Adam's Heart Valve Surgery Blog – Page 78

Yesterday, I received an interesting email from Karen, who has been diagnosed with severe aortic stenosis. Her cardiologist told her that an angiogram will be needed prior to surgery. Karen’s questions to me were about the exam and angiogram risks.

More specifically her questions were, “Does an angiogram hurt? Is it painful? Is there any potential danger or angiogram risks during the test?”

Unfortunately, I have no personal experience that enables me to respond to the questions about the pain of an angiogram. Although I did have a double heart valve replacement (aortic and pulmonary valves), I did not have an angiogram prior to surgery. Because, I was relatively young and in good, physical condition, my surgeon (Dr. Vaughn Starnes), did not feel it was necessary.

That said, many patients will have an angiogram during the diagnosis period and/or the day before surgery.

“Angiogram?” you may be wondering, “What the heck is an angiogram? What are the potential angiogram risks or dangers?”

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As we’ve talked about before, Coumadin (Warfarin Sodium) is used by patients following heart valve replacement in which mechanical heart valves are selected by the patient and/ or surgeon. You can click here to learn more about Coumadin medication and its long-term use for preventing blood clots on mechanical heart valves following heart valve surgery.

That said, this blog is also starting to answer some questions about Coumadin medication interactions with other popular drugs – including Coumadin and Prilosec and Ultram and Coumadin.

In the near future, Dr. Robert Light and I are going to be addressing some of the other contraindications of Coumadin use and pharmaceuticals.

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I spent the first 33 years of my life with a heart murmur resulting from a congential heart disorder known as a bicuspid aortic valve.

Now? After successful heart valve replacement surgery… Guess what? No more more heart murmur!

However, given my history, I am very sensitive to any questions I receive about heart murmurs. Although most murmurs do not results in heart valve surgery, some do. That said, taking preventative steps to minimize the risk of heart valve damage is critical.

Earlier today, I received an email about heart murmurs and loratadine. The questions read, “Can Loratadine cause a heart murmur?” and “Does Loratadine affect Aortic Stenosis?”

So you know, Loratadine is the generic name of popular antihistamine that is more readily known as Claritin. The product is made by Schering-Plough and is consumed in tablet or liquid form.

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There are several choices a patient will make as they prepare for heart valve replacement surgery – the surgeon, the hospital, the procedure, where to recover, etc.

For those patients who chose to have a tissue valve replacement, the question ultimately becomes, “Which tissue valve should I chose?” and “Which manufacturer makes the best valve for me?”

In this blog, I am going to profile a number of the leading valve manufacturers (Edwards, Medtronic, St. Jude Medical, On-X, ATS) and their valve replacement products. In my opinion, it really does help to know more about the valve that may accompany you during the rest of your life, right?

Today, I am going to profile the Medtronic Hancock Porcine Heart Valve.

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During my recovery from aortic and pulmonary valve replacements, there were many memorable experiences. There were “highs” during my recovery – my engagement to Robyn. And, there were “lows” during my recovery – cardiac depression.

That said, one of the more memorable experiences dealt with sex after heart surgery.

As you would imagine, this is a a very common question when I chat with patients and caregivers about the recovery from cardiac procedures including heart valve repair and heart valve replacement. The question usually goes like this, “How long until I/we can have sex after heart surgery?”

Well…

During my recovery, I did muster up the uncomfortable courage to ask Nurse Carrie this exact question about sex after heart surgery. Carrie looked at me and said, “Can you walk up two flights of stairs?”

I nodded yes.

Carrie exclaimed, “You’re good to go sailor! It’s time for sex after heart surgery! I hereby give you permission to do the Wild Thing!”

I laughed out loud.

It was a classic moment that belonged in some sort of fantastic movie.

FYI, this conversation between Nurse Carrie and I happened about four weeks after my double valve replacement surgery. However, you should know that while this story is quite playful, there are a number of post-operative issues which may inhibit the patient’s desire to re-engage in sexual activity following surgery.

Keep on tickin!
Adam

Earlier today, it was announced that Dr. Robert T. Light, American Board Diplomat of Psychiatry and Neurolgy, would provide expert medical commentary on Adam’s Heart Valve Surgery Blog.

Dr. Robert T. Light is a practicing physician in Virginia Beach, Virginia and specializes in drug interactions, human physiology, psychiatric medicine.

