Bypass not required

[Rick W]

Hello to all my good friends at VR.

I was thrilled to find out that my coronary arteries are clear during my angiogram yesterday. Looks like my AVR surgery might be delayed for a little longer as the results for valve area and mean gradient pressure were better than revealed by my last ECHO. More good news, all the chamber volumes and pressures were also normal. What a relief knowing that the heart itself is in fine shape and AVR surgery will be that much less involved. What is really interesting here is that I have always had elevated cholesterol and triglycerides a good diet and exercise, but did not suffer any CAD. Just like Steve, I will be "wait around" just a little longer.
The cardiologist said I am at 0.9 cm2 and he won't be concerned until it gets below 0.8 cm2 but did not offer a timeline.
Also, I was surprised that the angiogram did not reveal whether I had a bicuspid valve or not. I would welcome any and all comments.

Rick

 

[hensylee]

Truly good news that your heart is in good shape. Are you on any cholesterol lowering meds? Just curious since you mention high cholesterol and triglycerides.

Congratulations. The mountain will not be in your immediate future and that's wonderful news. God bless

 

[Bill Hall]

Rick - Great news. Not only do you get to delay surgery, but even if you have to, it will be easy going (comparatively speaking). About the cholesterol. I heard that it is the ratio of the LDL to the HDL that is important. My cathreization in 1999 showed my arteries were clear, but my cholesterol was high in 2002, LDL 219 to HDL 35. The doctor recommended I get more exercise and reduce fats, so I did. My Sept reading was LDL 180 to HDL 33, much better. The doctor told me 180 or lower for LDL and 40 or higher for HDL were the correct ratios.

 

[epstns]

We saved your seat. . .

We saved your seat. . .

Hey Rick,

Glad to hear you're "stable" (relatively speaking) enough to hang around with us for a while longer. We'll always save your seat in the waiting room until the surgeon comes out and says "It all went just fine."

My cardio warned me in advance that they won't predict a timeline because every case progresses at a different rate. One study I remember reading found that valve area (in their sample) decreased on the average about 0.1 sq cm per year. They didn't indicate the range, though, so it doesn't tell us much to plan around.

Anyway, glad you're still doing OK. Stay well -- we're all in this together.

 

[Nancy]

Rick-

That's very good news, a happy surprise. Enjoy your little Birthday Present, so to speak. I hope it will stay OK for a long time.

 

[ALCapshaw2]

Hello Rick,

One more question for your Cardiologist is whether you have any enlargement of the heart. This can occur due to higher pressures caused by a narrowed valve opening and may or may not subside following surgery. Bottom Line: It is better to have surgery BEFORE permanent damage is done to the heart walls.

I was in a somewhat similar situation as you in that I was told that I needed surgery. I got a second opinion one week before the scheduled date and the concensus between the cardiologist and another surgeon was to wait. There had been some discrepancy between the Echo and Cath results. The second cardiologist hoped I could get 2 to 4 more years from my valves. Bottom Line: ONE year later, my symptoms (shortness of breath on exertion) were noticably declining and there was no longer a discrepancy between the Cath and Echo results (0.8 vs 0.9 cm sq) I scheduled surgery for 3 months later to 'get ready (will, taxes, etc) and was REALLY noticing a decline the last few weeks
before surgery. I went into the local hospital 2 days before my scheduled date and ended up getting a 100 mile ambulance ride to the hospital where my surgery was performed. I hate to think of what may have happened if I had waited any longer.

Bottom Line: Get your affairs in order (Will, Living Will, Powers of Attorney, Donor considerations, etc.) study the valve options, and talk with a *surgeon* (or two) BEFORE it becomes critical. You may even want to set up a 'tentative' date.

'AL'

 

[ccrawford]

Hi Rick

Hi Rick

Glad to hear your news Rick. Looks like you'll be reading some of these old magazines in the waiting room with Steve and I - I may not have to wait too much longer, but sounds like you have some breathing room. An angiogram cannot detect a bicuspid valve Rick because it simply uses a flow of dye to show which arteries are flowing or not flowing. An echocardiogram will pick up whether your valve is bicuspid.

 

[Rick W]

Thanks to everyone who replied. I would like to address all the comments at one time.

The last echo report in Jan. did not reveal an enlarged heart and inconclusive about the valve being bicuspid. I got the angiogram done to get a second surgeons opinion. I will see which one I prefer to have do the surgery. The one I met with already will also need to see the results of the angiogram. They both are highly regarded and so are the hospitals. Al, you bring up a good point about getting things in order and I have been working on it.
The doctors were eluding that I ought to preparing myself to undergo this surgery before the year is out, but now I don't know. I would like to get it over with.
The site where the Cath was inserted is still sore, but not red or swollen. I had a previous stiffness in the area for some strange reason as there is also a hernia repair on the same site, but they avoided hitting it, they think because I told them about it. Anyone tell me how long they were sore?

Rick

 

[ccrawford]

post cath

post cath

Hey Rick - My first cath resulted in soreness for about a week or so and a bruise that went away after about a month. It tends to look worse than it is. I'm surprised your echo didn't pick up whether your valve was bicusp or not. Both of my echos have shown the valve clearly, and the fact that two of my three cusps are fused-were you distracting the lady echo technician ?????lol,Chris

 

[John Cochran]

All bicuspid valves are not created equal

Sometimes a conventional echo is not conclusive, and a TEE (trans-esophogeal echocardiogram) is then performed, which is much clearer. However, this is not really a big deal, as it sounds like you have a degenerative valve condition that will continue to progress--could be a unicuspid valve or a deformed tricuspid valve, or a bicuspid valve. At any rate, the degeneration is the result of on-going calcification of the valve.

Steve's metric of the valve area diminishing about 0.1 cm squared per year agrees with what I've read and heard from my doctors. However, I think in the late stages, it can progress much more rapidly. Mine went from 0.8 cm squared to less than 0.6 cm squared in less than six months.

Getting your affairs in order is a good idea, especially since it seems to be a big stress reducer once you've done it. That said, this surgery is extremely successful, with a survival rate over 98 percent. And remember that includes a lot of very old people and those with other health issues.

I know that this is a very hard time for you and your family, but all of us here will try to help any way we can!

Best,
--John

 

[ALCapshaw2]

CATH SITE SORENESS

CATH SITE SORENESS

The only comment I can make on Cath site soreness is to take it easy for a few days, maybe up to a week. The only hematoma I've experienced came after trying to go back to work too soon (3 days?) and pushing it a bit too hard.

If you ever need another cath, ASK the cardiologist if he would use the other leg because of your hernia repair and reaction to your first cath. Hopefully he will accomodate you.

'AL'