Comments on: Thoracotomy Vs. Sternotomy For Vicki’s Mitral Valve Surgery… Any Female Perspectives?

By: SUSAN LLOYD

SUSAN LLOYD — Wed, 02 Mar 2011 14:22:07 +0000

A year ago at the age of 54 I was diagnosed as having a large Atrial septal defect ( 29 mm) which I would have been born with .
In May 2010 I underwent keyhole surgery to try to repair the hole with an amplatzer device – this failed due to the position and size of the hole.

My Dad died shortly after this and so I had to deal with the grief before trying to move on. I have seen 2 surgeons recently . One is based in my home city in Wales and says he can use either a sub mammary ( is the same as thoracotomy> ) approach or a full sternotomy . He would not show preference – just said the sub mammary takes longer and is more taxing for the surgeon , but that time on by-pass the same . Also that there is a risk of ongoing pain afterwards .
The second surgeon is based in London , and definately favours the sternotomy . I was hoping he would attempt a lower sternotomy ( some of you have mentioned 4 inch incisions ?) but he laughed and said with women he tried to make the scar slightly lower but that was the best he could do . This surgeon has a very good reputation , but seems more traditional .

I am scared and confused . Can anyone help me ? Most of you seem to be from America sharing your information- well done . I can’t find discussion groups like this in UK .

By: Mary Ann Marko

Mary Ann Marko — Sun, 17 Oct 2010 04:28:04 +0000

At age 68 I had robotic repair of the mitral valve in May of this year. Ten days later, I suffered a rare complication, herniation of the lung into the robotic incision after a severe coughing spell. I underwent surgery to repair this. The recovery was extremely painful following both surgeries, worse after the second. At five months post op, my right breast is still completely numb and I expect it will remain so. By all indications, my heart is healthy and I am taking no heart or pain meds.All in all I am grateful to have my life back.

By: Doug

Doug — Thu, 26 Aug 2010 14:24:37 +0000

FYI, I had my surgery, and everything went as well as could be expected. Oddly, I didn’t have much pain in my chest afterward, except when coughing. Even then, it wasn’t terrible. The painkilling narcotics did give me hallucinations, though.

By: Glenda

Glenda — Mon, 02 Aug 2010 20:01:27 +0000

I’m a 69 year old female who is quite active. Don’t run, climb mts. etc, but work outside in my yard doing whatever needs doing.moving heavy pots, climbing ladders – painting , digging holes , hauling stepping stones etc. have had mitral valve prolapse for years, and have to stop and rest a lot. Doctor says I need replacement surgery but even tho the valve is getting worse, my heart is still too strong for surgery to be done now. Don’t understand why my heart needs to get so weak first. He said the danger of dying from the defective valve has to outweigh the possibility of dying during surgery. I currently take no medicines for anything beyond asprin or ibupropen for arthritis or something for bouts of sinus. Doctor said I will have to have a metal valve and take blood thinner forever. I wonder how many more drugs will I end up having to take before it is over. I hate to take medicine. The thought of pain doesn’t upset me nearly as much as being down where I can’t look out for my self for who knows how long.

By: Doug

Doug — Sat, 26 Jun 2010 23:02:52 +0000

I am a 48-year old male in good health who is scheduled for mitral valve repair (prolapse and regurg) in August. Regarding minimally invasive partial sternotomy v. thoracotomy, Dr. Keith Horvath of NIH and John’s Hopkins said that the thoracotomy was more painful. More interesting, he said that, if you are athletic you might consider sternotomy because the sternum can actually become stronger after surgery because it is held together by steel wires rather than “just” bone. He added that thoracotomy can sometime leave lingering or chronic little pains because it requires cutting through muscle and connective tissue rather than skin and bone. There are many other considerations, of course, but those who lift weights or swim should think about this.