“I am thrilled to welcome Dr. Robert Light to our growing team of experts focusing on patient care specific to heart surgery,” noted Adam Pick, the author of The Patient’s Guide To Heart Valve Surgery and blog moderator.

Adam’s Heart Valve Surgery Blog was launched in December, 2006 to serve as a resource for both patients and caregivers dealing with the realities of heart valve repair and heart valve replacement – from diagnosis through recovery.

“Adam has taken his own experience as a heart valve surgery patient and created something very unique and very helpful for patients and caregivers around the world,” Dr. Robert Light stated. “I am very excited to share my own thoughts and medical expertise on Mr. Pick’s cardiac surgery blog.”

Dr. Robert Light has already begun sharing his thoughts on prior blogs including Coumadin and Prilosec as well as Contraindications of Ultram and Coumadin.

I must admit. Entering Torrance Memorial Cardiac Rehab Program was the turning point in my recovery from aortic and pulmonary heart valve replacements (known as the Ross Procedure). That said, I am a big, huge, tremendous fan of finding a good cardiac rehabilitation program following open heart surgery.

“Why?” you are wondering.

Adam Pick At Torrance Memorial Hospital
Cardiac Rehab Program (California)

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The other day, I wrote a blog about the Contraindications of Ultram and Coumadin. Since then, I have been bombarded with questions about other potential issues, conflicts and side-effects of Coumadin (Warfarin Sodium). That said, I will respond to each of your questions over the next few weeks. To advance this topic, I have consulted with a psychiatrist who might be co-blogging with me on this subject.

Anyways, one of the questions I recently received was, “Are there any potential issues of taking Coumadin and Prilosec following heart valve replacement surgery?”

First off, it helps if we understand what the drugs Coumadin and Prilosec are and what they were designed to do. As I have previously written, Coumadin is used by heart valve replacement patients following surgery to prevent blood-clots on their mechanical heart valve replacements.

Prilosec, on the other hand, is used to treat symptoms of GERD, or gastroesophageal reflux disease, and other conditions resulting from excess stomach acid.

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It was six months after my aortic and pulmonary valve replacements (known as the Ross Procedure). I was back at work sitting at my desk when….

All of a sudden, my heart felt like it was flip-flopping and beating upside-down in my chest. Literally, my heart started doing a foreign dance. It was one of the weirdest feelings.

Then, it was gone. My heart returned to its normal beat. Sixty seconds later, I was on the phone with Dawn, the nurse of my cardiologist, Ben Rosin at Torrance Memorial Hospital. Dawn was pragmatic. She asked me to describe the sensation.

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Earlier today I received an interesting question regarding Coumadin (Warfarin Sodium) and the drug Ultram. Specifically, the question read, “Are there any contraindications of Ultram and Coumadin?”.

I have to admit, this is the first time I ever heard this question. That said, I became intrigued by the possibility of learning even more about Coumadin and whether or not there were any contraindications of Ultram and Coumadin. As you may know, heart valve replacement patients which select mechanical valves are typically required to use Coumadin (generic name Warfarin) to prevent clots from forming on the mechanical valves.

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So, I just received an email asking, “Do you have any pictures of a bicuspid aortic valve?”

Well, considering I had a bicuspid aortic valve for the first 33 years of my life, I definitely researched and located pictures of bicuspid aortic valves for my book.

As you can see below, the aortic valve on the left is normal – the valve has three leaflets and three cusps.

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I just received an email from Eddie who is preparing for his heart valve replacement surgery. Eddie has mitral valve prolapse and severe mitral regurgitation. Eddie is 67 years old and is considering a tissue valve. Specifically, Eddie is leaning towards a porcine valve (aka a pig valve) and has several questions.

Eddie writes, “Adam – My surgeon has had a lot of success with porcine heart valve transplants. But, I still have questions including… What exactly is a porcine valve? Do you have any pictures or images of porcine valves? Are there any adverse effects of using a porcine valve? Are porcine valves safe? Thanks, Eddie.”

These are critical questions for the valve replacement selection process. That said, I’m going to do my best to answer Eddie’s questions about porcine valves.

First, let’s see what a porcine valve looks like. While there are several porcine valve manufacturers, above you will find a picture of an Edwards Lifesciences’ mitral valve replacement, known as the Carpentier-Edwards valve. Recently, I toured Edwards manufacturing center and learned how porcine valves are manufactured.

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One of the most common questions I receive about heart valve surgery focuses on the “recovery”. As you can read in my story, I had a special type of aortic valve surgery known as the Ross Procedure.

