My random newby question thread

[Duff Man]

I have so many questions so often that I think it's best I just make a thread instead of messing up everyone elses with random questions that are kind of related.

My first question to start this thing off is: Do people always have cathertization before valve replacement?

My surgeon says it's indicated to check for "anatomical conditions which may impact the procedure." What all do they usually check? Arteries and valve function right?

 

[Philip B]

Heart Cath

Heart Cath

Yeah, I think you'll find that most of us under went a heart cath prior to surgery. Your cardiologist can answer the specific questions you have about the information the cath procedure will provide.

In my case, my cardio doc wanted to measure pressures on both sides of my aortic valve to assess the condition of the valve.

Facing the cath procedure was almost as traumatic as facing the surgery. I really objected to the idea of having a bunch of hardware stuffed into my beating heart. Twenty-seven years before my most recent cath procedure the guy I shared a hospital room with while waiting for our heart caths died during his cath.

-Philip

 

[greg]

I bet we are all in the same boat with this one.
My Cardio said the surgeon wouldn't consider operating without knowing if there other things to fix at the same time (bypasses, etc.). Like Philip said, they get lots of other information too.

greg

 

[Elcarim]

I didn't have one before either valve replacement.

I had a TEE before my first and a CT before my second. The CT was to check the scarring from the previous surgery, if I remember correctly. But I was 22yo for my first surgery and 27yo for my second.

 

[MarkU]

I actually had my first catherization at age 15 to establish a baseline on my bicuspid aortic valve, even though I didn't end up needing surgery until I was 47.

That first catherization some thirty years ago was a rather unpleasant experience. My last one, the day before my AVR, was no big deal thanks to the advancements in the technology over the years. Plus the drugs they give you are better these days...

Mark

 

[ALCapshaw2]

The 'incident' rate for catheterizations at hospitals that do LOTS of them is around 1 in 1000. The more they do, the better they are.

The Reason they want a cath is to see if you will need bypass surgery now or in the near future. In other words, they want to do "everything that needs fixing while they are in there!" The cath can also confirm the gradients across your valves and other valve parameters as a 'second opinion' to confirm the need for surgery.

 

[Bonzo Dog]

Catheterisation seemed to be the main diagnostic tool prior to my first VR 20 years ago. As Al says, it was to measure gradients. I suppose things have moved on and there are many more clubs in the cardiologists bag now.

For an amusing tale surrounding my first catheterisation visit here http://valvereplacement.com/forums/showthread.php?t=25644

 

[wcasey5]

I had a cath as well. And a tee, and every other test known to doctor. I didn't have any issues. Whatever they gave me I remember seeing light and thats it. I didn't feel a thing. I was in for over an hour, and it seemed like 2 minutes.

 

[Duff Man]

Alright! next question: Is there a surgeon that will guarantee I'll wake up and everything will be ok?

I'm just kidding, kind of. If you do hear about one give me a shout.

 

[Bonzo Dog]

Alright! next question: Is there a surgeon that will guarantee I'll wake up and everything will be ok?

............. .

Yeah, he's called Dr Liar and can be recognised by the $ signs in his eyes.

 

[Superbob]

Afraid not. In fact, they have to get you to sign an informed consent stating you recognize the risks, one being death. But hey those risks are very low, and there are risks with anything in life.

As far as caths, I had one, and I got the impression it was SOP.

 

[sue943]

What you also have to weigh into the equation is that without the surgery you ain't goin' to be around for long anyway so the very small risk of fatality or other complications has to be balanced against that certainty.

 

[ctyguy]

I had the cath procedure two days before my surgery. I was pretty well freaked out about it because that was the first "procedure" I'd ever had in my life. Turns out it was an absolulte no brainer. I had no pain or discomfort at all. The biggest drawback to it was having to lay on my back for 4 hours afterwards with a pressure pack where the put the catheder in. Really it was a total non-event.

