Differing cardiologist recommendations

[Phyllis]

Nelle, I agree with all the good advice you have received her and I think you should make finding a good surgeon your priority now and then trust in his opinion to timing.

 

[Adrienne]

I agree with what everyone has been telling you. Find a surgeon who is an expert in mitral valve repair. Then see what he says about when you should have the surgery.

 

[susieq14]

Nelle,
I would like to offer my sincere best wishes to you as you try to sort out all your options and the next step to take. I must admit that I think the same as you that "something this big would be less of a doctor's opinion and more of a "look at the test and see what to do" decision." It is all so overwhelming. I do hope that you are able to meet with a surgeon who can give you some definitive answers to help you make your decision.

Please forgive me because I don't mean to hijack your thread but I was intrigued by the following that Computec said and would like to ask you and the readers of this thread a question.

As for EF: Ejection Fraction is a subjective measure. Each cardiologist uses his own experience to arrive at a best guess using the dopler test. If you were to take the images of the echo to several cardiologists (without the interpretations from the previous specialist) you'd receive different interpretations. I've been told that the validity of the reading increases on multiple echos done and interpreted by the same person.

To those of you who have received second opinions from a cardiologist or a surgeon: Did the second cardio or surgeon review the actual prior echo tests themselves or did you they just review the written report from the original cardiologist? What is the correct protocol?

 

[Adrienne]

To those of you who have received second opinions from a cardiologist or a surgeon: Did the second cardio or surgeon review the actual prior echo tests themselves or did you they just review the written report from the original cardiologist? What is the correct protocol?

When I had a second opinion by the cardio at The Montreal Heart Institute, he just reviewed the written reports. When I made an appointment to see the surgeon who in the end was my surgeon, also at the Montreal Heart Institute, his secretary said to get a copy of the tape made to bring into the surgeon (it's a VHS tape). I brought it in, but I don't think he looked at it because I now have it and have looked at it on TV!! From what he saw on all the previous reports, he was sure I would need surgery within a year or two and told me to make an appointment for another echo (there at the Institute) in 6 months and an appointment with him.

 

[ALCapshaw2]

To do a THOROUGH review for a second opinion, the Best Surgeons or Cardiololgists will want to see the actual VCR Tape of the Echo or CD of a TEE and CD of a Left and Right Heart Angiogram / Catheterization. Some may even want you to repeat the echo with THEIR technicians and equipment.

Anyone who relies solely on the written REPORT from someone else (and possibly never even met), can only reitterate the judgment of the ORIGINAL interpreter, with Less Conviction.

'AL Capshaw'

 

[Computec]

There are several ways that EF is arrived at using the modern echo test. The most common way is when the technician outlines the chamber of the heart on a still picture captured from the live image. They do this twice, once when the chamber is fully expanded and once when it's fully contracted. The computer software, working with these two outlines of the chamber size, calculates the ratio and arrives at the EF. The accuracy of this method is tied to the accuracy of the outline which is traced free hand by the technician. It's very common for cardiologists to trust their technicians to accurately outline the chamber and to just sign off on the measurement.

As with anything requiring human intervention or interpretation errors can happen. If the technician is rushed because they have another appointment or they aren't quite on the top of their game that day the measurements will be inaccurate. If the images themselves are made available for recalculation another figure can be arrived at.

There are two echo technicians working for my cardiologist. They're sisters. One's name is Hope and one is Faith. The whole thing is ironic. I've had the experience of watching Hope perform an echo on someone else. She appeared to be very masterful but I'd be easy to fool at this stage of ignorance. I peppered her with questions and she was very forthcoming with explanations. It still didn't change the fact that it was to a certain extent subjective.

Other measurements taken, such as the thickness of the walls, are based on the distance between two points marked by the technician. Again, this is subject to error but less so since marking points is not as complicated an art project as outlining an area.

I hope this shows that a second "reading" of the images is better than a "rereading" of the first report.

Jerry

 

[njean]

Dear Nelle,

I can totally relate to your confusion. I have two mechanical valves, Mitral & Aortic.) I had my 3rd OHS back in March/06 to replace the old Aortic Valve (implanted in 1975) with a new valve (St. Jude). When the surgeon replaced the Aortic valve, the Mitral valve appeared to be working ok so he opted to leave it alone. (I wish he had asked me that question PRIOR to the surgery!): Well, about a year later, I started showing signs of CHF again! Doctors here ran echoes & CT scans & said that now my Mitral valve was failing & I had to go back to Houston to have it replaced. Keep in mind, this would now be my 4th OHS!!!

In Houston they did a TEE, Echo, Catherization etc., & the tests were conclusive, the Mitral valve is showing signs of stress. I had severe PH (88mm), severely enlarged left atrium. But the cardiologist there scared me to death by telling me that a 4th OHS would be very risky but I needed to have it done! Well, I was so frightened that I opted NOT to have the surgery & they changed my medications around (increased my Lasix) & said ok, "go home & think about it, but you will be back!" One of the doctors even expressed RELIEF that I had opted not to have the surgery!!

So, 5 months later, here I am. I'm not experiencing severe signs of CHF, SOB yet, but I'm constantly watching for the signs. I don't know how long it will be but I know it's coming!

My advise to you my dear, if you are strong enough now & all the reports are conclusive, have it done.

Best of luck to you & God Bless!

njean

 

[njean]

Dear Nelle,

I can totally relate to your confusion. I have two mechanical valves, Mitral & Aortic.) I had my 3rd OHS back in March/06 to replace the old Aortic Valve (implanted in 1975) with a new valve (St. Jude). When the surgeon replaced the Aortic valve, the Mitral valve appeared to be working ok so he opted to leave it alone. (I wish he had asked me that question PRIOR to the surgery!): Well, about a year later, I started showing signs of CHF again! Doctors here ran echoes & CT scans & said that now my Mitral valve was failing & I had to go back to Houston to have it replaced. Keep in mind, this would now be my 4th OHS!!!

In Houston they did a TEE, Echo, Catherization etc., & the tests were conclusive, the Mitral valve is showing signs of stress. I had severe PH (88mm), severely enlarged left atrium. But the cardiologist there scared me to death by telling me that a 4th OHS would be very risky but I needed to have it done! Well, I was so frightened that I opted NOT to have the surgery & they changed my medications around (increased my Lasix) & said ok, "go home & think about it, but you will be back!" One of the doctors even expressed RELIEF that I had opted not to have the surgery!!

So, 5 months later, here I am. I'm not experiencing severe signs of CHF, SOB yet, but I'm constantly watching for the signs. I don't know how long it will be but I know it's coming!

My advise to you my dear, if you are strong enough now & all the reports are conclusive, have it done.

Best of luck to you & God Bless!

njean

I feel I need to apologize to you Nelle for "hijacking" your thread. This is about YOU & the confusion & frustration you are going through with differing doctor's opinions. Clearly, you need to get as many opinions, as many tests & findings as you can & be totally satisfied with everything before saying "yes" or "no" to surgery. And of course, if you are showing signs of valve failure, CHF, SOB, swelling, etc., these are the signs you need to be paying attention to.

Please keep us posted on your condition & the best of luck to you!

njean

 

[John & Joann]

Cleveland Clinic generally do not perform any open heart surgery until it is absolutely necessary, but they will schedule the surgery before you are so weak that the surgery is a risk.

This is a decision that must involve you, your family, the cardiologist, and the cardiac surgeon.

Do not hesitate to go to a major facility for another opinion.