How many bicuspids had cath prior to surgery?

[karlaosh]

Hi everyone.

I'm scheduled for AVR and ascending aortic aneurysm repair on June 1st at Mayo. I saw my local cardiologist yesterday and he wants to do a catheterization here, himself, for more definitive information about the valve, left ventricle, aneurysm morphology, coarctation pressure gradient (I have a "mild" coarct), etc. before the surgery.

Having a cath makes sense to me, but I've heard that Sharo Raissi, the bicuspid guy at Cedars-Sinai, doesn't do caths on his bicuspid patients because of the potential fragility of the aortic tissue.

How many bicupid VR folks had a cath before their surgery? Did all go well? What about having a cath if you have an aneurysm, as I do? (4.5 cm measured by MRA last summer) Is that a concern?

Thanks for your feedback.

Karla

 

[PapaHappyStar]

I had a cath done at NY Presbyterian to make certain surgery was indicated -- I had conflicting trans thoracic echo measurements of stenosis due to a bicuspid valve, didnt have any problems with it... I did not have a dilated aorta or coarctation

Just to let you know what happened in my case...

My opinion on the cath:
I also read articles about the need for caution when you have a bicupid valve -- discus this with your cardiologist -- you have the right to refuse the procedure, although I dont know if they need to diagnose it via a cath to indicate surgery for insurance purposes.

 

[Randy'38]

Had 3 caths

Had 3 caths

Karla:

I had 3 caths before my AVR. One in '93 when the calcification was discovered; one '98 after a suspected "heart attack"; and one attempted in '04 when they couldn't get through the valve because it was so heavily calicified (0.7cm2 x-section). I had a bicuspid valve and a 5.0 cm ascending aortic aneuryism. No one ever suggested not doing the cath. In fact, the last cath is what triggered my decision to do the AVR. The cath itself was not a problem and I did not suffer any after effects. Hope this helps.

Randy

 

[perrybucsdad]

I had a cath done, but it was 10 years before my AVR, so I guess you can say I didn't have one.

Have you asked your Dr if he would conside doing a CT angiogram? This would not only be safer, but also in 3D so he would be able to get a better picture on what is going on.

 

[Rich]

I had one done a few months prior to my surgery.
My cardiologist felt this was the best way to really see what was going on.
It caused no problems for me.

 

[KAJ]

Karla,

There are risks with any medical procedure, especially involving the heart. However, I had a bicuspid AVR with an aortic aneurysm and have had 3 heart caths in 4 years with no problems. My aneurysm also measured 4.5., cause for concern, yes, I think any aneurysm is cause for concern but alarmed at 4.5, no. My 1st heart cath took place after a routine visit to a doc in the box where I failed the ekg, immediately scheduled for a stress test the next day, failed the stress test, even though I felt fine, was scheduled for a heart cath the next day. That was when the biscupid valve and aortic aneurysm were discovered. Since that time I had an echo every 6 months. The 2nd time I had major symptoms, but everything was fine. Last Oct, my cardio was very concerned about the condition of the valve because of what the echo showed. He thought I was getting close for replacement. In Jan of this year, I had what I believed was major, major heart burn. At my wife's insistance, I went to the ER. I was immediately admitted, an echo was done the next day. It turned out it was just major heartburn. However, the echo showed the stenosis on the valve had worsened considerably since Oct. My 3rd cath was the next day. It showed the valve area to be .45, not good along with worsend stenosis since Oct, . The cardio said the valve now had to be replaced. I am now about 6 weeks post-op after replacement of AVR and repair of the aortic aneurysm.

I am sure all will go well with you. To be perfectly honest, I was very scared during the 1st and 2nd heart caths but was relaxed during the last one.

Karl

 

[fyrfytr]

Hey Karla,
It is good to hear from you again. I hope everything has been going OK for you.
I have had 7 caths since 1957 with the last one being 10 days before my OHS that is how they found my 6.0cm aneurysm.
Who is going to do your cath? Dr. Green did mine at the Heart Center of The Rockies.
Take Care

 

[tommy]

I had a cath. I thought they used it for measurements and other details.

 

[catwoman]

I thought that all valve patients had a heart cath pre-op, regardless the location -- to get a better look at the valve, hopefully find other problems (blockages needing bypass).
Is there another way to get the same information?

 

[Tony]

I think the risk of a heart cath is small compared to the risk of open heart surgery.

 

[MarkU]

I had a catherization the day before my AVR surgery. It was partly to confirm the diagnosis with my BAV, but also to help determine if there was anything else that needed to be done in there while they had me opened up (blocked arteries,etc.). I got the impression that it was pretty much standard procedure, at least with my cardiologist and surgeon.
Mark

 

[karlaosh]

Thanks to everyone for your input.

My guess is that while Cedars-Sinai has decided to handle bicuspids with kid gloves, MOST cardiologists and surgeons would think that they were being ridiculously conservative in avoiding caths for bicuspids.

It would be interesting to see a study about cath complications in bicuspids vs. other heart and valve patients. If Cedars-Sinai is right, the complication rate in bicuspids would be higher.

I've e-mailed my surgeon for his opinion about having the cath here. If he says no problem, I'll have it here. If he doesn't like the idea of me having it here, I'll have my cardiologist call him and the two of them can hash it out.

Did anyone on VR have a cath complication that necessitated surgery immediately following?

