Angiograms before surgery?

[pellicle]

Hi

The angiogram was truly a non-issue.

Just wanted to add my +1 to this view (although I was not apprehensive about it at all).

 

[SuzanneSLO]

I was nervous about the angiogram, but it was a non-issue for me as well. My cardio was able to use the radial artery in my wrist which meant I was home shortly after noon. I was back at work the next day "pretending" I had a broken wrist and had no restrictions by the next day.

Both surgeons I spoke with were impressed at how clear my vessels were. They were appreciative that they knew the exact scope of work to expect. -- Suzanne

 

[iheart]

I'm going to play devil's advocate here ; ) I had the angiogram done 2 days before my surgery. I was really nervous about it, because my kidneys are slightly impaired and the dye they use can sometimes harm the kidneys, esp those like me with prior kidney disease. I was told the procedure was routine prior to heart surgery for the sole purpose of seeing if bypass would be needed during surgery. A doctor other than my surgeon performed the angiogram.

I predicted they would find no blockages. I'm in shape, work out, have been taking daily fish oil supplements for over ten years. And, I was right, my veins and arteries were in good shape. (Hard to beat dat fish oil.) While the procedure wasn't bad to go through -at least as bad as I'd imagined - I still wonder if I had gotten a less experienced surgeon or was just unlucky and ended up with kidney damage because of it, how I would be feeling today. My surgeon was top notch and used only 40% of the dye normally used. I guess it's a trade off, but they usually don't let you - the patient - make the decision on weather or not to do this. So I commend your doctor for his unorthodox stance - he's weighing the risks of the procedure vs. the benefits. And, if I need another open heart in 10 or 15 years, they will be hard pressed to have me go through the angiogram again if I'm still exercising and eating right. Of course, they may be putting the valve in using a Cath by then ; ) and I would have to have it anyway.

 

[iheart]

And PS, regarding the tissue valve, I also see his point, but only because that's what I chose--I'm 50. Just be aware Valve choice is completely YOUR decision. I think if you choose a tissue valve, you'd better resign yourself to the necessity of having another OHS someday. Just as, if you choose a mechanical valve, the knowledge that you must monitor your blood levels and take wafarin every day for the rest of your life. It's not an easy choice! But there is no wrong choice either! I'm very happy so far with mine. Good luck Andrea!

 

[big_L]

Sorry, I've been distracted and haven't been on the site for awhile. My reservations about the pre-surgery cath are primarily due to the risk. I just don't feel it's warranted at my age (54) and physical condition (excellent). The cardio and surgeon at Mayo did agree (maybe begrudgingly) and said a CT angio would be fine. They said it was my choice.

 

[Gail in Ca]

I had cardiac caths before my first 2 surgeries. Before my last, I didn't have one. However, I had 2 TEE's because they were looking for vegetation growing on my valves, I also had a staph infection, but endocarditis, before my last (3rd) surgery. My mitral was saved and just repaired.
My cardio just told me that the cath method of replacement isn't for mitral valves only aortic. About risk, my 2nd cath left me in congestive heart failure, due to nurses giving me too much fluid after the test. I then had to have urgent OHS just days after my cath, as I was in very bad shape.

 

[tom in MO]

I was given a choice and chose to have it. That's because I am the opposite of iheart "I'm in shape, work out, have been taking daily fish oil supplements for over ten years. And, I was right, my veins and arteries were in good shape. (Hard to beat dat fish oil.) " I am not in shape, don't believe in fish oil and don't work out. I'd been told after one of those heart imaging sessions (that insurance won't pay for) that I had "evidence" of plaque and a nurse told me I had coronary artery disease. However, the cardiac cath showed that I had clean pipes. I was also told that's why the insurance company won't pay for those heart imaging sessions, they have a huge false positive rate and are essentially useless except as a tool to scare one into supplements and gyms

 

[epstns]

I won't argue that the cardiac imaging systems don't have a higher than desirable level of false positive readings, but I don't think that is the only reason that insurance companies don't like to pay for them. Their other concern is that even if the positive determination is correct, the patient still needs to undergo another procedure to intervene and fix the issue. Case in point - I know someone who had an imaging study done to determine the cause of angina. The imaging study found an artery that was severely blocked. She was whisked right into the cath lab for a conventional cath and implantation of a stent. If they had just done the cath first, they would have found and stented the blockage in one procedure, resulting in mower cost to the insurance company.

On the other hand, another friend had an imaging study done. He was given a great report, no problems issued. Two days later he had a heart attack. Go figure. . .

 

[a_dalhouse]

Thanks iheart and big_L! Honestly this is how I'm kind of feeling. Like, for me, it is not worth the risk - I am a healthy, 45 year old woman. As my doctor said, it is highly unlikely that there would be any blockages and it doesn't seem worth the risk. The more I'm learning about my surgeon, the more I think he's just a progressive thinking guy, and considers all the factors. He just received the chair of surgery position at the Debakey Center and from what I see, he is wanting to lead them into a new age of medicine - especially for the heart.

All that to say that I'm feeling more comfortable now with forgoing the angiogram and also choosing a tissue valve if it is necessary.
I really do appreciate everyone's input. It really helps me to sort my own thinking out.
Andrea