BAV with TAA what to expect from surgery consult

[gelsinger13]

Hello my name is Mike and this is my first post. I am a 33 year old firefighter who is in good shape and physically active. I was born with a heart murmur and had yearly echos until I was 21. My cardiologist at the time said that the valve has not been getting worse and that I would probably live my whole life without having to do anything about it. About 3 months ago I volunteered to donate a kidney to my cousin. I went through all the testing and everything looked good. The transplant team asked that I get cleared from a cardiologist for the surgery because of the murmur. I then had an echo done and was sent to get a cardiac MRI. The results were as follows: BAV moderate to severe aortic stenosis (moderate by peak velocity 377 cm/sec and severe by pressure gradient 57 mmHg). There is a mild aortic regurgitation 9%. Ascending aortic aneurysm (46 by 48 mm at it's maximum). Concentric left ventricular hypertrophy with ejection fraction of 64%. I now have a surgery consult in 2 days and I've been taken off work due to weight and breathing restrictions. I've been researching everything but it all is a lot to process. I was wondering if anyone reading this has had similar test results as mine and ,if so, how things went for them. I am also very concerned about restrictions. I can't be a firefighter with any kind of physical restrictions. Any kind of help would be greatly appreciated. Thank you!

 

[Heart Of The Sunrise]

My situation was very similar. I went from diagnosis to surgery in 5 months. In that time my AA grew significantly.
View the video in my signature. I am over a year post op and doing fine.

 

[Midpack]

BAV with TAA what to expect from surgery consult

Hi and welcomed!
My guess is that, given your current numbers, surgery will not be indicated for the moment and you will now be monitored twice a year. Stay calm, and wait the surgeon opinion. You will be fine!

 

[AZ Don]

So you went a decade without being monitored? You are lucky the transplant team sent you to a cardiologist.

I can see why being a firefighter complicates things for you. Based on the description of your issues I would guess that the Dr's might not recommend surgery just yet. If the Dr's are not ready to suggest surgery, and they are telling you to avoid heavy lifting (firefighting), what do they suggest that you do? Before I found I met the surgical criteria for my aneurysm, I did some research on exercising with an Aortic aneurysm and posted some links, here: http://www.valvereplacement.org/for...se-and-stress-with-Aortic-Aneurysm&highlight=
It seems to me that surgery may be inevitable for you, so perhaps you could talk to your Dr's about going ahead with it to get it over with, so that you can go back to work. The alternative is to find another line of work until after you have surgery. I don't suppose there are lighter tasks that you can still do as a firefighter while your team members do the heavy lifting? A key question for your Dr's are how long they think until you need surgery. For the aneurysm, the criteria is when the largest measurement is 5.5cm, but some Dr's may be willing to intervene sooner.

The good news is that once you do have surgery, you should be able to return to your work as a firefighter - you can be fixed. Generally all restrictions are removed 3 months post op. It may take a few months more than that to feel fully back to normal but you'll get there. I understand completely how much there is to process, but I can tell you the surgery wasn't as big a deal as I thought it would be.

 

[gelsinger13]

Thank you for the information. I did have a TEE done in 2006 to check on the murmur. The cardiologist said that I still had a leaky valve but everything else looked fine. When I went to my new cardiologist to get cleared for the kidney surgery I had a copy of the test sent to him. He's the one that told me I had a dilation of my ascending aorta of 4.3 then. That is why he ordered the MRI on top of the echo. I also noticed on the TEE that no stenosis of the valve or LV hypertrophy was noted then. So by comparing now to 8 years ago I would say that surgery is a matter of when and not if for me. I understand that going 8 years without getting an echo was foolish and irresponsible of me. It was just that getting a $2500 copay bill for the TEE and going 26 years being told repeatedly that the valve looked fine and wasn't getting worse, I started to think the yearly checkups were a waste of time and money. It turned into something I kept putting off. As for the restrictions and my job, there is no light duty I can do. I have to be able to be put under a great deal of physical, and sometimes emotional, stress at any given moment. If I have any kind of restrictions I become a liability to myself and to the guys I work with. If I go into a fire with a 250 lb man and he goes down I have to be able to pull him out. I've been reading a lot of the posts on here and it sounds like most people are placed on some kind of weight restriction both pre and post surgery, although the post sounds debatable. If that is true then I can deal with that, I'm just trying to figure out what to expect. A silver lining for me is that if I can't return to work then I should qualify for a pension since heart/lung disease is presumptive for firefighters.

 

[joanpieroni]

You will be on weight restrictions for around 6 months depending what type of surgery. I had a AVR with only a small 3'' horizontal incision. The surgeon put a titanium plate to reconnect the rib bone back to the chest bone, so no lifting. Just remember you will feel better when it's done.

 

[OldManEmu]

Welcome Mike.
Severe stenosis is a pressure gradient over 45 mmHg, at 57mmHG you’re well past it.
As for the Ascending aortic aneurysm 50mm is the traditional indicator of when surgery is indicated, however there are now some surgeons that prefer to wait until 55mm.
My own Ascending aortic aneurysm was 47mm at the time of my first surgery and wasn't repaired then due to my poor physical state, and stayed stable for another 6 years until it grew pas the 50mm. The only weight restriction I had after 3 months post surgery was avoiding lifting the kind of weight that causes you to hold your breath to do it, like competitive weight lifters do.

 

[gelsinger13]

Thank you. I'm getting ready to leave to meet with the surgeon and for another day of tests. We'll see how it goes.