I'm Being Referred to a Surgeon...

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Elcarim

Well-known member
Joined
Jul 17, 2007
Messages
113
Location
Victoria, Australia
I'll try to give you the abridged version... I was born with a bicuspid aortic valve, which was replaced with a tissue valve in 2000 and then a mech valve in 2005. After the second surgery I ended up with heart block, hence a pacemaker, and a few years later it was found that the pacemaker lead was impeding the function of the tricuspid valve. My condition held steady for a long time, but 15 years down the track I am 46yo and the right side of my heart has become enlarged.

I feel pretty good, I have no symptoms like swelling in extremities or shortness of breath. I have to manage my energy levels carefully, but I get by pretty well on a combination of exercise, good hydration and plenty of sleep. I'm a self employed potter, I breed ponies, and my life is pretty good at the moment after many challenging years.

I saw my cardiologist today who said that it is time to put me in the hands of a surgeon to discuss my options and manage the timing of surgery if that is the best way to go. He said that even if my heart keeps going as it is for another 10 years at my age that is not really good enough, and I am kind of encouraged that he is thinking long term. But I know tricuspid valve surgery is risky, and having two other surgeries behind me only increases that risk.

I remember waking up after my second AVR with my new mech valve that should last forever and feeling absolutely elated that I had survived and would not have to go through another OHS. To get 18 years down the track and be facing it again is a lot to deal with. I have so many memories of my time in hospital, and none of them are good. I've had bad anxiety about my health for most of the last 15 years, and it is only recently that I have been able to start making longer-term plans again. So... yeah, it's a lot.

I know there is a good chance that I could come out of surgery in better shape than I went in and be able to live an active life for a good while yet, but I am still pretty scared.

So I guess my life is in a holding pattern until I get to consult with a surgeon. In the meantime I guess I should probably get my teeth sorted, as I am pretty sure I need a couple of fillings. Do they still do dental checks before heart surgery? As I said to my partner today, the only thing I am more scared of than open heart surgery is going to the dentist...
 
Hey, sorry to hear

To get 18 years down the track and be facing it again is a lot to deal with.
I know its no consolation, but at least its not the valve ¯\_(ツ)_/¯

Its often said that once you get into Club OHS that something else will perhaps drive another surgery, maybe nothing to do with the surgery, something like Endo is not uncommon. I haven't heard of the pacing wire disturbing the tricuspid before, so I'm guessing that's not common (right?).

the only thing I am more scared of than open heart surgery is going to the dentist...
I believe I know how you feel. I end up with white knuckles gripping my hands and my dentist usually asks me if I'm ok (with stuff in my mouth). I usually say "unn ughhh"

I hope it all goes better this time

Here's hoping
 
I am sorry to hear about your complications.

I am no surgeon. and I dont understand the details of your case. However, is the issue is regurgitation, perhaps they could try to repair the tricuspid valve via transcatheter?

From the randomised trial below, that seems to be a as good as OHS.

https://www.nejm.org/doi/full/10.1056/NEJMoa2300525
Perhaps that is worth exploring with your cardiologist and surgeon?

Good luck
 
Do they still do dental checks before heart surgery?
AFAIK yes. From the pre-surgery discussion in Fall of 2022, they were concerned about a possibility of loose fillings/crowns. I doubt this changed. Would imagine there may be a concern about infections, if there is an on-going tooth decay.

Thanks for the story. A part of me wonders if the pacemaker leads should've been adjusted earlier...

Best of luck!
 
I try to avoid dentists at all costs -- I've used amoxicillin to take care of some toothaches (which may be due to inflammation because of some nasty bacteria). I usually (in the past, fortunately) had brief dental pain that seems to resolve (so far) in a few minutes.

I'm pretty sure that I'll probably have to bite the bullet (or the rubber thingy that holds my mouth open), but am intimidated by the whole idea of seeing a dentist. (When I was three years old I had 36 cavities - more than one in some teeth - and probably have memories firmly embedded from that time).

There are a LOT of dentists in my area - probably more than McDonald's and Jack in the Box combined - but it's hard to know who is good (they're all licensed, so should be at least FAIR) - and who I can actually trust to not recommend a lot of extractions and a lifetime of trying to manage dental 'appliances,' which I KNOW I won't do.

I know this is off topic.

I recently had my pacemaker 'upgraded,' and the surgeon didn't use one of the leads (and I'm not sure why). He told me that I can never have an MRI (presumably because of the disconnected lead). I HAD an MRI, with a representative of Abbott, who made the pacemaker, adjusting and readjusting the pacemaker). I don't know anything about your lead, or about leads that may interfere with your valve.

I wish you good luck, and success, with whatever approach you choose to take.
 
Do they still do dental checks before heart surgery?
Yep, they do in Ireland anyway. I had to get a letter from dentist before my AVR a couple of years ago.

If I get my teeth cleaned by dental hygienist or anything else that might involve bacteria getting into the bloodstream, I have to take prophylactic.
 
