reffered to a Cardiovascular & Thoracic Surgeon by my general physician???

[paulschumann]

I was born with BAV and havn't been to a Dr. in years, decided to finally go in since the little voice in my head wouldn't shut up about it. I had to see a general physician first to be referred to a regular cardiologist since I did not have one. My blood pressure was 120 over 60 my blood work was perfect, cholesterol, blood cell counts etc etc, and my eccho showed 1.3 cm of my bav with some stenosis and I was under the assumption after I was givven an appointment date and a Dr.'s name I was being reffered to a cardiologist. I decided to look over the hospital's website and see that the Dr.'s name I have an appointment with is under the cardiovascular and thorasic surgery not the cardiologists section of the hospital.

any particular reason for this, or am I just making mountains out of mole hills? and cardiovascular & thorasic surgeons are who physicians typically refer people to with my condition?

 

[ALCapshaw2]

Are you saying that your FIRST appointment beyond your GP is with a Surgeon?

That is unusual.

With BAV, you would be best served by a Surgeon who has LOTS of Experience dealing with BAV and the often associated Connective Tissue Disorders. Such surgeons are most often found at the Major Heart Hospitals such as Mayo Clinic in Rochester, MN or Cleveland Clinic. You need to know that these issues are a step above 'mere' valve replacement. Personally, I would NOT be comfortable using a surgeon who only sees such patients a few times per year.

 

[paulschumann]

Yes, so far I have had one appointment with a GP, where I had an eccho, an EKG, and wore a holter monitor for 24 hours. brought the holter back, they took some blood and called me the following week with my test results which were all good (according to the GP) except for the size of my BAV (1.3cm) and said she was expecting surgery within a couple of months, the next day her nurse called and said my appointment with Dr. Brown at St. Alexis is on June 27th.

heres a link to some of his info. I hate to scrutinize and seem like such an "Angie's List" shopper, but I don't even want the best surgeon in the world doing (deleted gory details) this kind of major surgery on me if it wasn't such a very plain choice of life & death. but who knows maybe he's just serving as a cardiologist because the others are booked up.

http://www.endovascularfellowshiptraining.com/news/Michael+R.+Brown%2C+M.D.%2C+PhD%2C+F.A.C.S./

http://www.alexius.org/customers/finddoctor/specialist/specialty_sub_search.asp?SpecialtyID=5

 

[epstns]

Paul,
I would be surprised if a cardiologist proposed surgery yet, although a surgeon might. Your valve area, at 1.3 cm2, is not yet at the usual trigger point for surgery. Barring other complications or the emergence of symptoms, most cardiologists do not recommend surgery until the valve area approaches 0.8 cm2. I know that Al will chime in with a valid comment that "Sooner is better" for aortic valve replacement, but if a cardiologist agrees, you can probably get more years out of your existing valve. As an example, my valve area was about the same as yours when my aortic stenosis was diagnosed, and I had it replaced over 9 years later. I may have carried things a bit too far, but if yours stays stable, as it may, you can likely continue for a few years until you need surgery.

For all of the above noted reasons, I would suggest that you respectfully ask your GP for a referral to a cardiologist before you start interviewing surgeons. Cardiologists have a different job, in that they do a complete evaluation of your heart and vascular systems, and can develop a treatment plan tailored to your present condition, diagnosis and life style. They will then decide if now is the time (yet) to refer you to a surgeon. If your GP doesn't agree, I might be tempted to find another GP, too. (I speak from experience - I "fired" my GP when she missed the diagnosis of my heart murmur, which started my entire valve replacement journey.)

All this aside, welcome to The Waiting Room, the virtual room where many folks await their own turns at valve surgery. Stay a while, visit often and ask all the questions you want. The family here has a wealth of first hand knowledge of all things related to valves and surgery, and they are the most caring and sharing people I've found yet.

 

[ALCapshaw2]

Yes, so far I have had one appointment with a GP, where I had an eccho, an EKG, and wore a holter monitor for 24 hours. brought the holter back, they took some blood and called me the following week with my test results which were all good (according to the GP) except for the size of my BAV (1.3cm) and said she was expecting surgery within a couple of months, the next day her nurse called and said my appointment with Dr. Brown at St. Alexis is on June 27th.

heres a link to some of his info. I hate to scrutinize and seem like such an "Angie's List" shopper, but I don't even want the best surgeon in the world doing (deleted gory details) this kind of major surgery on me if it wasn't such a very plain choice of life & death. but who knows maybe he's just serving as a cardiologist because the others are booked up.

http://www.endovascularfellowshiptraining.com/news/Michael+R.+Brown%2C+M.D.%2C+PhD%2C+F.A.C.S./

http://www.alexius.org/customers/finddoctor/specialist/specialty_sub_search.asp?SpecialtyID=5

I looked over both links and there was a conspicuous absense of DATES or any indication of how long this Surgeon has been practicing. I would want to know how many Bicuspid Aortic Valves he has replaced in the last year and how long he has been practicing.

Beating Heart Surgery for Coronary Artery Bypass Grafting (CABG) is an interesting option for Bypass patients but is typically NOT done for Valve Replacement. If the Vast Majority of this Surgeon's experience is doing Bypass Surgery, I would look for a more experienced Valve Surgeon.

I would also want to know if he KNOWS how to recognize signs of Connective Tissue Disorder which is often associated with BAV and can lead to Aortic Aneurysms and if he has done any Surgery of the Aorta which is another step up in complexity above Valve Surgery. (i.e. If I lived in North Dakota, I'd be calling the Mayo Clinic for an appointment with their Aorta Specialist ... I've forgotten his name... hopefully it will come to me later).
EDIT - Dr. Sundt is the Aorta Surgery Specialist at the Mayo Clinic.

