Did you have a follow-up echo 4-6 weeks post-op?

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Amy

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Thank you for your advice about everything up till now. I’m grateful for you guys.

So, two weeks post-op, I had an electrocardiogram. That was it. The cardiologist listened quickly to my chest, but didn’t comment on my incision. He also didn’t give any guidance on continuing either the beta blocker or baby aspirin. He said I wouldn’t need an echo for a year.

I’m wondering if I need to find a new cardiologist - if a post-op echo is recommended, and to ask about my medications.

did you have a post-op follow-up echo?
 

Chuck C

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Thank you for your advice about everything up till now. I’m grateful for you guys.

So, two weeks post-op, I had an electrocardiogram. That was it. The cardiologist listened quickly to my chest, but didn’t comment on my incision. He also didn’t give any guidance on continuing either the beta blocker or baby aspirin. He said I wouldn’t need an echo for a year.

I’m wondering if I need to find a new cardiologist - if a post-op echo is recommended, and to ask about my medications.

did you have a post-op follow-up echo?
Hi Amy.
I had a follow up echo the day they released me from the hospital at UCLA, 7 days after surgery. I'm curious to hear what others think, but 12 months seems way too long to wait for a follow up echo after AVR surgery.
For what it's worth, I am still on 81mg baby aspirin and I'm pretty sure that the plan is to be on this for life, as it lowers the risk of a blood clot. I am also still on beta blocker, but in my follow up cardiologist visit he decreased my dose and moved me to one 50mg tablet of Metoprolol per day, slow release.
 
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Luckyguy17

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. He said I wouldn’t need an echo for a year.

I’m wondering if I need to find a new cardiologist - if a post-op echo is recommended, and to ask about my medications.

did you have a post-op follow-up echo?
Amy, it truly sounds like you have lost confidence in your cardio?

i am scheduled to see my cardio next week, and yes i expect an electrocardiogram, a revue of the hospital prescribed meds and a minimal exam. If no murmur is detected, other than forming a baseplate, not sure what an echo would achieve so early following AVR? But i am curious as to how others will weigh in
 
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Lynn

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Hi Amy, I had a 4 week echo. It was ordered by the surgeon and he communicated to me as part of the discharge information that it should be roughly 30 days after surgery. He made it sound like a standard thing, that should happen before my 6 week cardiologist appointment. In fact when I called to book the 6 week cardio appointment they asked if my echo had been scheduled.
 
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Critter

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I was told that an echo is not required but both surgeon and cardiologist want it so that findings can be followed. Curious as to what my gradient is now after AVR. I plan to schedule one next week.
 
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Chuck C

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It was nice to get some good news on an echo. Having about 5 previous echos with progressively worse news, finally, hemodynamics have improved, as one would expect.
Valve area went from .87cm2 to 2.0cm2, where it is expected to stay.
Mean pressure gradient lowered from 45mmHg to 9mmHg.
 

Amy

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Hmm. I’m still confused, lol. Thank you everyone for chiming in. I guess it wouldn’t hurt to ask for one then, to have a baseline for myself, even if no doctor is interested in my having one right away. Plus it would be great to make sure this cold/sinus infection I’ve developed over the last week hasn’t done anything to the valve (knock very hard on wood). Just need to wait another week or two (I hope) for the incision to completely heal.
 

almost_hectic

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I’m wondering if I need to find a new cardiologist - if a post-op echo is recommended, and to ask about my medications.
did you have a post-op follow-up echo?
I would imagine thats more on your surgeon than your cardiologist. But there's no harm in asking. If you were released by your surgeon I don't see why your cardiologist would feel the need to look at anything since your surgery was so recent.
 
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Chuck C

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Wow, Chuck, that is terrific reduction in mean pressure gradient. Congrats on that good news.
Thanks Lynn. After getting progressively bad news on echos, which is just what happens when we have AS, it was sure nice to finally see the numbers go my way once the new valve was in place :)
 

Amy

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I would imagine thats more on your surgeon than your cardiologist.
I thought so too!! Unfortunately, it seems CC also subscribes to the ‘one and done’ philosophy - - as in, ‘one patient out the door, done answering any questions afterwards’.
 

