Questions about aortic valve regurg surgery...not new to this valve disease

[bramma11]

Hello all...

My name is Debbie ...I have been on this site many times ...I have in the past posted...Recently I have just been reading posts & information ....The following holds a lonnng list of information...But, I would really appreciate your help & information/opinions/suggestions....

I would like to ask a few question of those of you who 'have been there'...BUT, first, some info leading up to my questions...

Stress echo on Dec 20 2011= Ejection fraction results = 45% at rest and didn't raise above 50% after the treadmill stressing excercise...Cardiologist ordered because >
Echo in Oct 2011 revealed ejection fraction was 50%
Cardiolite stress test March 2011 revealed ejection fraction = 56%= no showing of progression of coronary artery disease
Chest Xray on March 15 - lungs clear but upper aorta showing calcification -
Echo in 2010 = ejection fraction = 60%.
(Many more echos prior since aortic regurg diagnosis in 1992)

I am a 65 year old female..not over weight..fairly healthy diet...not much excercise

I am with the Mayo Health System in Eau CLaire, Wisconsin.

My symptoms are: progressively more fatigue, shortness of breath = up stairs etc, 2-3 pillows used to sleep, at times have a kind of choking sensation when laying down=a little harder time to breathe with ease...

My cardiologist gave me further info from the Stress Echo on Dec 20 = mild heart enlargement, moderate aortic regurg, on the lower end of average for my age with the stress testing....I don't have the echo report yet to list other levels/values...And, as my cardiologist reminded me, as I have always known, that reading echos are subjective...

In addition, because I have had very little excercise & need a determination if my being basically 'out of shape' is causing more of a problem than the valve/ejection fraction/heart, my cardio wants another 'definitive' pulmonary stress test which he has set up with the Mayo Clinic, Rochester, Mn in the Valvular department at Mayo...Also, my cardio told me that because the valve is still at a moderate level & only mild
enlargement, etc - he is not fully convinced it is time for surgery yet....I really like this cardio I have & appreciate his push to get a second opinion = see the following to explain.

I mentioned the word 'definitive' meaning my cardio has had 2 lengthy
conversations with me regarding the possible need for surgery & he wants Mayo to do this Pulmonary testing & get a second opinion from Mayo as to whether or not there is a need to replace the valve at this time...

MORE MEDICAL INFORMATION/BACKGROUND:
1. Diagnosed w/aortic valve regurg in 1992..on spironolactone @ 25mg per tab 3 times per day for fluid retention - also need for kidney disease retention

2. diagnosed hypothyroid 1992..on levothyroxin @.88 mg

3. diagnosed w/coronary mild artery disease in 2001 via angiogram for R&L ventricle - angiogram was performed because my echo at that time was - suffice it to say - interpreted as showing abnormal results & a thallium injection test was ordered & showing - again 'abnormal' results & then the angiogram was ordered...As it turned out, the thallium injection test was false/positive....& the angiogram proved no need for valve replacement but did show mild coronary artery disease

4. diagnosed w/lyphedema (arms only)1993

5. diagnosed w/celiac disease via endoscopy biopsy 2004 & endoscopy again in 2009 to check for cancer-non found

6. high cholesterol now under control with Pravastatin @20mg

7. high blood pressure in better control...medication=Amlodipine @5mg (per
nephrologist=need care w/blood pressure meds because of kidney disease

8. diagnosed with 3rd stage chronic kidney disease =39 egfr=creatnine=1.34...have one kidney (donor in 1992 for sister)

9. spine arthritis - had laminectomy surgery in 2010

Please respond with any opinions,suggestions, info you have regarding the above information

Ok...Now my questions:
1. Whether or not I will have surgery at this time or not...I am facing it at some point in time - One of my concerns is that I have Chronic Kidney Disease - Based on what my cardio told me & ALLLL that I have researched, I know that the kidney disease can become worse after surgery...Whether it stays that way or not - I don't know???? (I will be visiting & testing with my nephrologist)....Have any of you had kidney disease prior to having this aortic valve surgery????....Please, if you
have, tell me your thoughts, experiences, & medical/health consequences...

2. An angiogram will be done prior to surgery - my cardio said he will 'spread' the time out between the two - all the dyes, etc from such testing such as an angiogram is very hard on the kidneys - in my case only one kidney...My cardio told me if I have coronary artery blockage - a bypass would be done....Have you had a bypass in addition to aortic valve replacement?...How was the recovery?

