I really enjoy hearing from patients after their heart valve procedures. Their stories are often filled with inspiration and unique patient perspective. For example, here is a recent email from David Hooper following his aortic valve replacement surgery.

David writes to me…

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Alice just sent me a great question about the use of heart-shaped pillows after heart valve surgery. She writes, “Hi Adam,  I’m 61-years old and preparing for a mitral valve repair due to severe mitral regurgitation. I can’t help but notice the huge pillows clutched by patients in several photos across your website. What are those used for? Thanks, Alice”

In case you have yet to see them, here are four pictures of heart valve surgery patients (David Swendson, Anita Devine, Carla Hansen and John Turan) which feature these unique, heart-shaped pillows.

Heart Valve Surgery Patients – David Swendson,
Anita Devine, Carla Hansen & John Turan

To answer Alice’s question… These pillows are typically offered to patients for sternum support while coughing after surgery. As you may know, during most heart valve procedures, select breathing and circulatory functions are simulated using a ventilator and a heart-lung machine. Unfortunately, vapor can settle in the patient’s lungs.

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I recently received an interesting question from Rob about a post-operative cough following heart valve surgery.

Rob writes, “Adam, My wife — Gail — recently had a valve sparing aortic valve repair and had an artificial aorta. Gail has had a post-operative cough for about 5 days now.  Is this common? Are there any remedies to help it along? Thanks for all you do! Rob”

To ensure that Rob received an expert response to his question, I contacted Dr. Jeffrey Swanson, a leading heart valve surgeon from Portland, Oregon.

During his 20+ year career, Dr. Swanson has performed over 3,000 heart valve procedures at Providence St. Vincent Medical Center. (Not only is Dr. Swanson a highly-recommended surgeon – from many visitors of this website – he’s a very nice guy as well.)

Dr. Jeffrey Swanson – Heart Valve Surgeon, Portland, Oregon

Specific to cough following heart valve repair and heart valve replacement surgery, Dr. Swanson shared the following with me:

Post-operative cough can be a frustrating nuisance in an otherwise uneventful post-operative course. Frequently, the cough is of little significance and can simply be related to some residual inflammation in the trachea resulting from having been connected to a ventilator by a tube inserted in the trachea. This type of irritation-related cough generally resolves spontaneously after a few weeks and requires no specific therapy other than palliation of the cough itself.

As for a persistent cough, Dr. Swanson noted:

A persistent cough can also be related to some residual volume overload which is common, particularly in older patients, following cardiopulmonary bypass and fluid resuscitation for heart surgery. This can generally be managed with a short course of diuretics. A cough that does not resolve quickly can be a symptom of more significant problems, however, and might signal an underlying lung complication such as bronchitis, pneumonia, or a fluid collection in the chest cavity surrounding the lung. If the cough produces foul sputum (mucus with pus) or fevers, further investigation should be pursued aggressively.

Dr. Swanson also reflected on the potential link between post-operative cough and certain medications:

Finally, a nagging cough can be associated with medications and it is not uncommon that patients undergoing cardiac surgery are started on new prescriptions following their operation.One class of medications known as ACE inhibitors is very useful in the management of hypertension and coronary artery disease and is known to cause a persistent cough in some patients. In any case of prolonged post operative cough, the patient should report these symptoms to their physicians and not simply assume the cough is benign.

I hope this helps Rob, Gail and perhaps you learn more about cough following heart valve surgery. Thanks to Rob for his question. And, a special thanks to Dr. Swanson for providing some great clinical insights!

Keep on tickin!

I just received an excellent question from Teri about heart valve surgery recovery, stairs and recliners.

Teri writes to me, “Hi Adam – I want to know if I can take the steps upstairs once I return from the hospital. Our bedroom is on the second floor. Is that too much to expect? I am ordering an electric easy chair and need to know if I should have it delivered down stairs or up stairs in our bedroom — which is also close to a full shower. I really appreciated the great information in your book! Teri”

To help Teri, I contacted Dr. Paul Massimiano, a leading heart valve surgeon, from Inova Heart & Vascular Institute, to get an expert opinion on this topic.

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While the patient benefits of attending cardiac rehab after heart valve surgery are well documented, the utility of these post-operative programs remains disappointing — as only 20% of patients who could benefit from cardiac rehabilitation are referred to outpatient facilities.

For this reason, I contacted Dr. Ram Dandillaya, a cardiologist at Cedars-Sinai in Los Angeles, to learn more about the benefits and the issues that surround the use of cardiac rehab after heart valve surgery. (As you might recall, Dr. Dandillaya was instrumental in Kato Pomer’s MitraClip procedure.)

I thought you might want to review the highlights from my interview with Dr. Dandillaya so I provided them below.

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