Just curious

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Art O Ceitinn

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Before I had my first OHS in 1966 the surgeon offered me a choice. Would you like me to open the front of your chest or to enter from the left side and back. I picked the side and back, as being a 15 year old I was very interested in the opposite sex and did not want to turn them off with a scar in the front. I know I was vain, but my excuse was YOUTH. Any members offered that choice or was it just an Irish thing.
 

tom in MO

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I wasn't offered a choice. When I asked my surgeon, he said he preferred a minimal incision, but frontal access so he can see everything plus "just in case" he needs to do more. Others have been give that choice of front or side.
 

Keithl

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Before I had my first OHS in 1966 the surgeon offered me a choice. Would you like me to open the front of your chest or to enter from the left side and back. I picked the side and back, as being a 15 year old I was very interested in the opposite sex and did not want to turn them off with a scar in the front. I know I was vain, but my excuse was YOUTH. Any members offered that choice or was it just an Irish thing.
1966, that was the early days of OHS, they probably still were figuring out the standards.

 

spartangator

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Yeah, my understanding is that it was part of early thinking about surgical procedures and best practices, as @Keithl says. There were concerns about the scarring as well as the long-term issues of sternum healing.

I wonder, too, in Ireland how much the process was influenced by the fact that valve surgery, I think, started with mitral work, which makes entering through the side more plausible.
 

epstns

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@spartangator hit it, I think. IIRC, back before I had my valve replaced there was a lot of discussion here about alternate methods and the consensus was that for aortic valves, the surgeons always wanted full frontal access either via a full sternotomy or a mini-sternotomy. For mitral valve work, a number of the surgeons seemed to offer (favor?) access through the ribs or elsewhere. Their logic was that they needed to access different areas of the heart, and different incisions helped them to do so.
 

almost_hectic

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My valve replacement was initially scheduled to be a minimally invasive procedure whereby the surgeon was going to make a small horizontal incision between two ribs (don't recall the name of that approach) and leave a scar not much more than a couple of inches. Later when it was found out I also need an aortic graft they said they needed more access and so I had a mini-sternotomy instead. Still minimally invasive but I ended up with a vertical incision in the middle of my chest from the top of the ribs down but its only about 3.5 inches long, instead of the normal 10 inch.
 

newarrior

Have moderate AS live in Asia
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My valve replacement was initially scheduled to be a minimally invasive procedure whereby the surgeon was going to make a small horizontal incision between two ribs (don't recall the name of that approach) and leave a scar not much more than a couple of inches. Later when it was found out I also need an aortic graft they said they needed more access and so I had a mini-sternotomy instead. Still minimally invasive but I ended up with a vertical incision in the middle of my chest from the top of the ribs down but its only about 3.5 inches long, instead of the normal 10 inch.
What is why aortic graft ?)
 

newarrior

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Did you know this in advance? I asked because I may have to pay cash for everything
 

Superman

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Did you know this in advance? I asked because I may have to pay cash for everything
Generally an echo will show dilation of the aortic root and ascending or even descending aorta. Rough estimates tsken from the echo may prompt further investigation, typically via MRI or CT scan for precise measurement. Measurements greater than 4 cm may prompt more serious following. Somewhere north of 5.0 to 5.5 centimeters will require surgery where they replace the offending section of the aorta with a Dacron graft (a flexible but bullet proof material).

If you’re being followed with regular echoes, this typically won’t come as a surprise as it is a progression. Like a balloon slowly expanding over years. However fast progression may prompt earlier intervention, Mine went from 2.6 cm’s to 4.9 cm’s in a couple years. We decided not to gamble on another year and just got it done.
 
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newarrior

Have moderate AS live in Asia
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Generally an echo will show dilation of the aortic root and ascending or even descending aorta. Rough estimates tsken from the echo may prompt further investigation, typically via MRI or CT scan for precise measurement. Measurements greater than 4 cm may prompt more serious following. Somewhere north of 5.0 to 5.5 centimeters will require surgery where they replace the offending section of the aorta with a Dacron graft (a flexible but bullet proof material).

If you’re being followed with regular echoes, this typically won’t come as a surprise as it is a progression. Like a balloon slowly expanding over years. However fast progression may prompt earlier intervention, Mine went from 2.6 cm’s to 4.9 cm’s in a couple years. We decided not to gamble on another year and just got it done.
thank you))
 

almost_hectic

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Generally an echo will show dilation of the aortic root and ascending or even descending aorta. Rough estimates tsken from the echo may prompt further investigation, typically via MRI or CT scan for precise measurement. Measurements greater than 4 cm may prompt more serious following. Somewhere north of 5.0 to 5.5 centimeters will require surgery where they replace the offending section of the aorta with a Dacron graft (a flexible but bullet proof material).

If you’re being followed with regular echoes, this typically won’t come as a surprise as it is a progression. Like a balloon slowly expanding over years. However fast progression may prompt earlier intervention, Mine went from 2.6 cm’s to 4.9 cm’s in a couple years. We decided not to gamble on another year and just got it done.
Apparently any prior echo and even a heart Cath all missed my aneurysm and it wasn't spotted until my prep CT scan. Not sure how that worked out, but that's how it went for me.
 

Superman

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Apparently any prior echo and even a heart Cath all missed my aneurysm and it wasn't spotted until my prep CT scan. Not sure how that worked out, but that's how it went for me.
I’m inclined to think that you are an exception for patients who are actively being followed. Glad for you that they caught it when they did. Would have been awful to have to turn around and go right back in.
 

newarrior

Have moderate AS live in Asia
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Apparently any prior echo and even a heart Cath all missed my aneurysm and it wasn't spotted until my prep CT scan. Not sure how that worked out, but that's how it went for me.
Sorry to hear brother--what were the complications and additional cost ? How was your post op recovery ?
 
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