Adam's Heart Valve Surgery Blog – Page 65

David just wrote me an email that reads, “Hi Adam – I’m really confused right now. My doctor says I have severe aortic stenosis which could require heart valve replacement. Strange part? I feel fine. Can you help me better understand what are the key indicators for aortic valve replacement?”

Many patients believe that symptoms are the key indicators for valve operations. However, as I and others can attest, patients can be asymptomatic and still be very ill. That said, the key indicator for valve replacement due to aortic stenosis deals with the size of the heart valve and the rate of blood through the valve.

Example Of Aortic Valve With Severe Stenosis

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Lately, I’ve been doing a lot of shopping on eBay.

Robyn (my wife) is pregnant and I’m finding that most baby/nursery products are 20%-30% cheaper on eBay than at Babies R Us or Right Start. Earlier today, I was curious… So, I typed “heart valve” into the search field at eBay. Guess what I found?

I could not believe it. I actually found an auction for a complete mechanical heart valve sizer kit! In case you didn’t know, mechanical heart valve sizers are used by surgeons during operations to measure the patient’s valve size.

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The day before patients enter the hospital, they usually pack a travel bag.

Some patients mistakenly pack a big bag of stuff as if they were vacationing in Hawaii. The reality? You will only need a few, personal items during your time in the hospital.

In thinking about it… I believe the invisible, interpersonal things that patients bring to the hospital are incredibly important. That said, here are my top 5 invisible things that patients should pack in their minds:

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Rodney Dangerfield, who played the role of Al Czervik in the cult-classic Caddyshack, is still quoted when my family and I need a laugh. During the 1980s, we huddled around our high-tech, Betamax movie system to watch this legendary actor in the incredibly funny, golf comedy co-starring Chevy Chase, Bill Murray and Ted Knight.

As you may know, Rodney Dangerfield (1921 – 2004) is just one of many celebrities that had heart valve repair or heart valve replacement during their lifetime. Other living celebrities who battled heart valve disease include Arnold Schwarzenegger, Jim Lehrer, Robbie Benson, Teppo Numinen, Charlie Rose and many more.

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I just received a concerned email from Sean about nerve damage after heart surgery. I provided some thoughts for Sean below, but I’m curious to know if you experienced this heart surgery complication. Here is Sean’s story:

Hi, Adam!

I’m recovering from aortic valve and aortic root replacement surgery. It turned out my problems were congenital – a bicuspid aortic valve and a related aneurysm of the aortic root. My faulty valve and aneurysm waited patiently until I was 60-years old to need replacement! Nice of ‘em, huh?!

I am hoping you and your readers can provide some useful information, either scientific or anecdotal. I woke up in the ICU to notice that the left side of my left hand was “asleep” – you know, how your foot might “go to sleep” if you positioned your leg improperly for too long.

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Are you like me?

When I was diagnosed with severe heart valve disease, I wanted to learn as much as I could about aortic stenosis (my valve disorder), aortic valve surgery and the recovery from open heart surgery.

Specifically, during my second-opinion with Dr. Chaikin, I learned that my heart valve leaflets had narrowed due to the calcification of my bicuspid aortic valve. As a result, blood flow through my heart was compromised which caused my heart to enlarge. This was a dangerous precursor to congestive heart failure. Although I was asymptomatic, I was not in good health.

Calcified Aortic Heart Valve

Anyways… I was just doing some research on heart valves when I came across this incredible picture of an aortic valve that suffers from aortic stenosis due to calcification. As many of you enjoy learning about the anatomy of your heart and heart valves, I decided to post the picture (above) for your review. If you look real close, you can see actually the calcium deposits on each of the three heart valve flaps. Pretty interesting, right?

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I stress A LOT of things for patients to “watch out for” as they prepare for heart valve surgery. One of the most critical, potential pitfalls in this complex process is poor surgeon selection. As we all know, there is risk in any type of surgery. But, finding the right cardiac surgeon (with extensive experience) can minimize that risk.

It’s a sad fact… I receive emails from caregivers whose loved ones did not make it through surgery. Those are the toughest emails to read. The sadness and anger is overwhelming. Even with all the good happening in the heart valve community, mistakes are made.

