Told I need Urgent AVR

[justme]

Saw my doctor 2 weeks ago. Simpley exhausted. Winded walking from car to his office. He did breathing test, they're ok.Heart murmur was more pronounced. Annual Cardiologist appointment last week. Had an ecco and he was not happy with the numbers. He arranged the angiogram today I had that down and these were the ressults but mean nothing to me.

Date 10-31-08

Aortic Pressure
116/64/84

LV Presssure
162/11/37

Heart Rate Rhythm
NSR

Ejection Fraction
>65 %

RA 9
RV 39/14
PA 47/29
PCW 19
LV
AOV. AREA
TH=. 86 FICK=.82

Collaterals
{ } yes {x} No

ABG on RA 917.SAT
7.32/48.7/59.2

​

IMP (1) Severe AS
(2) Normal Coronaries
+ LV
(3) PA Htn
Ree URGENT AVR

I have a 2:15 appointment Monday with the surgeon to discuss replacing the aortic vavle. My BP is low. today it was 117/68. Last year it was much lower and I was told to increade my salt intake. I even asked for a ppescrption stating mmore salt because my daughter is always on my care about using salt. I add at the table but seldom when I'm cooking.


I'm scared after reading about replacement valves. Kind of think I'd prefer a pig valve. I've had both knees replaced and had a bo\loodclot form. I don't want to be on coumadin for the rest of my life. But then a mechanical valve will last longer. I'm 68 now, just retired and don'tm want another valve in 15 years. My Mother is 90+ and they wukk not replace her valve. States it is not a feasible surgery at her age. She's had a stroke..

If anyone can explain the nubers to me it would be appreciated. I'm scared.
I don't want my chest cracked open. From what I've read [the less invasive procedure is not ready for public use. Anyone with some knowledge please advice. I'll be reading most of the weekend.

Thanks, Justme.

 

[neil]

hi am sorry but the numbers dont mean much to me,the best person to ask is the doc on monday,i had my valve done this year,and having your chest cracked open isnt that bad,like you i was scared but honestly it aint that bad,talk it over with your doc and he will explain things more in black and white,am sure whatever course of action is taken you be fine,

 

[ALCapshaw2]

Welcome to our World !

Before going into specifics, you need to know that just about everyone on this site has Survived Open Heart Surgery or is a family member of someone who has Survived OHS. If we can do it, SO CAN YOU!

Second, almost everyone agrees that the WAITING is the Worst Part and the Surgery is NO WHERE NEAR as bad as they feared.

Third, Valve Replacement Surgery has evolved into a highly refined art with extremely high Rates of Success, especially when performed by a Surgeon who does many (over 100) per year at a Hospital that does a LOT of Heart Surgeries (hundreds per year....1000 per year would be nice).

I do not know how to interpret your pressure numbers.

MANY Cardiologists and Surgeons use 0.8 sq cm Effective Valve Area as their 'trigger' for recommending Valve Replacement surgery and your numbers are 'right there'.

Your Ejection Fraction is on the high side of normal which 'may' be an indication that your heart is compensating for a narrowed valve (which you have based on the effective area number).

Most Surgeons and more and more Cardiologists believe that "Fixing the Problem" SOONER with Valve Replacement is better than waiting for symptoms to worsen which merely confirms that DAMAGE has been done to the Heart. Early intervention usually Prevents Permanent Damage to the Heart Muscles and Walls.

The Bovine Pericardial Tissue Valve has a track record approaching 20 years for most patients who received them in their 60's. New anti-calcification coatings are "Hoped" to extend that another several years.

Unmodified Porcine Valves (directly from the Pig, NO improvements) tend to wear out faster than the Bovine Pericardial Tissue Valves, often in 8 to 12 years.

There are some 'New and Improved' Porcine Tissue Valves which are promising but it is my understanding that they have not been in use long enough to know if they will make 20 years or not, although that is their 'hoped for' result. Hopefully someone more knowledgable in Porcine Valves can provide the latest information on these valves.

Coming from a family of "Long Livers - in their 90's" you may want to consider a Mechanical Valve to avoid a repeat surgery. The On-X Valve (introduced in 1996) offers several improvements over earlier designs. See www.heartvalvechoice.com and www.onxvalves.com for more information. The Standard St Jude (Master's Series) valves hold the record for Durability (30 years and counting).