I don't think your gonna find a doc who will give you an iron clad guarantee regarding waking up, but of course I asked the same question to my surgeon. He just chuckled and told me that given my age and overall health that the odds of my not waking up were extremely remote. I "only" had a valve replacement but its still heart-lung bypass and the whole nine yards. This all leads back to the confidence level in your surgeon. I was 99% confident going in because of him. You still have small doubts but you just need to take a leap of faith on it. Like you, I had to have this surgery or ultimately it was gonna be the end of me. Once I was on the table and wheeled into the OR I was totally relaxed. Waiting for the surgery was the hard part, getting through the procedure and first few days of recovery really wasn't all that bad. One of my first memories waking up was realizing that the surgery was behind me, that in itself was a huge weight off my mind. You will do the same, I can't gaurantee it but given your age and the attention to detail your giving this whole thing I'm pretty confident your gonna be just fine.

 

[EireCara]

Aaron, Iv had 3 heart cath done because Iv had 3 positive stress tests, but my arteries are always clear. They did show moderate MV regurg, and arrhythmia.

As for the test itself, nothing to it.

((((( HUGS )))))

 

[upchurch131]

My cath was done 6 years ago to better assess the condition of my BAV. Additionally, the status of my arteries was also reviewed. I remember the procedure was no big deal- there wasn't any pain I can recall. I agree the biggest pain in my literal ASS was having to lay there for hours on end with weight on the incisions (oh yeah, they went into both arteries in both legs to get views inside and outside of the valve- so I had two incisions). Having had two lumbar surgeries, I can't lay flat for ten minutes without moving without intense pain. The nurses were upset with me- but walk a mile in my shoes, honey!

BTW, the arteries were crystal clear and they got pretty pictures of the valve. When I was told they needed to assess the current condition of my arteries before surgery and the previous cath was too old- I thought OH, GREAT! But thats when they offered me the 64 slice angio CT which sounded good to me! Arteries are still very clear with only one showing <30% which I was told was normal for my age and not to worry about it.

 

[WayneGM]

Yep, I'm pretty sure a cathnis normal pre-op procedure. They might as well check for blockages and other issues before going in so there are no surprises. It sounds worse than it really is.

 

[Ana]

My husband had to have the cath beforehand, the surgeon wouldn't operate on him without having all the information available. Carl didn't have any problems and the doc (McNeil) was quick and thorough and able to "call" the procedures that the surgeon would perform. Carl had a lot of fluid in his lungs, was constantly coughing and so even though he had to have the pressure applied for 45 minutes by a nurse, there were no real issues except for some crazy bruising from blood that had leaked up through his lower abdominal muscle wall over the following two weeks. Looked like he had been run over by a truck.

Just an FYI - there are two wys of "stopping" up the hole made by the catheter: 1) silicone plug; and 2) manual pressure. And there is no way of knowing which one you will need until they are inside you with the cath because it depends on your architecture and how the femoral artery branches off (above or below the insertion site).

 

[Leah]

Do people always have cathertization before valve replacement?

It's largely SOP. If you read the Cedars Sinai Hosp. website materials they articulate a minority view against doing cath for bicuspid valves. You can read their discussion, which is pretty brief. Rachel/Oaktree has commented on this before. But, per the comments you've already seen, the rate of complications is extremely low and most of us have found the discomfort far less than expected. I think asking these questions provides you with a good measure of the doctor or other professional, because you see how intelligently they respond and whether they respect your interest in knowing. But ultimately, if you have medical folks you trust and consider to be excellent, you have to rely on their expertise. These things seems very important to us but they really are details.

 

[Duff Man]

OK serious question now:

Are there good alternatives to coumadin if I should have some sort of allergy or adverse reaction?

Also, do all blood thinners have the potential to make a person more asthmatic? I'm convinced that when I take aspirin my asthma is much worse.

 

[Marguerite53]

That last question should have it's own thread, I think. Start a new thread on that.

As for the angiogram. My surgeon told me that it also allowed him to get some measurements so that he could have a handful of appropriately sized valves ready. It really does give them a lot of information.

I personally did not watch as they did the angiogram, though they offered that option to me. Too wierd for me!

As for closing you up, it's cardiologist preference. I did not get the "plug" which is the more modern way, but my Stanford trained cardio was old- fashioned (so the nurses said) and just used the pressure method. You really do have to lie there as motionless as possible for hour after hour. This is one of those times that your iPod is essential. I also brought knitting along which was useful....probably not an option for you!

Marguerite