Dr. says I need surgery ASAP

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Sean L

I just got a call from my Cardiologist today who looked at my echocardiogram from last Thursday and says I need surgery as soon as possible. He has me scheduled for a cardiac catheterization Friday which he said is the "setting stage for surgery" He told me my aortic regurgitation is at the severe level, says my ventricle is enlarged and is worried that my heart muscle has already been damaged. I also have a very low heart rate with an average of 38 bpm. He thinks waiting so long my have damaged my hearts ability to beat effectively. He seems to imply that the last cardiologist I had who had the wait and see approach should have done more tests on me and shouldn't have taken that approach.

Anyways, some of you suggested I should get second opinions and this cardiologist basically told me that I don't have time to sit around and wait for second opinions. He says the surgeon will review the cardiac catheritization and make the final decision on the surgery (I had tentatively decided on a surgeon prior to seeing this new cardiologist) . The new Cardio doesn't have a problem with me seeing the surgeon I had tentatively planned on.

However, this entire thing is moving faster than I thought. I had already set an appointment to see another surgeon for a second opinion but that appt. is two weeks out yet as I thought that IF I had surgery that I would have a little time. I was planning on interviewing surgions humming and hawing about it and taking my time to make a decision. Anyways, on one hand I thank this cardiologist for seeing the seriousness of this problem as it MAY be this serious but I am kind of skeptical. However, since the surgeon has the final say I feel a little better.

Thinking logically about this: my prior cardiologist diagnosed it about a year ago with two prior echos and a CT with dye has confirmed the problem. So I have no doubt whatsoever that I have a bicuspid aortic valve with regurgitation. Now I also have pain win exercising and a lower exercise threshold. Since the news today I now feel pain almost all the time (Not sure if I was overlooking the prior aching I felt or if it is in my mind now). Prior to this I did feel some pain at times but I think my mind was playing tricks on me. However, is this cardiologist jumping the gun? I am inclined to trust him.

Any thoughts would be appreciated. Thanks.
 
When I was first diagnosed it was 2/14/08. I was on the table 2/29/08 a mere 15 days later. I was also told that I needed the surgery ASAP. My issue was a bicuspid aortic valve with stenosis. The valve measured .9 and I was told .7 is critical. I also have a gradient (blood flow rate through the valve) of 115 when 20 is normal. I could have waited a few more weeks but like you I think my mind started playing tricks on me. Every little thing I felt was amplified in my mind. So rather than agonize for a few more weeks I decided to get it over with. That whole "sudden death" discussion just didn't sit well with me at all !

If you trust your cardiologist and your happy with the surgeon you've selected then I suggest to get it scheduled ASAP and get it over with. You know you need it. Otherwise your going to continue dealing with the anxieties that lead up to the event itself which I found to be far worse than the actual procedure. I think most people will concur on that. It also sounds like the more you wait there is the potential for more damage to your heart. Pain management after the fact isn't really an issue, that is the #1 priority for the hospital staff for cardiac patients.

Hope this helps....good luck and keep us posted on what you decide on.
 
Sean, this is the way it happened with me;I was being told by one cardio.
to wait for the surgery and this was for years-about 7 yrs I put it off because
the doctors didnt see how unhealthy I really was. I told them about the
extrme shortness of breath,the edema,etc.
So now ,though I had the surgery 9 weeks ago ,I still have SOB and swelling
in the ankles-the SOB seems to be better though.
Since I have right ventricular enlargement and damage it will take about
6-8 mos. for the ventricle to heal(this is what my surgeon told me).So there
is hope ,but you dont want to push it too far. Too far is defined(by me)as
how extreme you SOB , swelling, inabilty to exert yourself-people can tell
how bad something is usually.
So if you have heard good reports on this cardio. and esp. the surgeon,you
might want to think about doing it.BUT if you dont feel comfortable with
your doctors, go to someone else;during surgery you need to trust these
people and have a positive feeling re them. Even if you do feel ok with them,
check out their track record ,how many times they have done your surgery
type, number of successes, infections,etc.
The way it happened with me is the same:eek:ne day on a visit the cardio. told
me That l cant afford to sit on it anymore-my ventricle is getting weaker and
surgery is the only remedy.I had surgery 2 weeks later.
I also believe the less time that you have to dwell on the up coming event,
the easier it is.
Wishing you wellness and success, Dina
 
Sean,
You asked for opinions, so here's mine.
Have the heart cath on Friday, let the surgeon look at it, and if he schedules you for surgery, be thankful that this cardio pushed the timetable up.
 
"Any thoughts appreciated..."

"Any thoughts appreciated..."

It's difficult when it gets right down to making the decision, isn't it Sean? The way you explained things is very much the way that I would feel about it.

My surgery came up suddenly also, after the angiogram, even though I kind of "knew" that it needed to be done. But I had consulted with three surgeons and that had somehow helped me make my mind up and reinforced me mentally in regard to what needed done.

The fact that the surgery is called "elective" has been disconcerting to many of us but it's a very broad term--really a misnomer in my opinion in regard to these types of situations--and you really don't want your valve to get so bad that you need an "emergency" surgery.
 
