Different strokes...

Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
Thanks. Sorry about my endless replies. My surgery got canceled is because my doctor and I had a disagreement relating to the incision I'm trying to get him to do a smaller one either he doesn't think it's a good idea where he's not capable it's just weird cuz he's a senior surgeon. I should be getting my LPA test back again as well today. I'll let you know.
Oh man. Your surgeon has decided that you are impossible to deal with. OF COURSE he does not want to use a surgical technique that is wrong for you. Both because "Killing patients is bad" and "I'm the one dealing with a malpractice suit when this guy gets complications due to his demands." Also thinking "Why the hell did I go to medical school and get years of experience in valve surgery when THIS guy knows it all?"

This may be a perspective-taking issue related to autism which is why I am being blunt with you and explaining, so hopefully this can go better next time.
 
I never remembered to ask why my incision was longer with each surgery.
It is 10” long after the 3rd surgery. A lot was done and 3 hrs of cutting thru scar tissue. Maybe they just know it needs to be a longer incision or the dr doing the incision knows it needs to be longer than the last. I wish sometimes I was friends with a heart surgeon so I could ask these questions during a normal friendly conversation when I think about it!
 
The plain fact is that these scars give you bragging rights. A few months after my OHS, I took my daughter to a father/daughter dinner at her school. Somehow, the subject of heart surgery came up. I embarrassed my daughter (and probably other daughters) when she saw me and the other fathers opening our shirts to show our scars. I don't remember if I won.

But, yeah, for some of us, it may be a matter of 'my scar is bigger than your scar - nyah nee nyah nee nya nya'.
 
Not to be cosmetic but we all hate the longer incisions why do they do longer ones each time if you don't mind me asking?
I'm sure there are disfigured people out there that would gladly trade the scar(s) on their face with a scar on their chest. Your question never came up with my wife's 3 OHS. It's not a scar to her, it's her lifeline.
 
In August last year, I had a 45 second or so episode of double vision (diplopia) while driving in the fast lane. It momentarily made driving safely extremely difficult. The double vision eventually resolved, and I hogged the slow lane back to London without a recurrence of the issue.

I thought the diplopia may have been tiredness/eye strain from driving or low blood sugar. But I erred on the side of caution and got it checked out.

At the A&E they did a thorough work up… full blood count, MRI head scan, carotid artery echo, bloods for endocarditis. All came back clear. Was referred to ophthalmology for eye tests. Those tests all proved clear.

In early December, I was out and about and suddenly felt unwell and lightheaded and headed for home. Once home, I still felt queasy and dizzy, but then suddenly my left arm and hand felt a tad heavy and disconnected.

I’m having a stroke, I thought.

I sat myself down considering what to do, and things appeared to resolve themselves just as quickly as they had begun. I headed for A&E.

Had a variety of tests at A&E and initially treated as trans ischaemic attack and loaded with Aspirin 300 mg to be taken daily (up from my usual 75mg daily) and discharged with TIA clinic follow-up.

An MRI of my head a few days later showed tiny cerebellar infarcts, which the consultant said might explain my symptoms. It thankfully wasn’t a bigger and more debilitating cerebellar infarction. These tiny infarcts were new and not showing on my previous August MRI following the double vision episode. I’ve noticed distinct short-term memory issues since this “minor stroke”.

The stroke consultant wanted to rule out cardio-embolic source of the ischaemic stroke, considering my background history of bioprosthetic valve.

Told to stop aspirin and switch to Clopidogel 75mg daily until further notice. There was to be no driving for one month.

New blood cultures for endocarditis came back negative. Full bloods taken all looked fine. Wore an ECG monitor for 7 days. Lots of stuff in that, but I wasn’t sure how to read it. They were mainly testing for atrial fibrillation, which didn’t seem to be an issue. There was another clear scan of the carotid artery.

A recent related (29 February) echocardiogram result came back, and it states:


On comparison to previous echo April 2023 at GSST, there is an increase in gradients across the aortic valve replacement.

Tissue aortic valve in situ appears well seated.

Peak v max 3.8 m/s,

gradient 58 mmHg,

mean 28 mmHg,

functional AVA 1.1cm²

DVI 0.31.

No obvious regurgitation.

Dilated LA (Left Atrium).



This shows my gradients are up from April 2023 and considerably up from a 4 month post August 2019 replacement reading of peak gradient 22mmHg and mean gradient 12mmHg.

For context, my final gradients pre AVR op were mean 60mmHg, peak 33mmHg

My aortic valve area is now moderate at 1.1cm². 4 month post replacement aortic valve area was 1.8cm². So edging towards severe.

Left Atrium dilated. Not sure of the significance of that.

I had an annual cardiac review booked for late May but had an urgent cardiology consultation a few days ago.

The cardiologist did a review and now wants me on warfarin, probably indefinitely, because of the cerebellar infarcts. She also suggested a low dose beta blocker (Bisoprolol) for the higher ventricular ectopic beats percentage that she noted reviewing the 7 day Holter monitor data.