On that point, I just read an unfortunate story about Latricia Satterwhile, a mitral valve surgery patient. I am posting this story to emphasize the need for patients and caregivers to actively research their medical staff and facility. Here is Latricia’s story from the Herald-Leader newspaper in Lexington, Kentucky:

A $9.8 million civil verdict was returned in a lawsuit filed by a Lexington hairdresser who became paraplegic after a routine heart surgery.

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Over the years, I have collected many insightful and inspirational quotes from patients about their heart valve surgery procedures. Personally, I learned A LOT from former patients as I prepared for my own aortic valve replacement. Receiving direct advice from patients really helped me understand the potential ups and downs of heart surgery.

That said, I am going to start posting these quotes in this blog to support future patients and caregivers. I really hope these quotes help you.

The first “Best Piece of Advice” comes from Karen in Florida. It’s a quick, one sentence thought that focuses on the fear, uncertainty and doubt relative to heart surgery. Here it is…

I really appreciate that thought – especially considering our prior discussions about F.E.A.R. (the acronym for Fantasized Experiences Appearing Real.) As Karen alludes, your mind can play some awful tricks on you leading up to the operation. However, heart valve surgery statistics show that most patients live longer, healthier lives as a result of cardiac surgery.

Keep on tickin!
Adam

Hmmmmmmmmmm.

Did Doctor Vaughn Starnes, one of leading heart valve surgeons, make a mistake when he performed minimally invasive aortic heart valve replacement on Paul? Scroll down and read Paul’s email to find out why his incision scar is on the right side of his chest!

Hi Adam,

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Every few days, I receive a detailed email that illustrates just how poorly patients can be prepared for the realities of cardiac surgery.

Case in point… Gloria just sent me a disappointing note about her double valve replacement (aortic, mitral) and valve repair (tricuspid). My face soured and my frustration level soared as I read about each-and-every problem Gloria encountered in the hospital and during her early recovery.

With Gloria’s approval, I am posting parts of her email below to help future patients and caregivers avoid several of the unnecessary pitfalls of heart valve surgery.

Hi Adam,

Several months before surgery was an option, I went into atrial fibrillation.

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Matthew has an interesting, video request…

He writes, “Adam – Thanks for your book and blog. I’m 47 years old and in the ‘waiting room’ right now. I have a mitral valve prolapse with moderate mitral regurg. My cardiologist thinks I may need surgery within the next 1-2 years. Curious to know if you have any echocardiograms that show a severe mitral valve prolapse with mitral regurgitation? Thanks, Brian”

Sure thing Brian! Here is an echocardiogram of a mitral valve prolapse. Although the video has no sound, you can see a significant mixture of blue and red colors near the valve. (The colors in the echocardiogram indicate the motion of blood around the mitral valve.)

If you look even closer, you can see that the mitral valve in this echocardiogram has severe prolapse. You can see the failure of the anterior and posterior mitral valve leaflets to seal tightly. Plus, the rampant mixture of red and blue colors in the echocardiogram illustrates significant backward blood flow. Unfortunately for this patient, I believe this is a very diseased mitral valve that may require surgery.

I hope this echocardiogram of the mitral valve prolapse was helpful.

Keep on tickin!
Adam

Laura Lee is getting ready for her valve surgery. In anticipation of her recovery, she asks me, “Would you please tell me how to use the incentive spirometer so I can start practicing? Thanks for everything! Laura Lee”

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This email from Kenneth conjured up an ear-to-ear smile on my face.

As you can read below, Kenneth details the chronology to his best golf score ever. I guess bovine (cow) valve replacement and A-Fib helps your heart and your golf game!

Adam:

• April 25, 2008: Aortic valve replacement (bovine)
• April 30, 2008: First incident of atrial fibrilation
• May 02, 2008: Second incident of a-fib
• May 04, 2008: Third incident of a-fib
• May 06, 2008: Out of hospital of a-fib
• October 06, 2008: First “Hole In One” and shot 83; Best Score Ever

Thanks for your heart valve book and your encouragement.

Kenneth Kahn (Jane’s husband)

It’s a troublesome, patient dilemma..

Your primary cardiologist says, “You need valve surgery right away!” However, you’re second-opinion says, “Hmmmm… I’m not so sure about surgery just yet. I’d hold off for now.”

What are you supposed to when your first- and second-opinions ARE NOT on the same page? This is exactly what Susan is experiencing with her mother’s diagnosis. Here is Susan’s story and my thoughts:

Dear Adam,

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This is a great, inspirational story about Lynn, mitral valve replacement and his bike. Lynn writes…

Hi Adam,

I’m a 69-year old male who had mitral valve replacement and triple bypass surgery on May 28th. I just returned from my 50th high school reunion in Sioux City, Iowa.

