Saw New Cardio today

[JulieS]

Hello -
I saw my new Cardio today. So, I had the standard echo and ekg. Told him my issues and he said he knew why. Time to start thinking about the reop. He told me it doesn't have to be tomorrow but to call him after talking about a date with my family. He will then refer me back to Mayo. Just wondering how long do you think I have to schedule. I am thinking 6 months may be too long? He also told me Not to let them replace my mitral valve along with the reop on the aortic valve. He said the mitral issue should clear up when the aortic valve is replaced. He did not give me my mitral numbers but here are my May 2010 and May 2011 numbers:
2010 AVA 1.3 2011 AVA 0.69
2010 Mean Cant remember 2011 50
2010 Peak grad during stress test 63 2011 peak grad during rest today 89
2011 ASC AO 3.4
2011 lvef 60%

Seems to me like the numbers took a dive in the last year. I do have pretty good symptoms. What are you folks thoughts on how long before scheduling would be safe to wait? (There truely is a reason for wanting to wait)

Not sure why the peak resting pressure grad is so high. What does the lvef stand for?

Any thoughts from anyone on these numbers? He also did tell me that no surgeon at the Marshfield Clinic would touch my surgery. Why?

Thanks for everyones thoughts. Gee the day the reality comes for reop, even though you know it's coming..... is still scarey

 

[CATDOG]

Julie,
AVA .69 sounds ready anytime. From what I've read here, most people seem to have their symptoms worsen faster at your level. 6 mo. might be pushing it a bit if you are symptomatic now.
LVEF left ventricle ejection fraction = % of LV volume ejected with each pumping contraction. 60 is still ok I think (but I'm not a doc).
Your Peak gradient of 89....well mine was 100 on last echo, but cardio didn't seem too excited.
I don't know why he would say the local (?) clinic wouldn't do it. Do they not have a cardiac specialty? Are there more complications?
But perhaps you would be better off with a place you know has a lot of experience anyway. You were happy with their work last time at Mayo right? So why not go back there?

 

[Bina]

That AVA of .69 would be my concern.
When my effective AVA was at .80 my symptoms were severe and I was banned from driving my car.
(surgery was a few weeks later)

 

[JulieS]

Thank you. Marshfield Clinic here is not a Mayo. They do heart surgeries but I know they are not as advanced as Mayo surgeons. I am currently waiting for word back on a referral from Marshfield to Mayo. I guess I will go on their recommendation. My Cardio said it all depends on the rate of deterioration. I have so many questions.... with the stenosis as listed above, how can a person have mild aortic insufficiency? So complicated... I just want to feel better and get back to living.

 

[epstns]

Julie,
You can have both aortic stenosis and insufficiency if your valve calcifies severely. It doesn't open all the way, and due to the calcification, it doesn't close all the way, either. One can be mild, the other, severe. No way to know what to expect.

My concern would be your seemingly rapid progression to a very small AVA. A year ago it was bad, now it is a lot worse. I wouldn't wait too long before at least having a consult with a surgeon. Then, based upon what you and the surgeon conclude, you will know when to schedule surgery.

 

[ALCapshaw2]

Re-Do's require cutting through a lot of Scar Tissue and pose an additional risk compared with first time surgeries. You definitely want to use a Surgeon who has considerable experience dealing with re-do surgery. (FYI, most local / regional Heart Hospitals deal primarily with relatively simple ByPass Surgery and maybe a few first time Valve Replacements. For more complex surgeries it is usually best to go to a Major Heart Center, or at least be sure your surgeon has experience doing the procedure you will need).

FYI, a Left Ventrical Ejection Fraction of 60% is smack dab in the middle of the NORMAL range.

With an Aortic Valve Area of 0.67 sq cm, I would recommend making an appointment with a highly experienced valve re-do surgeon ASAP. I would also encourage you to set a date to 'get fixed' before your valve(s) deteriorate further.

'AL Capshaw'

 

[JulieS]

Thank you

I just found out that I have been referred to Dr. Hartzell Schaff at Mayo in Rochester. Has anyone here had him on a redo or other OHS and what was your experience please. THANK YOU

 

[ALCapshaw2]

Thank you

I just found out that I have been referred to Dr. Hartzell Schaff at Mayo in Rochester. Has anyone here had him on a redo or other OHS and what was your experience please. THANK YOU

I not very familiar with him, but have seen his name mentioned here before.
Do a VR Search for keyword "Schaff" and you should be able to find the posts that mentioned his name.
You should also be able to find a profile on the Mayo Clinic website under Doctors or Surgeons (and/or do a Google Search for his name).

'AL Capshaw'

 

[JulieS]

Thank you - I did just that and like you said not alot of mention about him. Also seems like older posts, does anyone have any current dealings with him? Also, when it comes to surgeons and rankings when a surgeon is a professor of surgery what exactly does this mean?