got second opinion/but i'm confused

[jx05]

I got my first echo and stress test in march 2005 and when the doctors looked at the results they told me i would need replacement within the year, this doctor then refered me to the cardioserasic surgeon and he had me do a cath and he said it looked good, but sugested for me to have surgery know.

I went to another cardiologist last week and had an echo and stress test done and when he looked at the results he said i would need replacement within the next 5 to ten years and he recommended that i get a TEE, i have tee scheduled for monday.

When i got my second test , i didn't mention to the doctor about my first opinion , but as i was leaving i told him the truth about my first diagnostic, as i told him this he kind of lost interest and he told me that if my orignal cath stated moderate to severe aortic , then i should get it done , i went home and looked at my results and it stated on the cath moderate aortic , so i faxed him a copy of my cath , the next day he scheduled my TEE.

I'm confused because why would my second opinion state 5 to 10 years for replacement and the first opinion said within this year.

I guess if have the tee done , the doctor can verify my first opinion.

Should i get the tee done because i have no insurance and this will be cash , i will apreciate any advice on this. thx%

 

[geebee]

One of the things we have all learned is surgeons tend to suggest operations much earlier than cardios. I do not know if a TEE will reveal anything better than a cath. Hopefully someone else will chime in for that one.

Waiting for surgery can take a toll on the heart. It is usually thought to be better to have surgery earlier to prevent damage to the heart muscle. However, surgery does carry risks so you do not want to have sugery too early. Kind of a Catch 22 scenario.

If you are having symptoms, I would consider going with the surgeon's timeframe. However, it does sound like you can take a little time to decide. Perhaps having the TEE might make you feel better about the diagnosis but I think the cath usually is considered conclusive.

 

[T-Money]

Thoughts

Thoughts

It sounds to me like you will have surgery either way. The cath. is kind of the end all be all of testing as far as I can tell. I'm not sure what you gain by having the TEE. Unless you feel like it will make you feel better, save your money and apply it towards the surgery. My understanding is that there isn't a ton of subjectivity to a cath. Why not just have the 2nd cardiologist review the tapes/pics from the cath. procedure. I may be off on this and defer to some of my more expert fellow members of VR.COM. I hope all goes well.

 

[ALCapshaw2]

It seems clear that you will need surgery at some time but the timing is not yet clear. Generally, surgery is not recommended until some condition reaches the "severe" level.

Cardiologists tend to be more conservative while surgeons like to operate BEFORE there is permanent damage to the heart muscle and walls. It is good to have your complete history of echos and other tests for comparison. Watch for chamber ENLARGEMENT which is a sign that the heart is having to pump too hard to squeeze blood through a narrowing valve. When you see increasing chamber size, this is probably a sign that surgery is warranted.

You may want to seek a second SURGICAL opinion.

A TEE is often recommended when it is not clear from the standard echo whether to proceed with surgery or wait some more. Images from the TEE are better defined because the probe is placed right next to the heart and the signal does not have to go through any bones. It is a good test. This may be a question to ask of your second opinion surgeon, i.e. the cost / benefit tradeoff of having a TEE.

FWIW, having gotten to surgery 'just in time', I generally favor early intervention. IMO, it is better to let your chosen SURGEON determine when to operate.

'AL Capshaw'

 

[tobagotwo]

You had a stress echo first, which can be inaccurate in a patient with stenosis (narrowing of a valve opening). From that, a cath was suggested, which sounds like a good idea.

A catheter angiogram, which it appears you had after the March stress echo is considered as good or better than a TEE, and is the Gold Standard usually required as a final check before surgery (it also checks for coronary artery disease, which a TEE can't).

A standard echo, which you had later, can be accurate or not, based mostly on the tech. Noramlly, it is acceptably accurate. A standard echo is not normally used to double-check the accuracy of a catheter angiogram, which the cardiothoracic surgeon had done earlier, and which is considered more accurate.

The appearance is that the second opinion cardio is wasting your money (or simply taking it). The results of a four-month-old catheterization should be more than ample for him to make a decision from. Compare the results from the cath and the second echo yourself, to see how close they are. If they are significantly different, ask him why he doubts the angiogram (cath) results. If they are not very different, ask him why he wants a TEE when you already have catheter angiogram results. If he can't give an answer better than he wants "his own" results, I would consider whether he is worth following up with.

Find a third opinion, if you like, but they should use the results you have so far from the three tests, and not ask for their own echo, TEE, or cath without an extremely convincing reason.

Just my two cents...

Best wishes,

 

[RCB]

You have a right to be confused!

You have a right to be confused!

As others have correctly stated, a cath trumps all the other tests you have
had. The only purpose a second TEE at this stage is to make someone money.
I am confused by your following statement:
"this doctor then refered me to the cardioserasic surgeon and he had me do a cath and he said it looked good, but sugested for me to have surgery know."

If a cath look "good" how is that indicative of surgery, or was he just commenting on the techinical quality of the cath?

If you want another unbiased opinion to make up your mind, send everything both doctors have to the Cleveland Clinic for their second opinion service. The service is easy to arrange and cost used to be about $600.00, which is roughly the cost of the TEE that you don't need. That way you get one of the best opinion you can get and you can save yourself the cost and hassle of the unneeded TEE.
The CCF website has all the details and the service is very helpful.
One more thing, we hotly debate about many things on this forum, but you won't find very many that think, waiting for needed surgery is good. "GET 'ER DONE" is the operative feeling here.
You will be fine.