My high school buddy, our wives, and I rode our bicycles from my home in Sheridan, Wyoming to Sioux City for the reunion. The 700-mile biking trip took us 12 days.

I feel great!

Lynn Heeren

I was just reading a rather frightening article about women, cardiologists and heart disease at the Dayton Daily News.

I was shocked to read a few statistics about the the incredibly large number of women that have cardiovascular disease. Furthermore, the annual mortality rate from heart disease was equally disturbing.

Here are the statistics that forced me to do a double-take:

• 42.7 million United States women have cardiovascular disease
• 459,096 women died of heart disease in 2004

According to the article women with heart disease outnumber men in both measures of the disease which costs $448.5 billion a year — $296.4 billion for medical care and $152.1 billion in lost productivity.

As you can see from the chart above, Associated Content suggests that stroke, lung cancer, chronic obstructive pulmonary disease and breast cancer are the other critical medical challenges for women.

Keep on tickin!
Adam

The genetic links of heart valve disease are fairly well documented.

As the Children’s Hospital Boston finds, “Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families.” More specifically, a recent study suggests, “Having a first-degree relative with mitral valve disease was found to increase the risk by 2.5 times.”

So you know, my Uncle Mooney had valve replacement surgery over 30 years before my aortic surgery. And, my Grandpa Zim (who has passed on) had heart trouble which resulted in a quadruple bypass. For this reason, I perked up in my chair when I received a very interesting email from Ed in Virginia.

Here is Ed’s email…

Adam,

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I just received an email from Barbara regarding heart valve anatomy, specifically her mitral leaflets.

She writes to me, “Dear Adam – Yesterday, I was unexpectedly diagnosed with severe mitral valve prolapse. Although my cardiologist did his best to explain the problems with my valve, I really could not focus on the words he was saying. I was in shock. There was some discussion about the problems with my mitral leaflet. Can you help me better understand what is wrong with my mitral leaflets? If you have a picture that would be helpful. Best regards, Barbara.”

I can relate to Barbara’s question. When my first cardiologist told me I needed aortic valve replacement, I went numb. My cardiologist talked for another 15 minutes about my diagnosis, but I only understood 10% of the words that exited his mouth. In that moment, words like valve leaflets, dilated heart and left ventricle thickening meant nothing.

Mitral Leaflet Anatomy

Your mitral valve contains two flaps known as mitral leaflets. The leaflets are composed of tissue. The sole purpose of your mitral leaflets is to open and close tightly. This tight seal ensures that blood flows through the heart in one direction, with no blood backflow (known as mitral valve regurgitation) into the heart.

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A few weeks ago, I posted a blog about Angie’s aortic mechanical valve replacement options.

Becky has a follow-up question that reads, “Hi Adam – My mitral regurg has worsened to the point where I need surgery, according to my cardiologist. I’m 48 and don’t want to go though a second heart surgery so I’m opting for a mitral mechanical valve. What are my options? Thanks, Becky.”

It’s good to see that Becky is aware that she has options for her mechanical valve replacement. Patient awareness is definitely on the rise! Just a few years ago, most patients simply said, “Okay. Okay. I want a mechanical valve. Thanks Doc.”

Now, patients are coming to their surgeons saying, “I want to be in the On-X trial!” or “What can you tell me about the Medtronic replacement?” or “I hear St. Jude’s prosthesis valve is great…. Can I get one of those implanted?”

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At 64, Jack has recently been diagnosed with severe aortic valve stenosis. Jack writes, “Adam – I’m like a deer in headlights right now. I need aortic replacement soon. I’m curious, the doc mentioned an aortic valve gradient following my echocardiogram. What the heck does that mean? Thanks for all you do, Jack.”

Jack asks a good question about aortic valve gradients (also known as AVG). In fact, I have never received a question about aortic valve gradients, so I just spent some time researching this diagnostic measure for valvular stenosis.

According Cardiovascular Physiology, stenosis of the aortic valve leads to a pressure gradient across the valve during the time in which blood flows through the valve opening. This aortic valve gradient is expressed as an increase and decrease on each side of the defective valve. The magnitude of the pressure gradient depends on the severity of the stenosis and the flow rate across the valve.

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