Question regarding cath before surgery

[lynn]

Hello all,

Well, it's been forever since I've been here....I've been dealing with breast cancer, ugh! Now that that is out of the way I had gone for my 6 month checkup at the cardio in September to check on the progression of my bicuspid aortic stenosis. He did an echo, treadmill and heart holter (sp?) and called yesterday (the nurse did) to say that I needed a heart cath done this Friday while he was in the lab! Freaked me out, is this a normal procedure to get done before a AVR?? My husband is asking why I should have to go through that and wind up having the AVR?? I'm assuming it's to clean out the vessels and either put the surgery off longer or prepare for surgery??

Thank you for any replies

 

[terryj]

I think this is normal procedure. My husband had a Cardiac Catherization done shortly before surgery to replace his bicuspid aortic valve. They explained it was to see if he needed any bypassed done when he had his surgery. All was clear in that department.

 

[Tom F.]

Very normal, and I believe almost always done. It will determine whether you need by-pass surgery in addition to the valve replacement.

 

[lynn]

Thank you....that makes me feel sooooo much more at ease!!

 

[Johnny Stephens]

It would be very unsual indeed to have AVR surgery without a catheterization. It is one last sense check on the state of the valve, but as the others have mentioned, it is done to image the coronary arteries and identify any candidates for bypass that should be done at the time they already have you open.

 

[PapaHappyStar]

In my telephone conversation with Paul Stelzer ( an AVR surgeon, Ross procedure specialist ) he mentioned that he does not always require a cath nowadays. Depends on the circumstances of the patient. Be sure to ask your cardiologist to explain to you in detail in as simple terms as possible why he wants the cath done if you can....

There are non-invasive procedures available which can provide information overlapping that of the cath images to a considerable extent, I dont know enough about this and I've had a cath done, although I did not have any problems with it I wondered if given the resolving power of non-invasive probes whether a procedure like this was always the best choice or was it done as part of following the traditional approach to diagnosis. So it is useful to ask this question.

In my case there was the question of a small gradient across the pulmonary valve that they were confused about and the presence of contradictory echo reports of AS severity ( although they might have used an MRA as a separate way of checking )

 

[ALCapshaw2]

The two primary reasons for a cath are:

1- to check your coronary arteries to see if they should do bypass surgery 'while they are in there'

2 - to double check the condition of your valves...
during a cath, they can make direct pressure measurements across each valve from which they can calculate the pressure gradients and velocities. I 'assume' these measurements provide more accurate information than from a standard echo.

'Al'

 

[Bryan B]

The 2 surgeons I talked to said they usually recommend a cath over the age of ~40 or if you have other factors that may predispose you to coronary artery disease (i.e. family history, smoking, obesity). In my case they were also able to get a really good look at my VSD that the surgeon was going to repair.

 

[tobagotwo]

I've had an MRA, and the cardiologists didn't see it as being as valuable for determining valve status or even arterial blockage as a cath. They sent me to see if I had carotid problems (I didn't).

They routinely do catheterizations prior to surgery (mine was the day before), as a last-ditch, just-to-be-sure-we-have-to-do-this check as well.

The cath isn't bad, and you can have the "happy juice" turned up quite high if you want it. I was nosey, so I asked for the smallest amount. I would up it a little next time, as I am apparently quite sensitive where he had to put the pressure to close the artery.

A sidelight to the MRA is the realization that medical stenographers can make or break your file. As you may know, a replacement valve, particularly tissue, is often referred to as a prosthetic valve. The interpreting physician must have come from NY City, as the report from my MRA declared that they had found "a prostatic valve" in my heart.

Pretty good find for a non-invasive procedure, huh? Or are they now using a different part of the pig than I thought?

Best wishes,

 

[breakingwaves]

tobagotwo

tobagotwo

Picking up some more info here, I have dreaded my next cath because I had trouble with feeling lots of pressure during mine, and I didn't know that you could request more sedation, I was feeling the sedation wasn't enough for me, so I will definitely mention that next time, I thought it was just me I am thinking that my visit to the new cardio guy will most likely request for one to be done.

