Good conversation with my cardiologist

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Paleowoman

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Jun 13, 2010
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Surrey, UK
I saw my cardiologist today for follow up after the last echo and to ask him questions as I can't ask too many when he does the echo.

I think things may be different in some ways over this side of the pond. He said that my valve area is approximately 1.2 (? what ? cm/sq ?) but that he goes on pressure gradient more to assess the time of when to refer a person for surgery....within the next two years or sooner for me. We'll see how the next echo goes in August.

He also told me that the minimally invasive surgery (as described by heartdoc of the New York hospital in another thread) where they go inbetween the ribs instead of cutting through the sternum, isn't new and is often how they do surgery on children. He implied that a good candidate for it is a thin person (I am). He said that the downside of this technique is that if they can't reach the valve properly and then have to do a sternumotomy (?spelling) then the whole thing is much worse. It's something for the surgeon to assess at the time I suppose.

He suggested I look up surgeons at the hospital where I'll have my valve replaced - St Georges, London. I already had so we were able to discuss that. I wouldn't know how to make a decision on who to choose though as he said they're all good and he works with all of them. He said I can have a consultation with more than one of them in order to help me decide. Of course, he can choose for me if I want.

I feel a lot better through having talked to him. I've also been watching little videos on the Cleveland Hospital website and have read 'Coping with Heart Surgery etc' by Carol Cohen and, although it sounds very ghastly, I feel better for knowing - I'm one of those people that likes things in full detail even when those details aren't nice to hear :eek2:

Anne
 
I know how you feel. I said and will say again, I wish I would have found this site:) prior to my OHS. I'm learning so much now :thumbup: that I probably should have know before. I didn't even know how many valves the heart had and what their purpose was.
I would have liked to have seen the St-Jude mech. valve before they inserted it. I would have probably watched the video on the Cleveland site that shows the surgeons removing the bicuspid aortic valve and replacing it with a tissue valve prior to my surgery. I didn't even think that this would be on the net. I have no problems watching surgeries and never have. The way I look at it is, this is our body and this is how were made and function. Why are we afraid to look at:eek2:?
I just got my post-op appt this morning and I have a list of questions including a view of what those valves look like, instead of pictures.
 
Paqleogirl, I am glad to hear you had a good meet with your cardio................I would encourage you to continue and engage other members here with your condition and always consider the soiurce ....Heartdoc was motivated by $s into his NY clinic ....maybe if there was anyway I could have had cath or minimally invasive I would still have a sternum but then again maybe they would have missed the need for a dacron ring on the mitral valve........I hope that if i ever need more work under the hood (bonnet) that cath procedures will be commonplace




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I will definitely continue to engage on this forum Greg - I'm learning so much here too, there's nothing like reading people's personal experiences.

I guessed that heartdoc was motivated to write here for $s - but I still found his info useful. I'm finding so much useful info from American hospitals like the Cleveland Clinic - again I know they are also trying to make $s :) But here in the United Kingdom none of the consultant surgeons write up anything about what they do in heart surgery on the net - although they are all evaluated on http://heartsurgery.cqc.org.uk/Survival.aspx Some of the hospitals give a brief description of the operation, as does the NHS Choices website, but they don't really discuss different techniques in detail, so I'm finding those US surgeons and hospitals a good resource for learning more :)

all the best,
Anne
 
Hi, Anne-
I worried a lot about the scar visibility before surgery. I ended up with a 2 5/8" long scar - a mini-sternotomy. I'm 3 months post op, and it is healing nicely. I have already forgotten it is there a few times, and the placement is such that it aligns with cleavage. Most shirts come up high enough that it doesn't really show. Others, I just wear a big pendant necklace or a cute scarf and it is hidden.

My boyfriend thinks it is "sexy." LOL

So where ever your scar is, it is not so bad.
 
Anne, The Mayo clinic has alot of good medical info too http://www.mayoclinic.com/health/DiseasesIndex/DiseasesIndex
I thought Heart doc gave alot of useful info too. I'm not sure if your cardiologist was talking about surgery between the ribs (thoracotomy) or min invasive surgery as being done on children for a long time, but I think he MAY have been talking about surgery between the ribs. Justin 's surgery when he was 10 days old was between the ribs (23 years ago on the 22nd) but it wasn't min invasive. Min invasive, either between the ribs or smaller incisions down the sternum, valve surgeries are relatively new.
 
Anne,
I had a small thoracotomy, incision between 2 ribs, for my AVR. My desire was not cosmetic. I live alone and didn't want to not be able to drive for 6 weeks (I was able to at 2 weeks) and for things like getting out of bed and just managing by myself at home when first home from the hospital. Though I have nothing to compare it to, I think it was a lot less painful than having the sternum broken. I had very little pain after surgery.

Surgeon ordered a CT scan to determine if he could do the surgery that way, and result was yes, it could be done that way. The consent form for the surgery did indicate that there might be the chance of a sternotomy were he not able to get good access via the thoracotomy, but I'm sure that was mostly for protection on the small chance he might not have been able to use that route. Surgeon should have a pretty good idea if it will work or not before surgery. I sure would not want to have had both incisions. I think some sort of imaging study would be in order before surgery to solidify if you're a good candidate for a thoracotomy.
 
Hi Luana,
I too am not thinking of the minimally invasive technique for cosmetic reasons, I'm thinking of it mainly because I have osteoporosis and also because I think that having a quicker recovery will aid the heart. Of course I will leave the final decision to the surgeon and I'd want him/her to be completely happy about doing it that way. That's interesting to know they do a CT scan to determine if they can do surgery that way.
Anne
 
Anne -

It sounds like you are getting a little more comfortable with your condition and your Cardiologist.

With an Effective Aortic Valve Area of 1.2 sq cm, you are heading towards eventual replacement, but probably aren't there yet. Many Surgeons and Cardiologists in the USA use 0.8 sq cm as their 'trigger point. It's hard to say how fast you will progress. Some go faster than others. That's why you should be having echos more frequently now, preferably every 6 months and certainly no longer than 12 months apart.

Keep up the Good Work. Hopefully you will reach that "peaceful feeling" that many experience as they come to accept their fate and look forward to 'getting fixed'.

'AL Capshaw'
 
Hi 'Al'

Oh my goodness, I was feeling fine after I saw the cardiologist and when I wrote, but these last two days I have gone completely downhill - I have got so tense and morose :( I'm having my echos every six months now. I wish I could get that positive feeling I had earlier this week back again.

Anne
 
Anne, it took nearly 5 years for my effective valve area to move from 1.2 sq cm to where two consecutive echo's indicated first 0.8 sq cm and then again 1.0 sq cm. Echo's are not very accurate. My surgery was eventually scheduled more on the pressure gradient and the velocity of blood flow over the valve, than the EVA.

I suppose what I am trying to say is that your actual surgery may still be a number of years away. Don't let it occupy your mind too much at this early stage...
 
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