Minimally invasive procedures can be performed by Surgeons who are experienced in those procedures. Not all surgeons have that skill. Going through the ribs is often 'more uncomfortable' that cutting the sternum. Most patients report a feeling of 'discomfort' rather than PAIN from their sternotomy. Pain control and management is NOT a major problem for the vast majority of patients.

I recommend that you browse around in the Pre-Surgery and Post-Surgery Forums to see how others have coped with these same feelings and fears.

I'm thinking that the Moderator (Ross) may want to move this thread to the Pre-Surgery Forum or maybe the Heart Talk Forum.

Hope this helps to give you a better perspective of what you are facing and the courage to face it.

You CAN do this!

'AL Capshaw'

 

[hensylee]

Welcome to VR. glad to have you aboard altho sorry for the reason you are here. I can't answer your questions but you are in a good place to find some. This is a great site for support and information - and a little fun, too.

 

[WayneGM]

Welcome to VR. Sorry for the circumstances but glad you found us. I can't help you with the numbers as I don't have a clue what they mean. I just put my trust in GP, Cardio, and Cardio surgeon when they all said I needed OHS. It's normal to be scared but now that I'm on this side of the mountain, I can honestly say it wasn't as bad as I feared. Best wishes and good luck.

 

[DebbyA]

Welcome to the forums! You sound so distressed. You'll find some comfort and support here, so stick around and READ A LOT.

No matter which valve you get, very soon after surgery you'll appreciate your improved breathing and feel like you wasted a lot of time worrying! After a few months, most of us who had symptoms beforehand feel better than they can remember feeling for a long time.

I see you're in my area--which surgeon are you seeing?

 

[Cooker]

Welcome to VR.com! ? I can?t help with the numbers but will tell you that coumadin/warfarin is not a problem and the surgery is not near as bad as you may think, at least this is ?my? experience ? This stuff is very scary; never feel like you can not express your fears or concerns here or to your doctors. The valve choice is one that is best made by reading as much as you can and talking with your cardiologist and surgeon.

There is a wealth of information and support here but keep in mind that we are medical professionals (there are one or two) ? We will walk with you up and over this mountain ? Take heart ? I feel sure will do just fine.

 

[hall]

Hi and Welcome! Just to let you know OHS is very scary. I was scared and the pain was not near what I thought it would be. Anymore, they can control the pain. Everyone says the wait is horrible. I can not help you with the figures either. I wish you the best of luck.

 

[Mary]

Your numbers indicate that you have severe aortic stenosis, and the only "cure" is to have your aortic valve replaced. You really have no other options.

Rather than worrying and waiting, you can take charge, schedule the surgery, and consider the positive health benefits replacement will provide.

When you meet with the surgeon, ask what valve he would recommend. That would be my starting place, and then if you're uncomfortable with the suggestion, do more research and decide what you want.

Let us know how the appointment turns out on Monday and best wishes!

 

[pamela]

Hi JM,

I'm glad you've joined us here. Mary as a good idea, altoug I'd suggest asking your surgeon if it were he or someone he loves, about to face Open Heart Surgery, what would he choose.

Be realistic about what you expect. A new valve won't turn a non-runner into a marathon racer and a mechanical valve won't mean that you have to stop all activities, you won't be fighting any UFC matches while on coumadin so if you do that sort of work you may want a tissue valve. Keep in mind that a tissue valve is no guarantee that you won't require anti-coagulant therapy in the future.

I have similar clotting history and I'm now anti-coagulated with coumadin for the rest of my life. I have a tissue valve, granted my INR dropping below 2 likely won't mean clot formation but maintaining a steady dose can't hurt. Visit the Anticoagulant forum here and there's a good chance you'll see living with coumadin therapy isn't all that horrible a life sentence.

Take Heart, make a choice you can live with and then live happily with it,
Pamela.

 

[Phyllis]

Glad you found us and hope all the great answers you got help to alleviate your fear. Be sure to get back to us after the meeting with the surgeon and we will always be here to help.

 

[Bina]

Welcome to the group. I am the biggest chicken on the planet and I survived the surgery.
Surprisingly, the actual incision was fine, my ribs ached, and I did without painkillers after 2 weeks.
Your valve area is .8 and you are having trouble, that was my launching point. Have faith and you will do fine.

 

[Eva]

Welcome to this website,

I was freaking when I heard of the need for OHS. As said before by many other members, I was able to deal with it and the benefits after the surgery outweighs anything else.

