Angio on 25th - Tee routine?

[linda janicki]

Hi Guys:
You are all amazing! I am on a big learning curve, but would like to know. Hubbie having an angio on the 25th to see if bypass is necessary. Will doctors recommend a tee as well as a routine before aortic valve surgery? I think he will opt out when and if he hears details of that!

Also will he likely have transfusions? Should he ask about banking his own blood? Thanks for all your infor.

Lin

 

[OldManEmu]

Lin
I had a TEE several months before surgery when my Endocarditis was being investigated, so I am not sure if everyone gets a TEE before surgery.
Blood transfusions however are not normally required with valve surgery these days only about 20% of patients require them.
That being said I turned out to be one that received blood however it was only 1 unit 300ml and it was 4 days after surgery. I didn't bleed post surgery, just my hemoglobin count was down and not picking up quickly enough.

 

[surfsparky]

Hi Linda,
My husband had a TEE (they call them TOE over here in Australia!) a couple of weeks before his surgery. They performed this for a few reasons, but the main one being to check the sizing of his pulmonary and aortic valves. He was hoping to have the Ross Procedure and they wanted to check that his Pulmonary valve was within the size range of his aortic valve. It was- just!
He asked too, if he could give his own blood for the surgery, but the surgeon did not want him to do it at that late stage (it was week before surgery). He ended up not needing a transfusion though.
All the best,
Yolanda

 

[Ross]

They most likely will want a TEE before surgery, but fact of the matter is, he's going to get one while he's out anyhow. They do it as part of surgery to check for leaks or anything else when their done.

Tee isn't terrible, but it's not exactly something you wish for either. I've had much worse stuff done. If it's done properly, he won't remember any of it.

It wouldn't hurt to bank blood, but most always, the patients own blood is recycled and given back to them. Doesn't mean that he may not need a pint or two during recovery, so it might not be a bad idea.

 

[Mary]

I don't know why they would want to do a TEE if he's close to surgery, so I wouldn't worry about it.

I asked about banking blood, but I was told no. I did need two units during surgery, but I think that's par for the course.

 

[Nancy]

Many times they will ask for a TEE prior to surgery. It gives good details. And as Ross said, TEEs are used throughout syrgery anyway. But sometimes, they like to see what's what so planning of the surgery is more accurate.

At this point, your husband should not opt out of anything they want to do to investigate his situation. The more the surgeon knows before surgery, the fewer surprises there are.

Joe's had many TEEs. In an expert's hands they are not bad at all. Just make sure there is someone who is dry behind the ears doing it, as they say here. In other words, someone who has done many of them, not just a few. Don't want someone practicing on your husband.

 

[tobagotwo]

If the need for surgery is plain, the "regular" echo is clear and not unusual, and your husband has symptoms, there is no call for a TEE. It is an unpleasant experience that is only valuable if an extremely clear picture of the valves is needed. Normally, a hyper-clear echo fo the valves is not needed to accurately diagnose the extent of need for surgery.

Some doctors can force the issue. If there is nothing unusual about your husband's case that would benefit from the TEE, I would consider pushing back, even to the extent of seeking a new cardiologist. Unnecessary is unnecessary. TEEs are not mandated in the ACC/AHA Guidelines for diagnosis of standard aortic or mitral valve conditions, or to verify the requiremetn for surgery.

However, if there is something unusual about your husband's valve (besides the obvious), and there is a technical benefit to being able to view the situation more clearly before surgery, then it would be more reasonable. This would be the small minority of cases. The appearance is strongly that most TEEs are done as CYA for the cardiologist, at the expense of the patient's discomfort, money, and time.

Best wishes,

 

[linda janicki]

Thanks very much!

Thanks very much!

Everyone:
Thanks for your replies. Things look a little clearer now. Cardiologist was very sure when he saw the echo that he needed valve replacement and just mentioned the angio. Seeing surgeon on Thursday. Thanks again.

Lin

 

[Marge]

I suppose your issues have been resolved by now -- hope everything is settled to your satisfaction.

About TEEs prior to surgery: my surgeon didn't want one. He said they'd do one right before the actual surgery, once I was "under", and he didn't think I needed to go for one ahead of time. I had had an angiogram. He did order a CT scan before the surgery. He said the angio and the CT scan gave him enough information.

If your husband ever does have to have a TEE -- I had one last year (a number of months after the surgery) -- and I didn't think it was all that unpleasant. And I am a major wuss about such things! I was sufficiently sedated that not too much bothered me, and the Versed they gave me for the actual procedure blotted most of it out. The worst part was a very brief yucky taste of whatever it is they put in to numb your throat.

 

[linda janicki]

Angio Over -Margie

Angio Over -Margie

Margie:
Yes, some of our issues are resolved. Hubby's 4 stents are holding up and the arteries where he had angioplasties are ok, so no bypass surgery. Saw surgeon and now question of which valve! We meet with surgeon again next week to sign consent and the surgery will probably be 2-3 weeks, (surgeon said something about .9). We will ask him about that next time. He's leaning toward the basic pig valve as he doesn't like the idea of comoudin and the super pig valve replaces the aortic root as well which at this point we don't think is necessary and could be more complicated if it ever had to be replaced. Surgeon said if it was himself he would go for the basic pig valve and enjoy life.

Thanks again everyone!