical Center in Seattle. It was a very tired, day-long excursion as it turned out. I live on the other side of Puget sound and so my husband and I took the ferry across to seattle and then a cab ride to the hospital. We ended up waiting 2.5 hours just to see the surgeon, which was fine because as it turned out he was in the middle of a surgery and I realize that comes first! They were fitting me in and it wasn't normally his day for consults so I appreciated that. My sister, who is a nurse in a cardiac cath lab, went along for support which was great.
Anyway, here is what he said: My aneurysm is actually right at 5 cm according to angiogram CT...not 4.8 cm. He does do aneurysm repairs involving the root and the arch...he says he does about 10 a year...but said for some reason this year he had done more, probably 10 in the last month. In fact, the surgery he was getting out of involved a lady with a 7.8 cm aneurysm.
He said that I do meet the criteria for surgery if I wanted to do it now but that it would be completely appropriate to take a "wait and watch" approach, get a ct in 3 months to see if it has grown and then every 6 months after that. He says that I am at a lower risk of rupture because he has me on blood pressure medicine (toprol 25 mg). He seemed to be very calm, cool and collected. He took us in and showed us the aneurysm on CT...and also noted a couple of congential abnormalities with my heart...something to do with my coronary arteries being almost fused together and enlarged...and my heart is enlarged which he says there is nothing that can be done about that.
We talked about my valve and replacement options...my aortic insufficiency is mild and he felt that there was a 80% chance of sparing my native valve for now. He feels that there is a 95% chance that aortic valve replacments will be done percutaneously ...without going through the sternum, etc. within the next 5 years. He felt that tissue valves work better then mechanical and since the future is bringing less invasive procedures for replacements that might be a viable option for me to consider...makes sense to me if they don't have to open up my chest! If I opted for mechanical he felt St. Jude's was best option...I asked him about On-X...he said they haven't been around as long and don't have the track record of success yet so he didn't recommend. I know lots of you have had this valve so I am sure there are advantages to it.
He did feel fairly confident that I have a bicuspid valve and said I present with classic results of that....the aneurysm involving root and arch. He said it looks like the aneurysm of the arch only involves one of the coronary valves so he wouldn't have to reimplant all three.
I don't know if doing 10 of these a year really makes me feel totally comforable...he was referring to aortic aneurysm repairs involving root and arch...I am sure he does a lot more valve replacments without aneurysm.
My dilemna is two-fold: Is doing 10 of these a year really enough to make you an expert in this field? Also, is this "wait and watch" approach desirable just because I am on blood pressure medicine? What would be the advantages to waiting? I realize that timing is important and I am relieved that he isn't whisking me in tomorrow...I want to get things situated at home...I have a 9 year old daughter...it would be great to do it on a school break or something.
The hospital itself is really beautiful....Swedish has several different buildings..this particular "wing" is dedicated solely to cardiac and neuro surgery and care. It looks to be recently renovated and is immaculate and clean smelling with modern furnishings ammenities...there is a Starbucks right across from the family waiting room...which lit up my sister's eyes!
Also, he said that in terms of the ventilator, I may only have to be on it for 3 hours...he would be cognizant of the fact that I am terrifed of this...and I may even be off it before I leave recovery.
I did send all of my records off to the Cleveland Clinic and I will be curious to hear what they have to say. Turns out there are quite a few out of pocket expenses involved in just having them review your records...almost $1000! My insurance won't cover since I am living in the tricare west region...yikes...Maybe I should just tell them to hold off on review? I did call my insurance company and told them I want to get a second option asap...
Thanks in advance for sharing your thoughts on these issues...sorry for being so wordy!