Chuck C

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I thought so too!! Unfortunately, it seems CC also subscribes to the ‘one and done’ philosophy - - as in, ‘one patient out the door, done answering any questions afterwards’.
I have to say that my experience at UCLA has been very different than this. The surgical team has remained very accessible to me, even 6 weeks out. One of the nurse practitioners who works with my surgeon recently spoke to me about some concerns I had about discomfort while urinating. Her input was critical in getting us on the right path in suggesting it was probably prostate related and not a UTI, which my local urgent care clinic thought it was.
I have direct lines to both my surgeon's nurse practitioner and my cardiologist's nurse practitioner and if I don't get them immediately, they almost always return my call within a few hours.

These clinics make a boat load of money for valve surgery,(I have seen the bills) which is why they promote themselves so hard. It seems the least that they can do is provide good follow up.
 

tezza

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Thank you for your advice about everything up till now. I’m grateful for you guys.

So, two weeks post-op, I had an electrocardiogram. That was it. The cardiologist listened quickly to my chest, but didn’t comment on my incision. He also didn’t give any guidance on continuing either the beta blocker or baby aspirin. He said I wouldn’t need an echo for a year.

I’m wondering if I need to find a new cardiologist - if a post-op echo is recommended, and to ask about my medications.

did you have a post-op follow-up echo?
Hi Amy, my surgeon required a post op echo prior to discharge, so that was 9 days after surgery. My cardiologist wanted an ECG at the 4 week check, and the surgeon has asked for a repeat at the upcoming 8 week check.
 

almost_hectic

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I had a follow up appointment with my surgeon after I was discharged from the hospital. Don't recall how many weeks after that it was. But there's been one or two things that had come up after my surgery (another story) that I did reach out to my surgeons office. The office staff seemed intent on not giving me access to my surgeon. That I was now the responsibility of my cardio and I couldn't see my surgeon unless I had a refferal for surgery. Anyhow I ended up in the ER (false alarm, part of that other story) which got me another follow up appointment with my surgeon. He encouraged me that he was available to me if I ever need anything... which was great to hear, but if his office staff keeps him off limits to me then hows that supposed to work? I imagine its maybe an insurance issue and thats why the office staff views it differently?
 
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Pete81

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Hi Amy, I got the impression that after surgery there’s a switch of tracks. First I had a stress-ecg 6 weeks after surgery which was still part of surgical discharge and a prerequisite for the commencement of the in clinic cardiac rehabilitation program, all under surgeons supervision and in clinic. Then, I was referred back to my local hospital and cardiologist for periodic follow ups, starting with an Echo cardiogram after 2 months, it was said this is important and serves as a baseline image. Whenever issues arise it is helpful to have a good image of post-op function.
 
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johnmarkos

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did you have a post-op follow-up echo?
I was scheduled for one at my cardiologist’s office four weeks after surgery. As it turns out, I was in the hospital next door recovering from AFlutter and tachycardia. They wheeled a very cool mobile echo machine into my hospital room and did it there. The scan showed an increase in ejection fraction to normal (58%, IIRC) and a reduction in left ventricle size to close to normal. Left ventricle size had been up in the range indicating surgery.

My surgeon told me that the echo I got just before surgery showed me very close to or in the early stages of heart failure, so the quick improvement was a great sign! He also said my natural valve was totally trashed (my words) — he had been considering repair rather than replacement, but when he saw the valve he knew immediately he’d be going with mechanical.
 

tom in MO

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My surgeon released me after an X-ray showed good sternum healing. My cardio said an echo wasn't needed at the first appointment, but insurance allowed him some discretion and he scheduled one later just to see. From what I can gather, cardios order echos post-surgery. I was told recently by my cardio that routine echos for mechanical valves are no longer needed.
 
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