TOE procedure

[sam04]

Can someone explain this to me in detail. I have no wish to be sedated as I'd like to get home and I am very sensitive to metals and chemicals, both of which are in an injection! I've been told it doesn't hurt. I may be sore for a few hours but nothing else. So, are there any side effects, why would they want to keep me in overnight considering the procedure is at 9.00am (they want me in that day/night) and do they use contrast dye because I've already been told at a CT scan I can't have that. I have a bad gag reflex so how big is that camera thing LOL.

My Consultant is a little gung ho for my liking and I am not getting far verbally with him so I did fire a letter at him telling him my medical issues which all started with a metal implant in my arm in 1999. From that day on I have never been well and gone through hell and back healthwise. Up to that very day I have never known ill health, no colds, no flu, no aches/pains nothing. Very active with horses/dogs and teaching etc. so all this is one heck of a shock.

I may have had a heart murmur that my old GP forgot to mention but my Consultant says this is Genetic. I'm not really sure what caused it.

thanks Sam

 

[Madsometimes]

I had a TOE recently, and was really panicking about it, but it was fine.

My TOE was done in the normal echo department, with a cardiologist and a technician. I had an iv line put in my arm for the medication. The first thing they did was spray the back of my throat with a numbing solution. It felt like a dental anaesetic and made my whole mouth feel numb. When they did that, I gagged slightly, so the cardiologist gave me some meds through my iv to relax my gullet. I was hooked up to oxygen, the ECG electrodes were stuck on, and I was given a bite guard to put around my teeth. This stops you damaging the camera, and also keeps your moth open.

I'm really bad at swallowing tablets, but the camera slipped down my throat quite easily. The doctor gave me some very light sedation, so I remember the scan clearly, and was able to obey instructions. These were mostly to breathe in and out at particular points. I was told that i could have more sedation if i needed it, but I didn't. The contrast dye used on me was agitated saline, which is just saline mixed with your own blood, and a little air. It is different to the CT scan contrast which contains iodine.

During the scan, I could slightly feel the probe in my gullet. It was a little uncomfortable, but not painful. The scan lasted for about 20 minutes. The purpose of my scan was to see if I have an ASD or PFO. The results were a PFO but only shunting during Vasalva, so hopefully no treatment will be needed.

After my TOE I was fine to go home, but told no eating for two hours, and then only soft food, and no driving for 24 hours. However, I was only discharged because my husband was with me, and because the sedation has been light. Other hospitals use heavier sedation, which makes people fall asleep or have no memory of the procedure. In these circumstances, perhaps patients need to be observed for longer.

 

[sam04]

Thanks for that. I actually don't want sedation as that means I have to spend 24 hours in hospital due to possible side effects of the drug and the injection. I will ask about the contrast dye as they have told me none will be used but I do imagine they need something. I'm not even sure about Saline as my body, due to some weird surgery reaction years ago, starts my heart thumping and I sweat if any salt is introduced into my system! I am not an easy customer.

This is to find out if my heart can take an aortic valve replacement or not and an angiogram is not on my menu. It is hard to find someone to really sit down with and explain all the allergies, and sensitivities that you suffer from that I've told them, I've written to them to explain and it's like banging my head against a brick wall. After the last surgery which was minor, I had a metal plate inserted into my lower arm, my entire body literally went nuts and from that day I went from being a very healthy, outdoor type to practically disabled and I have a history of seizures/blood clots. I'm a wreck with a sense of humour but the Consultant is not hearing me so my GP and I have talked about the possibility of all the things that can go wrong, how long the valve may last, if it can be rejected because it is a foreign body and I know they can use a Pulomonary artery to do this surgery, it's just done infrequently. So anything foreign my body sees as a threat. Even a dental treatment can knock me out for 36 hours solid sleep, so I have problems.

I feel a lot more comfortable knowing the procedure and wonder why nobody at the hospital could find time to explain it. That infuriates me. I hope your own health continues to do well and thank you for responding. I really appreciate it.

Sam

 

[Jkm7]

I had what they call conscious sedation (versed and a pain reliever) and remember very little after them freezing my throat. The procedure took about 25 minutes and after I fully woke from the sedation, I spoke with my cardiologist and I was permitted to go home. From start of my TEE (that is what the procedure is called in U.S.) to time I left the hospital was not more than 2 1/2 hours at most.

I stressed about it in advance and after it was over was so sorry I wasted so much energy worrying about it. I found it a very easy procedure and had no difficulty at all.

 

[Madsometimes]

Sam,
Perhaps it is because of your history of allergies, clots and seizures that your cardiologist wants to keep you in overnight?

I'm sure that you will be fine with saline, but you may well not need contrast. The bubble study that I had done is mainly to test for ASD's. I have had LOTS of trans-thoracic echos done, and never had contrast. However, I do think that the iv in your arm is non-negotiable, even if you decline sedation (and I wouldn't, because it will calm you down, even if it is very light).