She’s arranging an urgent cardiac angio CT scan of my 4 ½ year-old Inspiris Resilia bioprosthetic valve to look for any issues (BPVT – bioprosthetic valve thrombosis being one of them, I believe). The cardiologist confirmed my aortic valve area is now moderate and will monitor it again in six months with an echo. She will liaise with the stroke clinic.

She said my readings were not suggesting another surgery at this stage. But let’s see where things are in a year or two and what happens to my gradients and aortic valve area with warfarin treatment. Perhaps they will stabilise? Or better, I’m hoping the warfarin will reduce the current gradients. I read something about the possibility of that effect in a number of research papers. Let’s see.

Valve in valve (TAVI/TAVR) does not appeal to me for various reasons and is an unlikely option anyway I imagine, considering I have first degree heart block and left bundle branch block from my previous AVR surgery, plus the infarcts.

Should the day for re-operation arrive anytime in the next few years, I’m currently inclined to go mechanical. At least I will be warfarin savvy and well practiced by then… he said hopefully!

Onwards.
I’m so sorry to hear you are going through this. But I’m grateful you shared your story as it helps me think about some things. In Oct (nearly 6 months ago) I had AVR and aortic root repair and I awoke to the worst double vision I’ve ever had. That was the only lasting symptom of what we strongly suspect was a TIA I suffered during surgery. I had full left side weakness according to my wife, which resolved fully by the time I regained awareness after the surgery. But the double-vision was so bad I had to wear an eyepatch for the 5 days in the hospital. Long story short, it fully resolved after 3 months and today my vision is back to normal. I am very grateful looking back that it wasn’t worse.

I wish you the very best in your journey!
 
I’m so sorry to hear you are going through this. But I’m grateful you shared your story as it helps me think about some things. In Oct (nearly 6 months ago) I had AVR and aortic root repair and I awoke to the worst double vision I’ve ever had. That was the only lasting symptom of what we strongly suspect was a TIA I suffered during surgery. I had full left side weakness according to my wife, which resolved fully by the time I regained awareness after the surgery. But the double-vision was so bad I had to wear an eyepatch for the 5 days in the hospital. Long story short, it fully resolved after 3 months and today my vision is back to normal. I am very grateful looking back that it wasn’t worse.

I wish you the very best in your journey!
Hi @HokieHade

Many thanks for the words. Sorry to read about your post surgery stroke experience but pleased to know it eventually resolved. Good news indeed.

That's interesting that you mention the double vision and the eye patch. During my diplopia episode when I was driving, and basically trying not to crash, I spontaneously put one hand over one of my eyes and my chaotic vision instantly stabilised. Removing it, all hell let loose again.

I found out later I was experiencing binocular diplopia and not monocular. I read that monocular diplopia is more common and usually less serious. But binocular can be an indication of something a tad more unsavoury. Possibly, in my case, a warning TIA, although nothing was confirmed during my initial episode A&E work up.

What causes diplopia?​

There are many possible causes of diplopia. The most common causes include:

Monocular diplopia​

Binocular diplopia​


I'll update on how things develop going forward.

Sending good thoughts and best your way.
 
I spontaneously put one hand over one of my eyes and my chaotic vision instantly stabilised. Removing it, all hell let loose again.
That's interesting because whenever I get an episode of double vision I immediately cover one eye and that stabilizes me or else I feel completely dizzy and unstable.

My double vision is related to the migraine auras which I developed immediately post surgery.
 
I have an issue where my eyes don't coordinate - it makes depth perception for items within, say, 3 or 4 feet very difficult without effort. I think I've probably had it all my life.

There are times when both eyes turn on for distance things -- somehow, I'm able to ignore the different signals from both eyes (or they focus together on the same object). Still, I don't often have 'viewmaster' (remember those?) moments unless I really try. It doesn't help, either, that I need new glasses, with different corrections for each eye - this means that my eyes are seeing things differently from each other and this probably makes it even harder for the two to coordinate.

(Just a thought - for those with occasional double vision - is it possible that both eyes see things differently (you need a different prescription for each eye) and your brain doesn't know how to process the two images when it tries to combine them?)
 
Hi David.

Just to clarify to the other readers, I am aware that your Lp(a) was measured in mg/dL, because you sent me the results.

Getting a reading of 89mg/dL, compared to 88mg/dL 4.5 years ago, would mean that your level has not changed. This is to be expected and is exactly what I predicted a few posts up when I said the following to you:



I'll again underscore why the units matter when reporting Lp(a) results. If youre measurement was in nmol/L, a reading of 89 would only represent a mildly elevated risk, the threshold being 75nmol/L. However, as your measurement was actually 89mg/dL, this represents a significantly higher risk level, >30mg/dL being considered elevated risk and >50mg/dL considered substantially elevated risk for cardiovascular events, stroke and aortic stenosis.
Agreed and understood Chuck. Luckily in Thailand they call LPA in the proper unit measurement therefore I don't have to do any complicated multiplication.
 