As Steve recommended, you should first establish a relationship (and have a work-up) with a Cardiologist, preferably one who has treated several (many) l patients with BAV. I can't believe your GP suggested you would need Aortic Valve Replacement within 2 or 3 months with an Effective Aortic Valve Area of 1.3 sq cm. The usual 'trigger' for recommending replacement is 0.8 sq cm.

'AL Capshaw'

 

[paulschumann]

well I just called St ALexis with some questions and this surgeon's nurse was also confused, however she said the GP noted severe stenosis of the aorta with moderate to severe aortic insufficiency on my eccho results. so I agreed to keep my appointment with him just to at least let him look at the eccho & other tests to see what he thinks, and since they can't get me in to see a cardiologist for 6 months. can I just call Mayo and make an appointment. I had a hard enough time finding a cardiologist (and still havn't)

 

[kfay]

I don't know much about BAV, but to answer your question about the Mayo, yes, you can just call up and make an appt., or you can have that GP refer you to there as well if your insurance requires it. You will get a very through work up there, probably the best you've ever had.

Good luck,

Kim

 

[Lynlw]

well I just called St ALexis with some questions and this surgeon's nurse was also confused, however she said the GP noted severe stenosis of the aorta with moderate to severe aortic insufficiency on my eccho results. so I agreed to keep my appointment with him just to at least let him look at the eccho & other tests to see what he thinks, and since they can't get me in to see a cardiologist for 6 months. can I just call Mayo and make an appointment. I had a hard enough time finding a cardiologist (and still havn't)

First as Kfay said you can just call the Mayo and request an appt with a cardiologist yourself, as long as your insurance doesn't require a referal.
Its probably a good idea to keep this appt and go over your test results and IF you like this surgeon, I would ask him to rec a local cardiologist, since even if you travel somewhere for surgery, its good to have a local cardiologist too. Also if you don't already have them, ask for copies of your test results, so you can keep track of how things are progressing etc.

I don't know anything about Dr. Brown,(or St Aleius hospital) but from the St Alex link you gave it looks like he has been there since 2000. so has been an attending surgeons at least 11 years
"Michael Brown, MD, PhD
Dr. Michael Brown joined the staff at the Heart & Lung Clinic in July 2000. He is a specialist in cardiovascular and thoracic surgery, with special interests in the surgical treatment of thoracic cancers, palmar hydrosis (sweaty palms), beating heart surgery, heart valve repair and surgical treatment of atrial fibrillation."

 

[paulschumann]

but what is "severe stenosis"? if my sq cm is at 1.3? is "severe" a matter of opinion? and varies from a general physician to a cardiologist and a surgeon or is severe steonsis of the aorta a specific measurement?

 

[normofthenorth]

Paul, I want to second what Al said -- that it's very unusual to go straight from a GP to a cardiac surgeon, without spending some time with a Cardiologist in-between.

But I also find it unusual that you got an EKG, an Echo Cardiogram, and a 48-hour Holter monitor, all from your GP! I got all of those (and multiples of the first two) from my Cardiologist. Does your GP moonlight as a Cardiologist, or have a Cardio specialty?

I don't think my GP or her clinic even owns the gizmos you've been tested with, which is one reason they refer heart patients to Cardiologists!

 

[ALCapshaw2]

well I just called St ALexis with some questions and this surgeon's nurse was also confused, however she said the GP noted severe stenosis of the aorta with moderate to severe aortic insufficiency on my eccho results. so I agreed to keep my appointment with him just to at least let him look at the eccho & other tests to see what he thinks, and since they can't get me in to see a cardiologist for 6 months. can I just call Mayo and make an appointment. I had a hard enough time finding a cardiologist (and still havn't)

I found the following interesting listing from a Google Search for "severe aortic stenosis"
http://www.fpnotebook.com/cv/valve/artcstns.htm

Classification: Aortic Stenosis Severity

Aortic jet velocity

Normal: <2.5 m/sec
Mild: 2.5-2.9 m/sec
Moderate: 3-4 m/sec
Severe: >4 m/sec

Mean gradient

Mild: <25 mmHg
Moderate: 25-40 mmHg
Severe: >40 mmHg
Critical: >50 mmHg

Aortic valve area

Normal: 3 to 4 cm2
Mild: 1.5 to 2 cm2
Moderate: 1 to 1.5 cm2
Severe: <1 cm2
Critical: <0.8 cm2

SO, from this table, Severe Aortic Stenosis is when the Effective Valve Area is reduced to 1.0 square cm or less. It would appear that your GP needs to go re-read the Cardiology section of her Medical Textbooks if she thinks that 1.3 sq cm constitutes severe aortic stenosis.

 

[paulschumann]

Thanks Al thats exactly what I was looking for. I guess my sister in law has had surgery by this Dr. Brown and says he's great. she also does coding for that hospital and told my wife that Dr. brown does not do valve replacement surgery, she is guessing that he was the only available surgeon that could refer me to mayo on short notice.

I'm guessing my GP jumped the gun a bit, and I did tell her I'd like to be reffered to a cardiologist at St. Alexis and have any surgeries I would need at mayo, so maybe she just assumed (after reviewing my tests) I should just skip the cardiologist since they were so backed up anyway. I can't get in touch with her since our town is being evacuated due to major flooding.