Adam's Heart Valve Surgery Blog – Page 68

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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On the topic of preparing for heart surgery…

Lloyd asks, “Adam – Thank you for your promptness in sending your book to me last weekend. I have started to read it, but I am still a little afraid. My question is this, how did you physically prepare for your surgery? I am 61 years old and walk daily – approximately one hour. In bad weather, I walk in the gym, 3.5-4.0 miles per hour with grades up to 8 percent. I am concerned as to how do I get myself in the best physical shape possible if I need surgery. FYI, I am asymptomatic and a retired police officer. I have been treated for high blood pressure for years but have always maintained an active life. Thank you. Lloyd”

Here is my counter-intuitive response to Lloyd’s question:

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Talk about twists and turns during the early recovery from bicuspid aortic valve replacement surgery. Jim from Alabama has quite the tale to tell… Here is what he writes:

Hey Adam,

First, I’d like to say how much I appreciate you and your heart surgery book. You provided my family and I with great information and gave us some peace of mind prior to my surgery and even now as I recover.

My story really started about 5 years ago when I, and some medical folks, thought I had a heart attack. When the smoke cleared, I was diagnosed with bicuspid aortic valve stenosis. I guess the alleged heart attack (or “episode” as the cardiologist called it) was a warning shot that something was wrong with my heart. I was perplexed as to how I could have a congenital heart problem after serving 21 years in the Air Force and never being told I had an issue or even a murmur. Of course, now I understand. (To learn more about bicuspid valves, click here.)

Fast forward to June 2008…

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Last month, Scott was diagnosed with aortic valve regurgitation. After his initial research, Scott was going to select a mechanical valve. However, the more Scott learned about the use of anticoagulation therapy (e.g. Coumadin) to prevent clotting on aortic mechanical valve options, the more concerned he became. Scott’s email to me reads:

“Hi Adam – I’m 52 and suffer from severe aortic regurgitation. I’m torn between my mechanical and bioprosthetic options. Can you help me better understand the risks of anticoagulants relative to valve function and patient lifestyle?”

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Jill writes to me, “Hi Adam – My world is upside down right now. My dad was just told that he has aortic valve regurgitation and needs a prosthesis valve (or at least I think that is what he said). Can you help me understand what all of this means? Plus, I’m a visual person. If you have any pictures of a valve prosthesis that would be great.”

From Jill’s description, it appears that her father is in definite need of a heart valve replacement. That said, Jill’s father will need a prosthetic valve transplant to enhance the flow of blood through his heart.

According to Heart Health Online, a prosthetic heart valve is a replacement for a diseased or dysfunctional heart valve. There are two types of artificial valves:

• Mechanical heart valve – A mechanical heart valve prosthesis is made of man-made materials. The advantage of mechanical valves is that they can usually last a lifetime. They do not wear out the way natural or biological valves do. Here is a picture of a Medtronic mechanical heart valve replacement.

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In a recent email to me, Jerry asked one of the most interesting questions about the Ross Procedure. As you can read below, Jerry inquired about the surgical process IF the patient’s pulmonary valve is not qualified for transplant to the aortic position. To learn more about the Ross operation, click here.

Jerry writes:

Hi Adam,

I’m scheduled for a Ross Procedure in a couple of days. I’ve been nicely in denial about the whole thing, but I did have a question about “pulmonary spares”. My brother brought it up last night.

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When diagnosed with severe heart valve disease, most patients have a fundamental question which races through their minds. That question goes a little something like this, “Oh My Gawwwwwd… What Can I Do To Live?!”

Valerie has taken this question a step further… Valerie has been diagnosed with thickened, calcified mitral and aortic valve leaflets and moderate mitral regurgitation. She is almost certain that surgery is required. That said, Valerie’s email to me reads, “Adam – I am very afraid right now. My questions are… After a heart valve repair or replacement, can the patient live a regular long life? What is the lifespan associated with heart valve surgery?”

Calcified Mitral Valve – Thickened Leaflets

My response to Valerie first question is a confident… “Yes!” Patient’s can live a regular, long life after heart valve repair and heart valve replacement surgery.

As for her second question…

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When it comes to heart valve disease, professional athletes are just like us. We have heart valve surgery. Guess what? They have heart valve surgery.

In prior blogs, I have detailed the inspirational stories of several athletes including Teppo Numminen (Hockey) and Ronny Turiaf (Basketball). Both athletes returned to professional sports after heart surgery. Now, Etan Thomas from the Washington Wizards is on his way back to basketball court. The Washington Post issued this interesting story earlier today:

When Etan Thomas says that the process of recovering from open-heart surgery began with “baby steps,” he really means it.

“It started with just walking,” said Thomas, who missed all of last season after undergoing surgery last October 11 to replace a leak in his aortic valve. Thomas suffered from a congenital bicuspid aortic valve.

“Just getting up and taking a little walk around this little track they had at the hospital. I’d walk around maybe twice and I’d be exhausted for the day. Not tired. Exhausted. Wiped out. There would be older people out there doing the walking too, and they were whizzing by me. I was like: ‘Man, I’m doing bad.'”

To read more regarding Etan Thomas’ Return To The NBA, click here.

Keep on tickin Etan!!!
Adam

Since launching this website and publishing my book, I have been incredibly lucky to meet and become very friendly with many, many, many heart valve repair and heart valve replacement patients and caregivers around the world. Needless to say, I am blessed to know you. And, I consider all of you a part of my family.