Interesting hearing about the double-vision experiences.

What I'm about to say is not heart or stroke related but allows me to identify with the discomfort you folks are mentioning. Double-vision is not fun at all and can be rather frightening!

I was just at the eye Dr last week. Had that thing over my face where he changed the lenses for various eyes and asked is #1 better than #2 as you look at lines of letters of various degrees of size etc etc etc. We did all that for each eye at a time with other eye blocked. When he later followed up doing that with both eyes at one point I experienced double vision! He had asked me to read the letters and I couldn't! Told him I had double vision and couldn't read anything. He then had to fix something in what he was doing with the lenses then it cleared right up.

Thankfully the only other times I've had something like that is due to my eyeglasses getting knocked about, and not sitting straight on my face. But when it happens it sure is uncomfortable! I can't imagine having to deal with that for days/weeks/etc until it goes away...
 
Years ago, when I was taking Lanoxin (digoxin), I occasionally experienced a weird phenomenon - it wasn't double vision, but bright lights seemed to have ANOTHER directly below them. This was apparently a documented side effect from the drug.
 
  • Like
Reactions: V__
But before you said:
My surgery was cancelled 3 days before I was to enter the hospital. No reason was given.
I've lost touch with this thread, so please accept my apology for not reacting sooner (also apology to @dornole for same).

I'm trying to not get spanked (albeit gently) for my statements.

My name is Blunt ... Pellicle Blunt (forgive me Sean)

1715306759398.png
 
On the 25th day after my surgery, blurred vision occurred in my left eye and recovered after about 10 seconds. To be honest, I didn't think much of it at the time, and I didn't even realise that it could be caused by a clot.

Last night I had blurred vision in my left eye and this time it cleared up after about 3 minutes. This time I went to the emergency department of the nearby medical faculty hospital..

The emergency doctor first wanted to take my MRI, but I told them that I had a mechanical heart valve and I refused. Then they took my brain tomography, they took blood tests and took an ECG.

Finally the ophthalmologist came (by this time it was 2 am.) She gave me a detailed eye examination and told me that there was no problem with the eye vessels and that the clot had probably passed through that area. She looked at the brain tomography image after I reminded her and said the result was clean. (I was exposed to x-ray for no reason)

I use warfarin regularly, my inr level is in the normal range (2.35), so why am I having such depressing experiences?

I don't know if I'm too sensitive and worried, but all ophthalmologists on Youtube state that this situation is very dangerous and may be an eye stroke and recommend an urgent visit to an ophthalmologist.

I would like to get the opinions of those who have similar problems
 
I use warfarin regularly, my inr level is in the normal range (2.35), so why am I having such depressing experiences?
sadly its because "it just happens" ... some people would suggest that such an incident would be cause to justify a higher INR ... to me 2.3 (which in itself should be properly understood as ±0.1 anyway) is the lower end of safe, and if it happens a 3rd time I'd move to range of 2.5 ~ 3.5

are you also taking aspirin?
 
I would move to that first, as its actually what is required (for instance) during the On-X protocol. I would also move your INR target to 2.5 and when below that make minor adjustments to move up, when above 3 make minor adjustments to move back. There is no benefit to being below 2.3

I take half a 300mg tablet (IE 150mg) every second day as I find this alleviates a small ocular / blance issue I have from time to time. For the first 8 or so years I didn't take aspirin after my 3rd OHS; well excluding the first 3 months when I did. I did this because I know that:
  • duration of platelets (upon which aspirin acts) is 7 to 10 days.
  • half life of aspirin is short.
  • I prefer having some platelets which are "good and fully functioning" as this has had a positive impact (pun intended) on how I bruise
  • always take your aspirin with something (such as mouthful of milk or a spoon of yoghurt)


You may find this thread interesting.
https://www.valvereplacement.org/th...focus-on-bleeds-and-cancer.889418/post-930332
 
I finally got sent a copy of my Cardiac CT results recently sent to my GP:

... This showed good mobility of his bioprosthetic aortic valve leaflets with only mild generalised hypo attenuated thickening (HALT), no evidence of thrombus, mild LAD disease.

These findings are overall reassuring, showing satisfactory function of his bioprosthetic aortic valve and no presence of valve thrombosis.

In view of previously confirmed small cardio embolic strokes and mildly thickened valve leaflets, I think he should continue with warfarin long term.


So no evidence of valve thrombosis, which is good news. But...

In view of previously confirmed small cardio embolic strokes and mildly thickened valve leaflets, I think he should continue with warfarin long term.

Of course, there has still been an increase in gradients from a year ago and an incremental narrowing of the Aortic Valve Area also, close to the severe range. A review of that will be part of the follow-up monitoring due in September (echo and face-to-face consult). Let's see.

I'm still unsure what caused the clots, exactly.

... mild LAD disease

Would rather not have any degree of LAD disease, but hey ho. It could be worse.
 
Last edited:
Back
Top