3. Is it true that ALWAYS a lung (s) are collapsed during this surgery?

4. Is it true that ALWAYS insulin is given because the body goes into a diabetic state during/after surgery?

5. Is it true that ALWAYS warfarin/coumaden is administered during/after
surgery?...I will opt for a tissue valve (having kidney disease & other autoimmune diseases would be dangerous for me to have a mechanical valve & the need for coumaden)

I think that will do for my questions at this time...
Thank you for your responses...I will be looking forward to reading any & all responses...

Debbie

 

[Lynlw]

Hi debbi, it sounds like ou have alot of differnt things going on so it is good the card is trying to find out what symptons might be caused by your heart/valve or what caused by the other issues.
To ME given everything it sounds like part of the reason you need extra pillows might have more to do with the extra fluid than your valve or your Ef that is slightly lower than normal to normal depending on the test and results, but im not a doc just a Mom.

the quick answers to everything else
There have been a couple members here who have had kidney problems or 1 kidney before their surgery, it makes sense to space the cath and surgery to let the dye get out and kidneys as good as possible going into surgery.
Quite a few member also had CABGs during their valve surgery, the main difference in recovery seems to be if they also have another surgical site to deal with where the vein was harvested, otherwise they usually get home in about the same time as people who only had valve surgery..of couse the better shape you are going into surgery usually helps with the recovery.

It is not true a lung is Always collapsed
it is NOT true the body always goes into a diabetic state and need insulin, but it isnt that uncommon to need it for a short time.

It is not true IF you get a tissue valve you will always need a short time of Coumadin. Justin has had many OHS and never needed coumadin The trend seems to be going AWAY from a short course (3 month) of Coumadin after tissue valve implants and more surgeons/cards are just giving aspirin post op. Sometimes they keep you on it, usually if your in the age group many docs reccomend almost everyone take asprin for the benefits

 

[bramma11]

Thank you Lynn...your info was very helpful...I really appreciate your time to help me...

take care
Merry Christmas
Debbie

 

[Bill B]

Your cardiologist's approach sounds reasonable to me. S/he is concerned enough to refer you for a second opinion to the Mayo, which you know is one of the top 5 heart surgery centers in America. I think you will get a definitive answer as to whether the valve is a significant factor in your symptoms and whether surgery is indicated.

Your single kidney is doing about as well as my two kidneys. I had a pretty large rise in creatinine immediately after surgery, but it resolved in a few days (back to 1.3). I had a CAT scan with contrast 4 days after surgery. They used a treatment prior to the contrast that was intended to reduce the effect on the kidneys. Nothing bad happened from the contrast despite the creatinine rise a few days earlier.

Many, many people, including my mom, have CABGs at the same time as valve surgery. It's certainly the right time to fix that too, if needed. At this point you don't know if that will be needed. The cath will delineate that. Any other disease issues, such as CAD or CRF, do add somewhat to the risk of OHS. Still, the over all risk is quite low and the benefits are extremely high from CABGs and valve repair or replacement.

Get the pending tests done and go for the second opinion.

 

[Jkm7]

I also like your cardiologist's approach.

Quick answer to a few of your questions as applied to me:
I have never been diabetic but my second OHS, I received two doses of insulin immediately post op. By day two post op, I was testing normal glucose and never again received insulin.

I have tissue mitral valve and my surgeon ordered three month course of coumadin while my own tissue grew over the seating of the valve. As it turned out, I metabolized coumadin at a high rate and he didn't like the very high dosage to try to get me in range and had me stop the coumadin 2 1/2 months post op. I take aspirin now. My surgeries were at Mass General and they leaned toward short use of comadin post op. That surgery was almost four years ago so it may have changed in the interim.

 

[bramma11]

Thank you Bill B & JKM7= good information from both of you...I have in the past been diagnosed 'borderline' with Type 2 Diabetes...But, the last tests revealed a normal range...so, hopefully that is still holding true - will know with further testing IF surgery is the final outcome....

I am concerned with all of the possible meds/drugs needed during/after surgery...And, a concern with the anesthesia because I have had 'problems' with it in past with surgery - especially the donor nephrectomy - My recovery from that surgery was very, very difficult...At that time donor nephrectomy surgeries were quite different than today...I have a scar from almost mid abdomen to near mid spine & a rib was removed...I went into ICU for almost a day after post op with a tracheotomy team ready because of the concern I couldn't breathe on my own...it didn't take place, but I had 'issues' thereafter that were concerns.... It took me about 1 1/2 years to recoup....lots of problems...Therefore, I am & will be as diligent as I can with acquired knowledge regarding all of my health issues.....I am not necessarily scared of the surgery itself- it's more of the recuperation time that concerns me...


Anyway, thank you both for your time to help me...I most certainly appreciate it.
Debbie