Your doctor/cardio/and surgeon would be the best ones to advise you about the valve suitable for you. If you are hesitant, as others said, do your own research, get the facts, and rediscuss with your doctors. In my personal case, my doctor and surgeon were luckily patient with me and I asked them many questions over the phone and they responded diretly or through their nurses. We shall always be here to listen to you, support you, and share with you our experiences.

Good luck, all will go well -- we had been there and here we are wishing we had done this surgery many years before.

Prayers,

 

[justme]

Thank you all very much. I'm spending time reading the many informative threads here. My questions will be ready for the surgeon on Monday and I'll post afterwards. (Sorry about all the typos earlier.)

 

[ottagal]

welcome

welcome

Hi,
Welcome to this wonderful site. I don't have much to add to what everyone else has said. Good luck on Monday and keep us posted!

 

[Marguerite53]

Hello, Just Me and welcome to this wonderful community.

Some of us find out about our surgery after we've had the surgery as emergencies. Some of us find out years and years ahead (me) and some of us have but a few weeks to decide things. We are all here in this group. The best thing is.....we are living proof that this surgery is well-rehearsed and leads to prolonged life. That is something you are being denied by the "severe" stenosis of your aortic valve. That is a disease of the heart valve that is making your valve crusty and stiff and not allowing your valve to function properly...thus your windedness. It will only get worse. It will eventually cause your heart to not be able to function at all. So of course....you must have surgery!!

Valve choice is a very personal thing. The best thing you can do is go with your gut instinct as you read and educate yourself about these valves. Then find a surgeon you can trust. You are not far from the DC area. Surely there is an abundance of qualified surgeons at some of the nations best hospitals.

The experience is no picnic, but honestly it is far easier than you would expect for most of us. We can help guide you through some of the particulars. Please continue to come here for anything and everything. We are a great support group!

Best wishes.

Marguerite

 

[njean]

Just wanted to welcome you to VR and wish you well on your appointment on Monday. I hope you get answers to all your questions and you are able to make the right valve choice . Whatever choice you make, will be the right choice!

We're here to listen anytime you wanted to post. Take care!

 

[Marty]

Just me, I live in McLean 300 yards from the Arlington border. In 1998 I saw Dr. Lefrak at Inova Fairfax. I was 72 then. I didn't tell him what to do. I was hoping for a good repair. My mitral valve was so torn up, a repair was not possible. At that time the tissue valves were not as reliable as they are now so he put in a mechanical St. Jude. I am grateful for this and not possibly looking forward to another surgery. By the way, Dr. Lefrak trained with DeBakey and Cooley in Houston.He subsequently wrote one of the early books on valve surgery. If you need a second opinion he would be a good one to talk to.

 

[ponygirlmom]

My BP is low. today it was 117/68. Last year it was much lower and I was told to increade my salt intake.

I'm not a blood-pressure expert, but 117 doesn't sound low to me. Or if it's considered low, it's a good low, not a bad one.

I don't want to be on coumadin for the rest of my life. But then a mechanical valve will last longer. I'm 68 now, just retired and don't want another valve in 15 years.

Unless you tend to react adversely to a variety of medications, I don't think you will have a problem taking blood-thinners. I could be making an ageist assumption, but I am guessing that you are not worried about having to give up a hard-contact sport.

I'm scared. I don't want my chest cracked open.

Yes, that is a sucky part. But actually not as bad as continuing to be exhausted all the time. It might help to stop thinking of it as "cracking," which sounds like an accident rather than a medical procedure. The doctors don't actually come at you with a giant lobster-cracker! Although that would be funny. Think of them smoothly opening your ribs to see your heart, and you will feel more relaxed about it.

 

[justme]

I saw the surgeon today. I'm scheduled for surgery on 11/19. He'd prefer to do it sooner but I need some time to adjust mentally and get some things straighten out at home. I just spent 3 months finding a nursing home for my mom and cleaning out her place.

Ok, I'll have a tissue replacement valve and the surgeon answered my questions to my satisfaction. Didn't have many after reading most of the posts here. He gave me a book and a video and said to call if there are any questions I want answered. I did ask about the repair being made between the ribs instead of opening the chest. I liked his answers and think I'm Ok with this.

I'm glad I found this forum and so much information. I was really stunned on Friday. One day I'm fine and the next boom! Could be a lot worse, I know. At least I had some warning. Thank you all for positive support.

I'll be back...