On that note, I have some wonderful news to share with you… Robyn, my wife, and I are expecting our first child – A BABY BOY!!!

Robyn recently entered her second trimester. All the tests (and we’ve had a bunch done) suggest that we are going to have a healthy newborn baby around April 11, 2009. Here is a profile ultrasound of Lil’ Baby Pick:

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At the age of 62, Etta’s mitral valve regurgitation has reached severe status. That said, Etta will be having mitral valve repair surgery in three weeks. In her last email to me, Etta raised an interesting question. Etta asked, “Adam – Do I really need full-time help after open heart surgery?”

This question really brings back memories from my early, early, early recovery from aortic valve replacement surgery. My family and support group was insistent that I was not home alone for the first two weeks after open heart surgery. We even created a detailed Microsoft Excel Spreadsheet that highlighted which days my mom, sister, brother, dad and Robyn (my wife) were responsible for me.

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As we have previously discussed, there are a number of symptoms related to mitral valve prolapse. However, Cindy just wrote me an interesting email about whether-or-not anxiety is a symptom of MVP.

During my own research, I did not find any clinical evidence of the relationship between mitral valve prolapse and anxiety. That said, I thought I would post a blog and see if YOU have any ideas for Cindy. Here is her story:

Hi Adam,

I have a question that I am hoping to get some feedback on. Are there other people out there who have mitral valve prolpase and an anxiety disorder. I am not talking about anxiety that may be present AFTER you find out you need a mitral valve repair or mitral valve replacement. I am talking about a “free floating” anxiety – when you get anxiety for no particular reason, not related to any psychological problem per se. I can go for months and then suddenly one morning I wake up with anxiety in my chest.

This can go one for several days in a row.

Always occurring upon waking up and often leading to depression for those days on which this happens. I am under doctor’s care for depression but this is something that is stumping even him.

It is the strangest thing. I just thought MAYBE it has something to do with having severe mitral valve prolapse. Anyone out there know what I am describing?? I am not at all worried about surgery. This has gone on for years and years. I’m just thinking maybe there is a connection.

Thanks,
Cindy

I just received an insightful email from Charlene (in Florida). First of all, her surgery was a success. YEEEAH! CONGRATS TO CHARLENE!!! Second, she raises some critical points for those of you preparing for valve surgery. Here is what she writes:

Dear Adam,

This past July, I found out that I had an aortic aneurysm and would need my aortic valve replacement as well as aorta replacement. As a 45-year old woman with small children, I have to admit this scared the hell out of me. Your book helped so much with all the information and uplifting stories. I would like to pass on some of the wisdom of what I found to you and the others reading your blog.

1. I recommend that everyone get actual copies of all their testing. You may not understand the test results but when you go for a second opinion it helps so much at least you can point out the parts you do not understand and ask the questions. My cardiologist in Florida obviously did not read my initial echocardiogram. It showed the aneurysm back in 2006 and he never said a word about it. It was not until 2008 that he sent me for a CT scan to see what was going on.

Getting Second Opinions – Patient Survey (2007)

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I recently received an interesting question from Emily about her upcoming aortic valve replacement.

Emily writes, “Hi Adam – After years of monitoring it, my aortic valve now has severe stenosis and I need a valve replacement. Yes. I’m scared. Yes. I’m confused. One thing I’m both scared and confused about is the cracking of my chestplate. Is it true that AVR can be done with smaller incisions to the sternum? If so, is that common?”

Mini Sternotomy Scar (3-inch Incision)

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If you are a patient or caregiver preparing for heart surgery, I want to make sure you don’t have a false expectation regarding overnight visiting hours in the hospital.

While many caregivers want to sleepover in the hospital (see “Ali’s 12 Night Hospital Stay“), each hospital has its own rules about whether-or-not caregiver slumber parties are allowed.

In my case, I was blessed one night… Cursed the next… And then, blessed again.

On my first night in the intensive care unit, Robyn (my wife) negotiated with the Head Nurse to stay with me. Many years later, I still can’t believe what Robyn did that night.

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I just received an email from Everitt, 65, about anemia. He writes, “Adam: I had mitral valve replacement two weeks ago. That was some experience. I’m glad to be home but I’m also concerned. I’m very pale and lethargic. By pale, I mean I’m white as Casper the Ghost. Do other patients become anemic after heart surgery?”

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Every once-and-a-while, I receive patient email that is both curious and comical. This email, from Greg (in Oregon), qualifies as one of those special emails…

Hi Adam – My name is Greg and I bought your book a couple months ago and have been reading your blogs ever since! I have never written to you with a question before, but I have one that I would really like answered for my own peace-of-mind.

I have a bicuspid aortic valve with stenosis and regurgitation that I am told will need to be replaced possibly as soon as November of this year (that is when I am scheduled for my next EKG with my cardiologist). Thanks to your book and blogs I feel I have educated myself quite a bit in regards to what I should expect during this process, but one question that I have never seen addressed is in regards to the “breaking of the sternum”.

Is the sternum really BROKEN? I just always assumed that a saw or cutting wheel of some kind was used, but all I ever hear or read is about it being broken. How do they do this? Does the surgeon and an assistant across the table make a wish first?

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