Jason
Always Assume Positive Intent
Hello all,
I had my 1-month follow up and handoff to cardiology today, which due to schedules actually occurred on my 6-week post-op date. In general the meetings went very well, with one slight moment of panic.
First, I met with my surgeon's PAC, as my surgeon was still in surgery operating on someone else. We had a good discussion, and he told me that my chest X-ray, EKG, bloodwork and Echo all looked great. I had 20 questions for him all typed up (literally) which he thought was kind of funny, but we walked through them. My ejection fraction before surgery was 65%, and after is measured as 60%. My aortic root was measured by CT and post echo as slightly dilated at 4.0cm, which is better than the 4.2cm it measured in previous echos. I am released to drive, although not to working full time as they want to see how driving is for me in town before I start driving out of town for long days, as my job requires. My sternum is still clicking and presenting some tightness, which is the muscles and nerves coming back together. I am going to run the remainder of the amiodorone I have out and then stop it cold-turkey, and the metoprolol will stay where it is and we will evaluate it as we go. They were actually concerned with my heart rate due to how slow it is, running in the low 50's resting. My pre-surgery resting heart rate was 75-85 bpm, so quite different. However, taking the amiodorone off should make a big change in that number.
I was asking Matt (the PAC) about the rationale behind leaving a slightly dilated root as opposed to replacing it with a total graft. I was pressing him about dilation of the root in the future, as it seemed to me that a smaller valve, followed by a slightly dilated root, followed by a smaller graft was a balloon waiting to happen. He explained how short the root was and how it was structurally enforced with the ring from the mechanical valve as well as the sutures to the graft. He was just explaining to me that studies indicate good long-term success with no further dilation after AVR and grafting of the aorta. He again explained that there is risk with scar tissue forming at the attachment point of the coronary arteries, the time of surgery and time on the bypass machine goes up as well, etc. Just then my new cardio walked in.
His first words were, "So what's the plan?" I knew I had a meeting with him scheduled after my meeting with the surgical team, but this seemed a bit odd. The PAC also looked surprised, and explained that he could join us right now if he wanted, etc. The cardio said "Well, from the echo his aorta is over 5cm, on it's way to 5.5cm, so just wondering what the plan is." The PAC grabbed him and said that they should go review the echo, as he had been waiting for him to read it, etc. and they walked out of the room. For a few minutes my wife and I were sure that the root had already dilated and I was looking at another surgery, despite our present conversation.
The PAC and the cardio came back in, and the cardio was very red-faced and apologetic. The PAC explained that he had been reading the echo from just before the surgery, and indeed I had needed surgery. Both of them proceeded to tell me that my new echo looked great, and risk of further dilation was very low.
Finally, I met with my surgeon. She was very happy with her handiwork, and we talked for a short while and reviewed what I had talked about with the cardio and her PAC. From the sounds of it, this is my last meeting with her. I will meet with my cardio at six months unless something changes, at which time I am supposed to call him or his staff. We will run an echo at that time if there is anything that would indicate this, or else we will do that at 1 year and every year after.
Someone had asked earlier if I would have permanent restrictions due to the aortic graft, and the answer I got today was no. The restrictions I am on now is for the incision site, and those will drop off as everything heals up.
Overall, I had a very good visit and feel much better afterwards. Aside from the little mix-up of the cardio thinking I was pre-surgical instead of post-surgical, it was excellent!
I had my 1-month follow up and handoff to cardiology today, which due to schedules actually occurred on my 6-week post-op date. In general the meetings went very well, with one slight moment of panic.
First, I met with my surgeon's PAC, as my surgeon was still in surgery operating on someone else. We had a good discussion, and he told me that my chest X-ray, EKG, bloodwork and Echo all looked great. I had 20 questions for him all typed up (literally) which he thought was kind of funny, but we walked through them. My ejection fraction before surgery was 65%, and after is measured as 60%. My aortic root was measured by CT and post echo as slightly dilated at 4.0cm, which is better than the 4.2cm it measured in previous echos. I am released to drive, although not to working full time as they want to see how driving is for me in town before I start driving out of town for long days, as my job requires. My sternum is still clicking and presenting some tightness, which is the muscles and nerves coming back together. I am going to run the remainder of the amiodorone I have out and then stop it cold-turkey, and the metoprolol will stay where it is and we will evaluate it as we go. They were actually concerned with my heart rate due to how slow it is, running in the low 50's resting. My pre-surgery resting heart rate was 75-85 bpm, so quite different. However, taking the amiodorone off should make a big change in that number.
I was asking Matt (the PAC) about the rationale behind leaving a slightly dilated root as opposed to replacing it with a total graft. I was pressing him about dilation of the root in the future, as it seemed to me that a smaller valve, followed by a slightly dilated root, followed by a smaller graft was a balloon waiting to happen. He explained how short the root was and how it was structurally enforced with the ring from the mechanical valve as well as the sutures to the graft. He was just explaining to me that studies indicate good long-term success with no further dilation after AVR and grafting of the aorta. He again explained that there is risk with scar tissue forming at the attachment point of the coronary arteries, the time of surgery and time on the bypass machine goes up as well, etc. Just then my new cardio walked in.
His first words were, "So what's the plan?" I knew I had a meeting with him scheduled after my meeting with the surgical team, but this seemed a bit odd. The PAC also looked surprised, and explained that he could join us right now if he wanted, etc. The cardio said "Well, from the echo his aorta is over 5cm, on it's way to 5.5cm, so just wondering what the plan is." The PAC grabbed him and said that they should go review the echo, as he had been waiting for him to read it, etc. and they walked out of the room. For a few minutes my wife and I were sure that the root had already dilated and I was looking at another surgery, despite our present conversation.
The PAC and the cardio came back in, and the cardio was very red-faced and apologetic. The PAC explained that he had been reading the echo from just before the surgery, and indeed I had needed surgery. Both of them proceeded to tell me that my new echo looked great, and risk of further dilation was very low.
Finally, I met with my surgeon. She was very happy with her handiwork, and we talked for a short while and reviewed what I had talked about with the cardio and her PAC. From the sounds of it, this is my last meeting with her. I will meet with my cardio at six months unless something changes, at which time I am supposed to call him or his staff. We will run an echo at that time if there is anything that would indicate this, or else we will do that at 1 year and every year after.
Someone had asked earlier if I would have permanent restrictions due to the aortic graft, and the answer I got today was no. The restrictions I am on now is for the incision site, and those will drop off as everything heals up.
Overall, I had a very good visit and feel much better afterwards. Aside from the little mix-up of the cardio thinking I was pre-surgical instead of post-surgical, it was excellent!
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