 

[Harpoon]

What Al said, plus the cath is a good opportunity for the surgeons to look inside your heart and REALLY see what's going on before they actually cut into it during valve surgery. They can take a number of pressure measurements in various places and see with their own eyes what's going on so they know what to expect when they go in and can plan for it ahead of time.


It's all about taking as much suprize out of the equation as possible. The last thing a doctor wants to do is go into a procedure assuming he's just going to fix a leaky valve only to find out he needs to make multiple repairs AND replace parts.


Kind of like scouting out the front lines before going into battle.


Oh, and somewhere around here (I think in the Heart forum, or maybe the Pre-Surgery) there's a good thread on how to prepare for surgery that also has some good tips for cath procedures.

A few highlights:

Bring your own portable CD player with headset and some of your favorite CD's. You may be allowed to listen to them during the proceedure or they may actually play the CD's for you in a "house" stereo system in the cath lab. if not, then you'll at least have it for the 6-8 hours you'll end up having to spend laying on your back in bed afterwards. Music or maybe a "book on tape" selection, especially for the bedrest.

Loose clothing is essential. Don't worry about fashion, drag out your favorite pair of sweats or even those flannel pajamas and pack 'em in an overnight bag along with the kinds of stuff you'd bring with you for a night in a hotel room (GET YOUR MIND OUTTA THE GUTTER!)

No perfumes, some patients get really bothered by them. Deoderant is ok.

An electric razor is nice for the guys, though if you're only spending one night, it might be best left home.

If you are spending just one night, you might ask ahead of time about bringing your own pillow from home to sleep on. Many people find it easier to sleep that way and the hospital may allow it for your stay.

Obviously plan on someone else driving you in and driving you home.


The worst part of my cath really was laying in bed afterwards. It wasn't unbearable, just the "worst" part. Some of the stuff that happened during the cath was a little, interesting.... You'll more than likely feel your heart doing some pretty strange things as they wiggle that fiber optic line around inside of it. I said something right away and the surgeon that did my cath (it was her specialty) was already on cue to let me know it was normal and that it would go away as soon as she moved the line around which it did.

I just wish I was able to see the monitors...

 

[PapaHappyStar]

Didnt notice you are going to have the cath done tomorrow ( almost today ), well then let me add its nothing to fear much. I was walking in 3 hours and they let me go at aound 7:00 p.m. ( the procedure was at 2:30p.m. ). I took the subway back ( was in manhattan at the time ). The soreness in the groin area lasted around 3 days and now I dont even remember the pain ( mine happened a bit more than two weeks ago ). There was some bruising but thats faded too.

I got some looks at the monitor during the procedure, since I didnt get heavily sedated ( the downside was I tried to lift my head through the process a few times and got yelled at by the interventionalists doing the procedure, apparently this puts pressure on the groin area and causes extra bleeding -- so dont do that ). The contrast dye lights up your blood vessels in a really dramatic way ( imagine christmas lights ). After the procedure be sure to drink a lot of fluid to get rid of the dye from your system ( give your overworked kidneys something to dilute all that stuff with ). I am sure they told you not to eat or drink anything from the midnight before the procedure...

What Harpoon suggests sounds good ( I brought nothing to listen to, was extremely bored and fidgety and they wouldnt let me use a laptop... ).

All the best.
Burair.

 

[lynn]

Thank you again everyone, the cath went fine.....doc said I'm not ready for replacement yet! No blockages or anything!

I guess the holter monitor I wore last week was the culprit, my heart is beating about 4 x's faster than normal! So, I have another one on and I'm just praying that monitor was defective!!

 

[medtronic of borg]

caths

caths

In years past I have had the monitors turned around so I could watch. On another one they let me view the film afterwords. It was cool to see. But I have a great team of Dr's and we have learned to trust one another! I still don't like caths because I have had some horrific experiences with them as well as some that went perfectly well. Oh well.

Med

 

[Candy]

Rachel- I had my Ross procedure for bicuspid aortic stenosis this past March, and a cath was performed the day before. There was no discussion of another option. That was standard procedure. Fortunately, nothing else was found!

 

[Sherry]

Hi, Lynn. I did not have a cath done before my surgery. I always wished he would have in retrospect, but I guess it was my age (33). Like the others have said, different docs have different standards.