Certainly none of us have read your echo reports or are qualified to anyways, but we can give you our thoughts on the surgery in general. This should be pretty self-evident, but there is reason to be extremely concerned when your Cardiologist is telling you that you are on the verge of permanent heart damage at the age of 36. At this point (hopefully) you still have the option to have the surgery, go through the difficult road to recovery, and feel much better in a few months and get on with a normal life and lifespan. Based on what your Cardiologist has said, that option may not be available to you even a short time from now. It's very possible for the heart muscle to be so enlarged that it cannot fully recover after it is fixed, and you would continue to have heart-related symptoms for the rest of your life. There is no reason for you to have to go down that path. I personally would push forward as quickly as possible, but what you do is completely up to you.

Best wishes.
 
I think Mary said it pretty succinctly. Sounds like you have been having lots of symptoms. Whether more have surfaced now because they're new, or whether you've just ignored them until faced with the information that causes you not to ignore them anymore (not unusual at all for valve problems) doesn't really matter right now.

Have the cath, see what the surgeon says. If he believes it's an immediate need but you still feel a second opinion is needed - I'm sure they can get another surgeon (maybe even the one you have the appointment with) to view the cath tape quickly and give an opinion without having to schedule a go-see appointment.

Best wishes! Keep us posted.
 
Karlynn said:
I think Mary said it pretty succinctly.

YEAH... getting to the point never was my strong suit,neither are my
organizational skills :eek: DINA
Click to expand...
 
It's clear that you have Heart issues that can only be treated effectively by Surgery so difinitely go ahead and see a surgeon ASAP.

Be sure to ask the surgeon about his experience with BAV and Connective Tissue Disorders (which are often associated with BAV). IF this surgeon does not have a lot of experience with those issues, ask for a referal to someone who does.

THAT is your Best Bet for a 'second opinion'. There's not much that Cardiologists can do for you at this point. They've already done their job by identifying the problem.

And of course go ahead with the Heart Cath. ANY Surgeon will want to see the results of that test before surgery.

'AL Capshaw'
 
Sean,
Look at it this way. You are going to have to have it done at some point anyway. Sooner is better than waiting too long. If the surgeon thinks it's necessary now, I wouldn't hesitate.

With my own experience, I had been closely monitored for over 2 years. Then an annual echo showed some deteriation. My cardiologist wanted to do another echo in a year. I wasn't satisfied with that and wanted to play it safe. I insisted on a surgeons opinion. My cardio didn't think it necessary, but recommended me to a surgeon anyway. My surgeon looked at my info and said "no surgery yet", but recommended another echo in 6 months rather than a year. Well, long story short, 6 months later both cardiologist and surgeon were recommending surgery. Another 6 months would likely have resulted in permanent damage.

Besides, what kind of quality of life is it when you are physically unable to do everyday things? Good luck!
 
Though my cardio had been watching my valve for going on three years, when he saw the change that he said warranted surgery, he wanted surgery quickly. He said I was not in an emergency state but there was no good that would come from waiting. I saw my surgeon within two weeks and was in surgery two weeks after that.

Good luck with your cath. Hope your conversation with your surgeon leaves you feeling secure with him.

Please let us know.
 
My "two opinions" were my Cardiologist and my Cardiac Surgeon. They both came to the same conclusion...I would need surgery within a year and that was good enough for me. Between my GP first noticing the heart murmur for the first time and having the OHS was only about 18 months. Best wishes and good luck.
 
Call your 2nd opinion surgeon and tell him what your cardio is saying. I'm sure that he can get you in right after your TEE. Other than that, I say do your surgery ASAP so you don't have permanent heart damage.
 
Best of luck, hope all goes well. If it needs to be done, better to get it over with, all the best. Take care.
 
Get the tests you need done and keep the ball rolling. If he is that worried you need to have it done soon. Keep us informed will be praying and keeping you in mind.
 
Thanks for the recommendations which are invaluable. My cardiologist spoke with the surgeon and have surgeon's appointment Monday and possibly Tues or Wed will be the surgery. I will keep you posted.
 
ctyguy said:
I also have a gradient (blood flow rate through the valve) of 115 when 20 is normal.
Click to expand...

Actually, GRADIENT refers to the Pressure Difference across a Valve measured in mmHg (millimeters of Mercury) and NOT "blood flow rate through the valve".

'AL Capshaw'
 
It's difficult to pick the optimal time, and symptoms and LV enlargement tolerance vary enormously form person to person. However, the consensus of years of experiences on the site regarding when to do heart surgery really sounds quite sane when you put it into simple words:

"Better too early than too late."

Get whatever confirmation you need. Be sure you are as comfortable as it's human to be with your surgeon. Discuss your valve choice with him (if you want to be involved with the choice), and be comfortable that he will follow the path you've discussed (if possible) or whatever backup plan you discuss (if possible). If you've got a bicuspid valve, ensure that he will check for any possible aortic enlargement and act upon it, rather than leaving it in a "wait and see" state.

Then do what you believe will get you well best and soonest.

Best wishes,
 
Don,t dwell to long. On 08/20/08(Monday) I went in for a cath(my 4th), and as soon as I was out, my cardio and a surgeon were in recovery with me. On 08/24/08(Friday) my aortic valve was replaced. Not much time to think about it, but the one thing I can positively state now, I feel and act like a new person . Rather sudden for me, but thanks to a couple good Dr.'s, at least I can talk about it. To coin a phrase, "Just do it!"
I agree with Mary and Sean. Might as well get it over with. Keep us informed.
 
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