Pre-Surgery Curveball. Need some help.

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E

Espoe

Well just when I thought I had it all figured out, a curveball. I had my mitral valve replacement surgery scheduled for July 2. On Thursday April 2 I went in for my pre-surgery angiogram. When they ran the left heart study the regurgitation came back as a 1-2. My surgeon happened to be in the cath lab so he peeked in. He and the cardiologist said, based on that result I didn?t need the surgery.

Now just one month earlier I had been in the hospital for an infection with high fever they were trying to track down. At some point during my 7 day stay I had a TEE done to rule out endocarditis. The results were moderately severe mitral regurgitation, dilated left atrium, smoke detected (though that was an interesting term), EF estimated at 40%. I also had an echo done and showed my EF of 40%, Left atrium of 5.6. My cardio said that my BP was up a little and that would make those results look worse.

My symptoms that I have been complaining about for at least 2 years are shortness of breath, swelling in my lower legs, exercise intolerance. I am 49 years old and have difficulty getting past one flight of steps. I can?t play with my kids like I like to because I can?t keep up. I have started several exercise programs and just can?t get going due to sob.

I sent all my results including my most recent stress test to the Cleveland Clinic and I was ?invited for an 8 day stay.? I ruled them out since I had a previous repair and they said they most likely could only do a mini sternotomy. So I elected to go to a local surgeon. When I brought the records to him he said there was no use in waiting, that it was only going to get worse and I was risking further damage

After the angiogram my cardio is now saying he wants to try to get some weight off and reduce the pressure on the valve. He is suggesting a rehab program (I need to lose about 40 pounds I picked up in the last 3 years. We call that Katrina weight in these parts) and I am OK with that, but a little skeptical as I have been unable to get exercise going for some time. I am also wondering about the valve getting progressively worse and causing damage as my surgeon said in our earlier appointment.

My cardio appointment will be this week and I will call my surgeon also. I am kind of at a loss as to what to do, what to ask them. I certainly like the prospect of not having surgery but I really just want to get this fixed so I can play with the kids and not delay this any longer if surgery is eventually where I am going. I am looking for some guidance, questions to ask, educated opinion etc. All the things this forum is so good at.
 
Echo, Angiogram, Nuclear Stress and EKG.

I would try losing some weight, and see if your symptoms improve. You were going to have a three month wait anyway, so take that time to see if there's improvement.
If there's not, you can always seek out a different surgeon and get an opinion about the advisability of replacement.
 
Yep, it sounds like you are between a Rock and a Hard Place.

My Cardio would like me to lose some weight also and thinks that if I can get back to my 'recommended' weight that would give me as much benefit as Valve Replacement so I can relate to your situation.

OTOH, your symptoms do sound compelling. Many Surgeons give Symptoms equal 'weight' as test results. Good arguments can be made for either case. I guess it's your call. Flip a coin? Risk / Reward analysis would seem to come down on the side of lose some weight and see how you feel after that...

Good Luck with whatever course you decide upon!
 
I will be getting second opinions for sure. Talked to my GP yesterday and he too is a little skeptical because of my symptoms. There really is no downside to going ahead with some rehab other than putting things off for a few months if I end up getting the surgery. I was also going to have a maze procedure done at he same time to try to rid myself of the chronic a-fib.

My main fear I guess is I am really concerned about permanent damage to the size of the heart and the left atrium.
 
If your heart is enlarged and showing signs of continuing to enlarge, I would think most 'Good Surgeons' would recommend doing surgery before there is Permanent Damage.

For A-Fib, have you tried Sotalol (generic form of BetaPace)?
Many of our members have had good results with this medication and the side effects are mild and short-lived compared with the 'Heavy Duty' drugs, especially Amiodarone. The most common side effect is some mild dizzyness for a few weeks while your body adjusts to the medication. It is recommended by the manufacturer to be hospitalized when first starting Sotalol 'just in case' one of the 'dangerous arrhythmias' gets triggered.

'AL Capshaw' (I am not a medical professional)
 
You would think. BUt that's why I am pretty confused at this point. I am going to gather all of the data and investigate. I should get the written angio report Thursday. Right now I take Dijoxin and some blood pressure medications like toprol, captopril, cardizem and of course, coumadin for anti coagulation.

I have had a-fib for 20+ years. That's why I was looking forward to the maze. I know the succes rate is less for chronic cases but I was going to be opened up so why not?
 
Eddie,

I would say seek another surgeon's opinion and have the tests repeated somewhere else.

My ex-cardio wanted me to lose 40 lbs in 2006 :eek: while now I think he should have recommended surgery instead. Trusting him, I never looked at the details of the echos and now I regret for not having pushed him to admit the real cause for my increasing fatigue was not weight...was deterioration of valves. At least in 2006 I did not have PVCs nor the trace/mild tricuspid and pulmonic leak which started October 2007...and still he did not recommend surgery until March 2008!!

As for losing weight, it will be very difficult now with your symptoms. When I tried to lose weight, I took Tylenol before exercise to get some stamina. I did pilates, aerobic, fast walking, etc. and all of a sudden I could not do anything for four months as my valves had deteriorated without me realizing that! I lost weight, Yes, but I almost lost my life!!

Good luck and keep us posted.
 
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