Another interesting tidbit he mentioned: connecting the cardio-pulmonary bypass machine through the femoral artery (as is often the case in minimally invasive techniques) has, according to a recent as-of-yet unpublished study at NIH (?), a slightly greater chance of causing stroke. A possible reason is that the blood flows BACKWARDS through the femoral artery, possibly dislodging stuff that shouldn’t be. Going through the aorta, on the other hand, goes with the flow, so to speak. Further, the femoral artery is small, and more difficult to work with than the aorta. . . . Has anyone else heard anything like this? I don’t like the idea of blood flowing backwards in my arteries. (Maybe I misunderstood.) (Of course, the chance of these side effects is very low.)

By: Kellie

Kellie — Sat, 29 May 2010 16:59:45 +0000

Hi Melisa. At 40 I thought I was young to need a valve replacement. Like you, I need to decide which type of sugery I want. My surgeon says the only difference is the size of the incisions…. I also need to choose which type of valve I want (porcine or mechanical). I’m curious to know which you plan on choosing. I was leaning one way but am giving more consideration to the other lately. My surgery is scheduled for mid-July.

By: Melisa

Melisa — Sat, 15 May 2010 04:38:25 +0000

I am a 30 year old female in need of an aortic valve replacement. I am still trying to decide between a thoracotomy or a full sternotomy. Worried about tubes, pain, etc. Not much concerned about scars. The anxiety is killing me…my surgery is still a month away. I just want to make the right decision. I am having the surgery in Utah. Any suggestions or comments from anyone is appreciated! Thanks!

By: Freddie

Freddie — Tue, 11 May 2010 01:55:33 +0000

Hi, My younger sister(49) needs a mitral valve repair in 2-3 months for severe prolapse and regurgitation, ruptured cords, pulmonary hypertension, enlarged heart. The head of UW Madison advised her to have a full sternum approach. Mayo says she is a good candidate for robotic. Northwestern head of cardiac surgery says full sternum.She is going to consult with the Univ. of Chicago also. We are very interested in the healing time and complications from the minimally invasive technique vs traditional approach.The UW surgeon was the one who mentioned the rib pain, muscle pain and possible right breast numbness. She wants to avoid the big scar but also has 4 teenagers and is otherwise athletic and in good health. Her lungs need to recover for a few months more from severe H1N1 and pneumonia last winter according to one of the surgeons. I would appreciate input, especially for small boned females having had both techniques. Thank you.

By: April

April — Sun, 21 Mar 2010 18:16:16 +0000

I am a 55 year old female and almost 1 year post op from a minimally invasive mitral valve repair in Houston. “Minimally invasive” doesn’t mean “minimally painful,” although no one told me that beforehand. I can honestly say it was the most excruciatingly painful thing I have ever been through, and there is little or nothing written about this type of surgery on females. The first two weeks were the worst,but I rapidly improved after that. Having sufficient pain meds and someone to help out the first week home is very important. I had a couple of complications – had to have fluid drained from my chest a couple of weeks after surgery and I also developed a lymphocele at the groin incision which required another surgery. All in all, I am very pleased with the results and have no regrets about anything. I feel great and am able to exercise and do anything (and more) that I could do before the surgery. I had lingering breast and shoulder blade pain and recently received a couple of rounds of steroid injections which has helped.

Has anyone experienced strange muscle contractions under the right breast when the chest muscles are flexed? If so, has anyone tried to get it repaired?

By: wendy

wendy — Wed, 03 Mar 2010 04:43:49 +0000

Hi Wendy,
Thank you so much for responding to my request for more information and insight on having a thoracotomy. It would be so helpful to be able to hear more from you. I haven’t been able to talk with anyone personally who has been through the experience, and because of the privacy laws my doctor hasn’t been able to connect me with anyone to talk to. I told his office that I would be happy to be a patient advocate after my surgery. The unknowns and uncertainties make facing the surgery so much more difficult. I am very grateful to Adam and all the participants of this blog who are building a circle of support and information for each other. It is a gift that keeps on giving and touching lives to those in need. I will write him and ask him how we might be able to connect more directly. Thank you again. Be well, Wendy