Surgery postponed-Indefinitely because of the angiogram

Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
G

gageyk

24 hours ago I thought I'd be in AVR surgery right now(8/24). Things changed while in my angiogram yesterday (8/23). Doc was just checking my coronary arteries when he noticed my pressure was much lower than the echo had shown 4 weeks ago. Technician asked Doc if it would be ok to go to the valve with the cath. They were pleasantly surprised to see that valve area was not as severe as the echo had shown. They checked 3 times and couldn't believe what they saw. Doc said to postpone surgery indefinitely, do a follow-up echo in a couple of months and then follow-up once per year. I should be good to go for anywhere from 1 to 10 years, same thing I was told 6 months ago after an echo. Has anyone else had this experience? Doc said that do not routinely use the angio to measure the valve. He said they will start now on patients like me, I am 44 years old and asymptomatic. I've known about a heart murmur all my life. 2-3 years ago I had my first echo and subsequnt echos every year. Valve has been getting worse but I was told in 11/04 that I had 5-10 years before surgery was needed. I had been getting my echos done at the local hospital. For my most recent echo in July 05 the cardio wanted me to use their people and equipment. This echo was way out of whack with the others but I thought and was told that my valve had deteriorated drasticily so I never even thought to question the results. Of course now I'm asking why I didn't ask for another echo or why the doc didn't want to do a redo when the results were so different.

I am perplexed as to how the most recent echo(7/28) could differ so much from the angio(8/23). Echo showed valve area of 0.9 cm, pressure @ 62mm Hg. Angio (8/23) showed valve area of 1.4 cm and pressure @ 34mm Hg. So I went from severe aortic stenosis to moderate. The numbers from the angiogram match closely my previous echo from 11/04.

I'm now confused more than ever and not sure what to believe. I don't trust my cardio or his echocardiogram tech or equipment. I was less than 24 away from having perhaps uneccesary OHS. Should the cardio have asked for another echo when the July 05 results showed such a dramatic change in only 6 months? Has anyone else had similar results from an angiogram?
 
It sounds like your cardio wanted to test out his new equipment and his technicians. I would have asked for another echo when it was so different and on new machinery and I would think that your cardio should have questioned it too even though valves do sometimes deteriorate quickly. At any rate, enjoy your reprieve. You have clean arteries, are symptomless and it sounds like you have some time in the waiting room! :)
 
OFTEN MEMBERS ARE URGED TO GET SECOND OPINIONS - THIS IS A CLASSIC EXAMPLE. (oops sorry for the caps). Thank goodness you have been saved from some very unpleasant days, expenses, all that goes with surgery. Perhaps your life. You will be our poster child for second opinions. Good to know your dr was right on top of if.

Congratulations on the LONG delay til poss surgery.
 
Maybe that's why so many doc's require cath prior to surgery. The cath is said to be much more accurate in measuring valve data. Echo's have so many variables that they are second best, but are relied upon in the early stages of valve disease because they are non-invasive.

My own cardio is watching my echo's but not going into surgery-search mode for me yet, as even though the echo measurements are approaching the "think about it" stage, my physical responses are those of a milder case (aortic stenosis).

This is great news! Now I'll have some long-term company here in The Waiting Room.
 
The second opinion

The second opinion

I hate to tell you this but I've seen a few patients make it to the OR table, have an preop TEE (transesophageal echo), and then a canceled surgery. Many times the transthoracic echo shows different numbers than a TEE. Don't know why......I was told I didn't need a TEE prior to surgery as "it wouldn't show anything different than a transthoracic for aortic valve evaluation". A cardiologist was called in when my preop TEE showed a peak gradient of 56 versus my last thoracic of 103. I had the surgery anyway due to my aortic aneurysm. I don't recall.......was it the surgeon making the call for no surgery or the cardiologist? Be sure you get the same answer there. I would also get a good explanation as to why this discrepancy happened. Could a mistake have been made with the cath numbers? Just a few thoughts. Oh, I'd also get a second opinion if only for the peace of mind. :)
 
CCRN said:
I hate to tell you this but I've seen a few patients make it to the OR table, have an preop TEE (transesophageal echo), and then a canceled surgery. Many times the transthoracic echo shows different numbers than a TEE. Don't know why......I was told I didn't need a TEE prior to surgery as "it wouldn't show anything different than a transthoracic for aortic valve evaluation". A cardiologist was called in when my preop TEE showed a peak gradient of 56 versus my last thoracic of 103. I had the surgery anyway due to my aortic aneurysm. I don't recall.......was it the surgeon making the call for no surgery or the cardiologist? Be sure you get the same answer there. I would also get a good explanation as to why this discrepancy happened. Could a mistake have been made with the cath numbers? Just a few thoughts. Oh, I'd also get a second opinion if only for the peace of mind. :)

Supposedly they checked the readings three times with the cath. Surgeon was involved in the decision. I talked with surgeon yesterday, he said he would trust the cath over the echo. Surgeon also told me he would have done one more test when I was under anesthsia before splitting me open, perphaps what you mentioned above. Cardio's said wait 3 months before doing another echo, surgeon and I both want one now. I have an appointment Monday and I will request an echo at the orignial lab in the hospital.

I pulled my first ever echo results from 2000, pressure mean of 12 mmhg, peak of 22 and a valve area of 1.3 cm. Cath showed peak of 34 mmhg with a valve area of 1.25 cm. Not much change over 5 years!!

I'm more and more convinced that my July 2005 echo was botched and that I was going under the knife becasue of it. I get more and more annoyed everytime I think about it.

The info and expereinces from this website has helped a tremendous amount. Thanks so much to everyone who has posted to this and all the threads I've read over the past month. I think the doctors are blown away by the amount of information some of their patients have.
 
On top of things......

On top of things......

Stick with that surgeon......he seems like a good one. Looking at gradients in judging the time to do the surgery is not as important as how it is affecting you. As it has been explained to me, some people walk around with high to moderate gradients and are basically asymptomatic. It's the symptomatic people that really need close attention. The great thing is YOU are on top of things here and that is the best of situations. Sorry you're back waiting again but I'm glad you're okay and have what looks like a pretty good relationship with you physicians.
 
P.s.

P.s.

Just reviewed and saw you are bicuspid. Just a little hind-sited suggestion when you see your surgeon again. Amaze him/her by explaining you have a very good up to date understanding of your congenital heart defect and that you know it can predispose you to ascending aortic aneurysm. Follow this with a request to have your aorta evaluated by MRI or CT with contrast with follow-up evals along with the echos. This is the one thing I wish I had done. If I had, I would probably be sitting here 7 months post op instead of barely three. Hope this helps.
 

Latest posts

Back
Top