Am I Letting Them Push This Too Fast?

[tigerlily]

Hello everyone. I went to see the surgeon today I'm seriously considering for my second heart surgery. He did my first 12 and a half years ago. I saw him 14 months ago when it first became apparent to me that my aortic tissue valve was degenerating. I went to see him again today to be sure he's my guy and also I wanted to see how he feels about the Inspirus Resilia valve. The first time I saw him, he wasn't using that valve yet and wasn't very interested. Now, he has experience with it and likes the valve quite a bit. He wants to do some more testing besides my most recent echo (which was done at another hospital) including an Echocardiogram Transesophageal Echo and a Cath. I think he mentioned a CT too but I'm not sure about that. Anyway, to get to the point, I'm a little worried that we are rushing things but maybe not. He asked me the usual questions about how do you feel which are so hard to answer! I had very few symptoms before my first valve replacement. I only knew a few weeks before surgery that something was really off. These are my stats from my last echo (July 18) and I'm hoping that some of you can tell me if you were about at this point when some more invasive tests were ordered. I'm also wondering if they find out that surgery isn't needed yet, if these test results will last a while or if they will have to redo them. I guess I also feel weird because I'm moving away from the hospital that followed me previously and planning to move all my cardiology care to where my surgeon is currently practicing. It feels sort of like when you buy a new car and you think you've made a good decision but a part of you is going... Wow, I hope you know what you're doing, that's a big investment.

Aortic Valve:

Mild aortic regurgitation is present. The peak gradient across the

aortic valve is 64mmHg. The mean gradient across the aortic valve is

35mmHg. The aortic valve area by VTI is calculated at 1cm2. DI 0.32

There is moderate to severe aortic stenosis.

Summary:
1. The left ventricular chamber size is normal.
2. The EF is estimated at 55-60%.
3. This is a 23mm aortic prosthesis.
4. There is moderate to severe aortic stenosis.
5. There is mild mitral regurgitation observed.

My aortic root appears to be normal. Thank you everyone.

 

[tom in MO]

I don't know much about the numbers. For me, my echos were first evaluated by my cardiologist not my surgeon. My cardiologist controlled how many tests and when.

Once the cardiologist thought surgery was needed, I saw the surgeon. My subsequent test ordered by the surgeon was a cath just to make sure the only problem was the valve before they opened me up (e.g. no bipass needed). I believe I had the esophageal echo right before surgery but after anesthetization.

I know how you feel about new doctors or hospitals. Personally, I stick with the hospital, until they screw up. I believe in medical teams more than individuals. When I asked my cardio why that surgeon, he told me he was the next in line when the cardio called the scheduler. I asked if he was any good, my cardio said he'd let him do the work on himself. I did investigate the guy and he was solid.

My hospital group screwed up my sleep study big time, so my sleep apnea is treated elsewhere, but I get everything else done at the same place with the same group.

 

[tigerlily]

I don't know much about the numbers. For me, my echos were first evaluated by my cardiologist not my surgeon. My cardiologist controlled how many tests and when.

Once the cardiologist thought surgery was needed, I saw the surgeon. My subsequent test ordered by the surgeon was a cath just to make sure the only problem was the valve before they opened me up (e.g. no bipass needed). I believe I had the esophageal echo right before surgery but after anesthetization.

I know how you feel about new doctors or hospitals. Personally, I stick with the hospital, until they screw up. I believe in medical teams more than individuals. When I asked my cardio why that surgeon, he told me he was the next in line when the cardio called the scheduler. I asked if he was any good, my cardio said he'd let him do the work on himself. I did investigate the guy and he was solid.

My hospital group screwed up my sleep study big time, so my sleep apnea is treated elsewhere, but I get everything else done at the same place with the same group.

That would be the normal way things are done. I'm following my surgeon in this case. He moved from WakeMed in Raleigh to UNC Rex in Raleigh. Although both hospitals do a lot of valve replacements and repairs and other heart surgeries, I like that this surgeon put in my first valve and also that he likes the valve that I would choose if it's a good match. I'm going to be doing some research on the hospital.

