Surgery next week, but still confused.

[rakesh1167]

Hello,
A little background. I am 30 year old suffering from BAV with moderate AR.
Had symptoms from last 7 years. Echo was done in 2007, it came out clean and they said it was all in my head. I had mild LV dilation( they said no to worry about this) with no leakage. It must have been done incorrectly, since no BAV was mentioned.

Kept lifting weights and increased weight to 90 kgs(was skinny before) . Symptoms kept on increasing, especially shortness of breath after heavy meal and palpitations.
I suspected minoxidil to be one the culprits since i started using it for falling hairs in 2007 only. Little research confirmed this as this drug has potential to harm heart. Stopped using it and felt immediate relief. By this time i was cursing myself that i damaged heart for few hairs.
But symptoms were still there and started increasing in intensity again .
So last june i had one more echo. I was shocked to find out that i had BAV with moderate AR and my LV had dilated to 7.1, EF was 52 and aortic size was 3.6. Surgery looked imminent(after reading stuff on internet) due to LV dilation. But my cardio put me on ramipril. I stopped lifting weights, focused on aerobic exercise and yoga for heart, reduced salt intake to like 1 gm or less. Lost 15 kgs in 3 months and symptoms were reducing and LV was reduced to 6.9, EF increased to 56. Cardiologist increased dosage of ramipril and asked me to meet him after six months.

Now yesterday, he referred me to surgeon for aortic repair(without doing echo). Surgeon looked little concerned at LV dilation . Fixed me for next Friday. He told that some surgeons from outside are coming with expertise in repair and that they would try to repair it and if not possible would replace it.

Echo was done today in same hospital and it was little shocking . LV has come down to 5.4 , EF is 58 and aortic size is 3.3. AR is still moderate . But i admit that some symptoms are still there especially palpitations after heavy meal but it is mild compared to last year and no shortness of breath now . Basically i feel like a patient all the time and not like normal person. It is depressing.

Cardio had talk with surgeon and surgeon( he is renowned in India) is saying is that i am perfect candidate for repair and by luck specialist is this area are coming next week. Cardio is also insisting on that saying that at this young age he would prefer that i have repair and lead normal life. I was suspecting him last year when he didn't put me under knife after LV dilation. But after this improvement in echo report i trust him more that internet. I think they know about real deal with the patient,

So i am confused now whether to go ahead with surgery or not since echo report looks fine. Personally i want to go ahead and have normal life after surgery where i don't have to worry about palpitations, quick exertion and sleep in any position i want.
Though i am worried about my 2 year old daughter and wife, if something goes wrong, since they are completely dependent on me.

Your inputs on this would be greatly appreciated. This forum has been great source of information so far

 

[ManiSham]

Hi

If you are unsure about the echo report or the fact that you need surgery, you should get a second opinion atleast that's what I would do or you can even point out the stats to your cardiologist and ask whether surgery is really required. I don't really know much about BAV so cannot advice you on anything but I hope that everything will workout smoothly for your.

Good luck!

 

[kimcdougc]

They did an angiogram on me after my echo hadn't changed in a year. They did this because I had noticed a difference in my shortness of breath etc. They noted when they did the angiogram that indeed my valve was .09 cm. It is a more defined test. You might suggest that to your dr. Good luck with your decision.

 

[river-wear]

I'm mostly asymptomatic but I'm going ahead with surgery per two surgeon's (and my cardiologists) advice. My LV was measured at 5.9 via echo, but last week a CT scan showed it's actually 6.4cm. "Very big" per the surgeon. I have severe AR.

You need to be comfortable with your decision before going into surgery, but with the symptoms and the advice of a respected surgeon saying it's time, I encourage you to fix this before permanent damage is done. The ramipril was a short-term fix to buy time.

Best wishes to you and your family!

 

[rakesh1167]

I'm mostly asymptomatic but I'm going ahead with surgery per two surgeon's (and my cardiologists) advice. My LV was measured at 5.9 via echo, but last week a CT scan showed it's actually 6.4cm. "Very big" per the surgeon. I have severe AR.

You need to be comfortable with your decision before going into surgery, but with the symptoms and the advice of a respected surgeon saying it's time, I encourage you to fix this before permanent damage is done. The ramipril was a short-term fix to buy time.

Best wishes to you and your family!

I had second opinion with another surgeon. He said that he doesn't prefer arotic valve repair and replacement is not needed now. So i am cancelling surgery now.

 

[adnan]

Hey Rakesh,

Did you go to Hrudayalaya?

 

[rakesh1167]

Hey Rakesh,

Did you go to Hrudayalaya?

Hi Adnan,
First i went to Fortis and took second opinion from Apollo. I am planning to go to Manipal for another opinion.
When is your surgery and who is your surgeon?

 

[adnan]

I am going to Fortis. My surgeon will be Dr. Krishna Iyyer. He is the head pediatric cardiac surgeon. I went to Naryana Hrudayala before this but I didn't like the surgeon over there.

 

[OldManEmu]

Rakesh welcome to VR.org.
Your numbers now all look at the upper end of normal as far as LV size and EF go. At 3.3 your Aorta is a long way from the 5.0cm that is indicative for surgery.
Be be guided by the cardio and surgeon as far as the need for surgery. Given that your heart function has improved and if your medical team suggest surgery isn't required immediately,
I would certainly follow their advice. At under 4cm you are unlikely to have an aortic dissection leading to sudden death. If the surgeon feels you are a good candidate for a repair this would be my choice. I can't comment on what are good hospitals in India and who are good surgeons.

 

[rakesh1167]

Rakesh welcome to VR.org.
Your numbers now all look at the upper end of normal as far as LV size and EF go. At 3.3 your Aorta is a long way from the 5.0cm that is indicative for surgery.
Be be guided by the cardio and surgeon as far as the need for surgery. Given that your heart function has improved and if your medical team suggest surgery isn't required immediately,
I would certainly follow their advice. At under 4cm you are unlikely to have an aortic dissection leading to sudden death. If the surgeon feels you are a good candidate for a repair this would be my choice. I can't comment on what are good hospitals in India and who are good surgeons.

At this point of time i am more worried about leakage. I took two more opinions(and another echo) and both of them were of the opinion that surgery is not needed now. So i have cancelled it. Although i must admit that i was mentally prepared for the surgery and that is the tough part. Now i will have to go through all this again.