Thanks for mentioning dentists. I just called and made an appointment! The dental visits don’t bother me. I’ve even had crowns done with no shots.
I’ve had 3 surgeries, and actually recovered quite well after the 3rd. My issues were lots of scar tissue the surgeon had to get through and then a partial collapsed lung, also a pressure sore on my heel which took forever to heal. But I was only in the hospital 6 days.
I know it’s disheartening to face a 3rd surgery. I wasn’t nervous until the morning of my surgery and my hands were shaking. I asked for the most qualified person to intubate me and also for a good scar. Ha, I guess I wasn’t nervous, yet when asking for those things!
 
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I am sorry to hear about your complications.

I am no surgeon. and I dont understand the details of your case. However, is the issue is regurgitation, perhaps they could try to repair the tricuspid valve via transcatheter?

From the randomised trial below, that seems to be a as good as OHS.

https://www.nejm.org/doi/full/10.1056/NEJMoa2300525
Perhaps that is worth exploring with your cardiologist and surgeon?

Good luck
Thanks for the link, I will check it out. It would certainly be nice to avoid a full sternotomy this time around.

Edited to add: the findings of that study are very encouraging, I will definitely be bringing this up when I see a surgeon. Thanks again!
 
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Just in case it helps someone - I am not bothered by the dentist but my son with autism is, to the point had had eight cavities and we tried tons of dentists and he just could not stay calm (he is terrified of all anesthesia and tranquilizers too) But we found a dentist who uses a solara laser and he was able to have all cavities filled in one appointment with no sedation, not even Novocain - and zero pain. Just thought I’d mention it.
 
Yep, they do in Ireland anyway. I had to get a letter from dentist before my AVR a couple of years ago.

If I get my teeth cleaned by dental hygienist or anything else that might involve bacteria getting into the bloodstream, I have to take prophylactic.
Yes, I've just had a deep clean of all my teeth. It was required for me to be able to get my 'dental clearance' at my pre-surgery appointment
 
I'll try to give you the abridged version... I was born with a bicuspid aortic valve, which was replaced with a tissue valve in 2000 and then a mech valve in 2005. After the second surgery I ended up with heart block, hence a pacemaker, and a few years later it was found that the pacemaker lead was impeding the function of the tricuspid valve. My condition held steady for a long time, but 15 years down the track I am 46yo and the right side of my heart has become enlarged.

I feel pretty good, I have no symptoms like swelling in extremities or shortness of breath. I have to manage my energy levels carefully, but I get by pretty well on a combination of exercise, good hydration and plenty of sleep. I'm a self employed potter, I breed ponies, and my life is pretty good at the moment after many challenging years.

I saw my cardiologist today who said that it is time to put me in the hands of a surgeon to discuss my options and manage the timing of surgery if that is the best way to go. He said that even if my heart keeps going as it is for another 10 years at my age that is not really good enough, and I am kind of encouraged that he is thinking long term. But I know tricuspid valve surgery is risky, and having two other surgeries behind me only increases that risk.

I remember waking up after my second AVR with my new mech valve that should last forever and feeling absolutely elated that I had survived and would not have to go through another OHS. To get 18 years down the track and be facing it again is a lot to deal with. I have so many memories of my time in hospital, and none of them are good. I've had bad anxiety about my health for most of the last 15 years, and it is only recently that I have been able to start making longer-term plans again. So... yeah, it's a lot.

I know there is a good chance that I could come out of surgery in better shape than I went in and be able to live an active life for a good while yet, but I am still pretty scared.

So I guess my life is in a holding pattern until I get to consult with a surgeon. In the meantime I guess I should probably get my teeth sorted, as I am pretty sure I need a couple of fillings. Do they still do dental checks before heart surgery? As I said to my partner today, the only thing I am more scared of than open heart surgery is going to the dentist...
Yes, they still do dental checks. I am in Victoria, and have just had my dental check which was requested by the hospital to get clearance for my surgery later this month. I needed to have a complete deep cleaning of all my teeth. It's important to do I think, so luckily it didn't bother me too much. It was just one more thing to tick off the pre-surgery list
 
My current cardiologist certainly seemed to think so, although he did not quite come straight out and say it.
Regarding rerouting the PM lead. I'm assuming the surgeon ran the lead right through the tricuspid valve where it can interfere with the leaflets. Apparently that is standard procedure because my surgeon was going to do the same thing. During our discussion prior to the OHS I asked if the lead could be run around the valve by going under the sewing skirt. Surgeon immediately said, yes he could do that, like he'd done it before. I don't why that isn't SOP.

They can do amazing things now percutaneously so maybe they could replace that lead with a new one or reroute the existing lead, threading it around the tricuspid by slipping it under the valve's sewing ring, and thereby avoid another OHS. Worth asking. I hope they can do it!
-Dana
 
Dental health is connected to heart health. Us OHS people need to practice good dental health: brushing of course. But also ...

  • floss regularly
  • dentist every 6 months for a cleaning
  • waterpik a couple times a week to get what the flossing can't
  • consider swishing your mouth with some Listerine after flossing to disinfect anything you've disturbed
 

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