 

[Paleowoman]

tigerlily My cardiologist referred me to a cardiac surgeon last year for "sugical assessment" of my aortic valve prosthesis as the pressure gradient had risen so much since aortic valve replacement surgery four years previously. The surgeon I saw was very knowledgeable about prosthetic heart valves (as I would think most cardiac surgeons are) and referred me first to a cardiologist he works with to asess the valve with an expert echo. My peak presure gradient is currently 58mmHg and mean gradient 31mmHg, and my "effective valve orifice area" is 0.76. I had to have a transoesophageal echo too to check the state of the valve leaflets to see if they were degenerating - mine are not. It seems that the transoesophageal echo is one of the most important in this instance to check if there is degeneration or something going on which doesn't show on regular echocardiogram.

 

[tigerlily]

tigerlily My cardiologist referred me to a cardiac surgeon last year for "sugical assessment" of my aortic valve prosthesis as the pressure gradient had risen so much since aortic valve replacement surgery four years previously. The surgeon I saw was very knowledgeable about prosthetic heart valves (as I would think most cardiac surgeons are) and referred me first to a cardiologist he works with to asess the valve with an expert echo. My peak presure gradient is currently 58mmHg and mean gradient 31mmHg, and my "effective valve orifice area" is 0.76. I had to have a transoesophageal echo too to check the state of the valve leaflets to see if they were degenerating - mine are not. It seems that the transoesophageal echo is one of the most important in this instance to check if there is degeneration or something going on which doesn't show on regular echocardiogram.

Thank you Paleowoman for your response. That's what my surgeon is doing by referring me to a cardiologist who specializes in the Tee and Cath procedures. I assume since your vavle isn't deteriorating that you are fine waiting a while. Correct? It might give me a lot of peace of mind to know more about what is happening.

 

[Paleowoman]

Thank you Paleowoman for your response. That's what my surgeon is doing by referring me to a cardiologist who specializes in the Tee and Cath procedures. I assume since your vavle isn't deteriorating that you are fine waiting a while. Correct? It might give me a lot of peace of mind to know more about what is happening.

Hi tigerlily - I'm not having redo surgery right now because the valve isn't degenerating, that's right. The problem is that the valve is too small (patient prosthesis mismatch) but the mortality risk of surgery is too high to put in a larger valve so we will wait until the valve degenerates, so I will be followed with that in mind.

 

[jwinter]

Hello tigerlily and hope you are doing well. It always seems to take time for everyone to get on board with cardiac valve replacements. You want to go slow and listen to everything and yet you want it done if inevitable.

My experience and to make it short as possible was porcine valve installed-lasted 4 years-may have been like Anne's and too small but became stenosed anyway-mechanical ON-X in 2016 and is working out.

Like you I did not have much notice either time. No heart attack, no chest pain. Passed out while recovering (I thought) from bad cold first time and shortness of breath second time. This is also the short version.

I cannot find my numbers right off hand as changed laptops but will look later.

Main thing is now that this is all about YOU. I like your doc already because he asks how YOU FEEL (not many do, especially the big ego freaks) and I think he wants you in with the team making decision. Nothing wrong with moving around a bit (I am part gypsy so I totally understand) and what better reason is there than yours? I say as long as the doc is not too old to practice or has several lawsuits you know about, the main thing is TRUST. Trust that he will lead and guide you where you need to be. Listen to them. Do the tests (yes, a couple of them I did not like much either) Write down the questions you have, ask and keep asking until you feel comfortable. Make decisions together and go from there.

I preach to no one and am not a show biz Lutheran, but I do not believe you or the docs have the final decision of how this goes. If you are spiritual at all pray and listen for answers to come. If not.......do what YOU got to do. Be confident in your decisions and as much proactive as you can be.

Always speak up and then listen to answers or write them down. Who really cares what others(including me) do, think, or say? Do what is good for you.I know I already said this but it is so very important as it pertains to the most important person

I feel you are in good hands and the people here mean well and will help you with some questions and numbers but it is up to you. If you hold awhile then just keep living and enjoying and when the time comes for surgery hop on that gurney and move to the other side of this. Easy? No, not unicorns and rainbows for sure. What is the alternative?