If you are kept in overnight, then just go with it. Take a good book, your iPod or whatever you like to relax yourself. It's very unlikely that you will be feeling unwell. The food will be bad, but then there are eating restrictions after a TOE anyway.

 

[Sarah_Louise]

Hi Sam,
Welcome to the boards
I've had several TOE's but haven't got much more to add as i think madsometimes has covered everything and like she has said, they may want you in overnight because of your history,
Good luck for the TOE,
love Sarah xxxx

 

[sam04]

Thanks everyone. I know I have to go with the flow. I will react to the IV as my body will see it as invasive. I'm not nervous about this procedure I just wanted to know what it was and you've been great so far.
I spoke with the Consultant's secretary yesterday and she told me that she wasn't sure if I had to be kept in, if I was or wasn't having sedation etc. this is stressing me a little as I've made arrangements for someone to collect me from hospital and stay with me overnight. I think it is just the total lack of communication that's bugging me.
I have a collection of books and I will avoid hospital food but will take my own in or have some brought in if I have to stay assuming that is allowed. I really need my special pillow for my spine but that has been refused in case I bring in MRSA. So I know now that I will not sleep. It will all be over and I'll know what the next step will be good or bad. I still have questions about the actual surgery and things I've heard from people I know have had different types of heart surgeries. Nobody has had this AVR that I know of.

Pre 1999 as I said, I would not have given this surgery a second thought. I would have sailed through it but since that metal plate went in, I cannot begin to describe what happened to my body physically, something went very wrong but I have a lot left in life I want to do. One thing I have been told, due to my medical issues, is that I probably will only gain around 5 years with the new valve assuming no problems after surgery. I gather with most folks it's 10 - 15 years. I've been considering if having surgery is good because i could have the worst 5 years and without quality of life, that's not me.

I guess I'm still at sixes and sevens. Everything has happened so quickly and I have no support as in family or friends. My family are in denial and by family I mean my parents and brothers. My friends all passed last year of various cancers. I like to recover from things on my own so I can go at my own pace but I also know I have to be sensible this time. Talk about confused LOL. I'll take a few days then ask about the surgery and the dreaded waking up with a tube stuck in your throat. Nobody else is going to answer my questions, not even our British Heart Foundation wanted to, so I am pretty glad to have found this list and will try and read all the posts that matter to me,so to speak. I just admire everyone on here for being around to help others just starting the journey. Trust me, it means a lot.

 

[Jkm7]

Who told you that valve replacement patients only live 10-15 years? That could not possibly be more wrong.
We have member here with valve implanted 45 years ago and they are well into their senior years and doing fine.
Many, many have had 25 year valves many of us are told after our replacement/repair surgeries that it is likely we'll die of old age from something other than heart valve disease.

EVEN if a replaced valve should fail, it is nothing unordinary about have a second replacement. Surgeons have no difficulty with a re-do.

You will do yourself a huge favor to start reading on this site and become more educated about your condition.
ASK questions here. We are more than happy to help in any way possible.

Get out of your head valvers should only expect 10 years of life.

 

[Madsometimes]

As I'm sure you know, having any OHS does involve having a lot of tubes and lines being inserted. From memory, I had a central line in my neck, an arterial line in my wrist, an iv line in my hand and chest drainage tubes plus the ventilator when I woke up in ICU. Also I had pacing wires, which were a life saver for me, plus a urinary catheter. These are just the normal tubes that you get with uncomplicated heart surgery, and they gradually get removed over the first few days as you recover.

In terms of medication, you get a cocktail of drugs during the anaesetic, plus plenty more in ICU for pain. I remember the nurse was often putting saline into me too, and giving me a horrid potassium drink. There was a diuretic tablet, omeprazole to prevent stomach problems, warfarin, fragmin. I'm sure there was more that I've forgotten about, or never knew about, too...

I suppose what I'm trying to say is that it is impossible to avoid iv lines and medication during and after heart surgery. I think that you would be wise to discuss your concerns with your doctors, but if they want to sedate you for your TOE, then go with it. It is quite unusual to have this test with no sedation at all. The doctors can then observe your reaction to metals and medication in a controlled environment. I know that surgeons and cardiologists are pretty hard to pin down, so maybe talk to your GP. The person doing the TOE will be a cardiologist, so you should also explain your concerns to him or her just before the test.

I also agree with Jkm7 that you should have a positive outlook for your valve replacement. A tissue valve may only last 10 years in a younger person, but can last for a lot longer, especially in recipients in their 60's plus, and if it fails, you get a re-do. Did your doctor tell you that you would only get 5 years from the AVR?

I have a genetic condition, but I'm positive about things. It's the best way to be.