Karla

 

[PJmomrunner]

That sounds sensible to me, Karla!

P. J.

 

[JimL]

I had a cath, and that resulted in scheduling surgery three days later because it was so much worse than the other tests had indicated. I have years ago seen a consent form that had to be signed before the cath, saying that if necessary they had permission to take you right into surgery; do they still do that?

 

[Mary]

Jim,
Both times I had a consent form that said if they needed to put a stent in while doing the cath, they could.
I hope we get some answers on this thread. I was awake last night worrying about it along with a host of other things. I don't expect to have another heart cath before surgery, but since I'm a bicuspid, I'm concerned with what's been posted.

 

[Arlyss]

Discussion Regarding Caths

Discussion Regarding Caths

Individuals with bicuspid aortic valve disease right now are part of an evolution in the understanding of this condition. In the medical literature, as well as in reading about the experience of other people, one quickly realizes that this is not a simple condition. I am glad that more and more aneurysms are being found in time because of a greater awareness that this may occur, and that it is not just a valve condition.

Perhaps some of you read the account of my husband's experience with his aneurysm surgery, which is posted on the aneurysm support site. I mention there that he did not have a cath prior to his aneurysm surgery. However, he did have all the testing needed to give a clear picture of his condition before surgery. Here is the link to that account for anyone who would like to read it.

http://www.westga.edu/~wmaples/velebir_arlys.html

Cardiac angiography is an important tool in profiling the condition of the coronary arteries. Before any cardiac surgery, it is important to know what is needed so that everything is addressed during surgery. If someone would benefit from bypass surgery of the coronary arteries, it is important to know that, as well as everything else, before going into the chest.

There is another screening tool, nuclear medicine, that is useful in looking at the coronary arteries, and it is less invasive than an angiogram. If the arteries are clear on this test, there is no need for anything more invasive. However, if after having a nuclear medicine test there is any question about the condition of the coronary arteries, the more invasive test may be needed to clarify whether or not there is blockage.

Like many things about bicuspid aortic valve disease, the reason is not clear, but most people who have it usually do not have any blockage of their coronary arteries. They generally will not need either stents or bypass surgery. However, there are some that will - they may have diabetes, have smoked, or have some other risk factor that creates plaque in their coronaries. Just to be sure, their coronary arteries should be checked, and the nuclear medicine test usually clearly reveals that their arteries are clean.

Diagnostic testing continues to move forward. Magnetic resonance, or MRI, has made great strides recently. Some centers now offer cardiac imaging, called cardiac MRA, along with MRI of the aorta. Cardiac MRA currently can be used to evaluate the heart valves and chambers. I believe work is underway to advance this technology so that it can also evaluate the coronary arteries, but that is not there today.

Diagnostic testing is an important area, and I hope that research will continue to move it forward toward more and more patient-friendly procedures. In the mean time, it is certainly possible to use the least invasive tests first. When it comes to the coronary arteries that may be all that is needed, especially if you have bicuspid aortic valve disease.

I should add that it is not possible to determine with any tests just how thin the walls of the aorta actually are when there is enlargement or an aneurysm. If the tissue is very thin, it could easily be damaged by a catheter. In an emergency, if a dissection has occurred but not been diagnosed, going in with a catheter is extremely risky because only the thin outer layer of the aorta is intact, and it would be very easy to puncture it. The coronary arteries themselves also may dissect during a cath procedure if the tissue is fragile.


Best Wishes,
Arlyss

 

[karlaosh]

For the record, here's Dr. Zehr's response to my question about having a cath before surgery:

Dear Ms. Oceanak,

I have no objection to your being cathed by your cardiologist back home. I am at home so don't have your records here to remember your age. My general rule of thumb is to cath every women over 45 and every man over 40 in anticipation of non-coronary cardiac surgery to r/o coronary artery disease. I make exceptions in younger patients if there is a history of coronary artery disease or diabetes, etc. and adjust in older patient if they have complete lack of risk factors.

In regards to your surgery, the cath adds very little except the coronary anatomy. The other parameters are easily assessed by the pre-operative echo and the intra-operative transesophageal echo. The coarctation is not approachable through the front and thus requires assessment in and of itself which has been done in the past showing minimal gradient.

To reiterate, from a surgeon's perspective the only reason for a cath is to r/o coronary artery disease which is reason enough. Your valve and aorta do not increase the risk of a cath perceptively. We usually cath patients the morning of surgery. If you wish to have this at home, I would request to see the coronary cine loops and not just receive a report.

Sincerely,
Kenton J. Zehr


I guess I'm going to go ahead and have the cath here in Fort Collins. I'll let you all know how it goes.

 

[Bionic Man]

Had pre-surg cath

Had pre-surg cath

bicuspid valve, very diseased and leaky
also had aorta measuring 4.5 but near dissection.

The doc was resisting doing a cath but I had complained of chest pains and so he broke down and did one. It didn't occur to me at the time to ask why he was resisting doing a cath. Perhaps for that reason?

David C.

 

[Shine_on_Syd]

I did not have a bicuspid, rather severe regurgitation. I had a cath done 6 weeks before surgery. Since I was 53 the surgeon wanted to know the condition of my cardiac arteries and if needed could do a bypass while I was opened up.
The cath was done at a different hospital that my surgery. My surgeon said don't let them put any stents in