That said, I can provide some personal insight in answering questions like:

• “What is it like recovering from aortic valve surgery?”
• “When did you return to work?”
• “Is the recovery from aortic valve surgery painful?”

As you can probably tell, the list of questions regarding the recovery from open heart surgery could go on and on and on and on.

In my opinion, this is one of the biggest problems with cardiac surgery today.

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Earlier this year, I interviewed 78 patients about their heart surgery experience. Most of those patients had open heart surgery – including heart valve replacement surgery and heart valve repair operations.

One of the questions asked during this survey was, “Did you travel outside your hometown for your cardiac surgery?”

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I will never forget my first interview with a heart surgeon.

My cardiologists – Dr. Wyman and Dr. Chaikin – had already confirmed that my aortic valve was suffering from severe stenosis and regurgitation. As they both told me, I needed a new valve and I needed it soon.

That first, surgical interview I held was with Dr. Alfredo Trento, the Director of Cardiothoracic Surgery at Cedars-Sinai Medical Hospital in Los Angeles, California.

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The heart is an amazing muscle. For reasons described on this previous blog, “The Anatomy And Heart Function“, I am constantly marveling at all the complex elements that makes the heart operate. Interestingly enough…

Electricity has a lot to do with the actual starts and stops (aka contractions) in the cardiac conduction system. That said I thought you might like to see a diagram of cardiac conduction system.

I could go on and do my best to scientifically explain the cardiac conduction system illustration above. However, it’s the Internet age. So, I’m going to let the American Heart Association do that for me. Here is a link to an article all about the “Diagram of Cardiac Conduction System”.

It’s actually a very, very, very interesting article!

Keep on tickin!
Adam

As I remember…

When I was first diagnosed with heart valve disease, my immediate thought was, “Okay. What’s the first step to treating it? It must be curable, right?”

For this reason, when I receive an email that reads, “What’s mitral valve prolapse? Or, how can I cure mitral valve prolapse?”, I tend to stop and remember that moment.

As for the first part of the question, mitral valve prolapse effects the flaps (or leaflets) of the mitral valve. Simply put, the valve leaflets don’t seal properly. In mitral valve prolapse, one of the flaps, or leaflets, moves back into the atrium when the heart beats. This “prolapse”, or buckling, enables blood to flow from the ventricle back into the atrium as shown in the anatomy of the heart.

So you know, about one in twenty Americans has mitral valve prolapse – so, it’s a relatively common heart valve disorder. People are usually born with it as a congenital condition. Interestingly, more women have mitral valve prolapse and mitral valve prolapse symptoms than men.

Now, for the tough part of the question… “How To Cure Mitral Valve Prolapse?”

Well, the first thing you should know is that many people with mitral valve prolapse do not need to treat, or cure, their mitral valve prolapse. If the blood flow back into the ventrical is trivial, no treatment is necessary.

However, if the blood flow back into the ventricle is significant – a cardiac disease known as mitral regurgitation – the heart becomes strained as it is forced to work “overtime” to help circulate blood throughout the heart. If this occurs, symptoms of mitral valve prolapse may manifest in the patient.

• Sometimes, this may result in the patient taking medication to enhance the flow of blood through the mitral valve.
• Other times, if the mitral valve prolapse is very significant, the patient may need to have mitral valve repair or mitral valve replacement surgery.

I hope this help you better understand mitral valve prolapse and how to cure it.

Keep on tickin!
Adam

One of the most common questions I get via email is about heart valve disease symptoms. I just received an email that reads, “What are the tricuspid valve regurgitation symptoms?”

It’s a great question. Knowing what the documented, heart valve disease symptoms is critical as the patient or caregiver tries to diagnose themselves or their loved. But, you should be aware, some patients are completely asymptomatic – see more below. As discussed in the anatomy of your heart valves, the tricuspid valve is one of four valves in your heart. Along with the mitral valve, the pulmonary valve, and the aortic valve, the tricuspid valve acts to help manage the flow of blood in one direction through your heart. Similar to the pulmonary and aortic valve, the tricuspide valve has three leaflets.

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Hey eveybody,

One of my readers from Chicago, Tracey Orr, had heart valve surgery on Monday at 7am.

She had a cow valve replacement surgery.

According to her husband, Tracey is still in the ICU.

Unfortunately, Tracey’s heart rhythm has yet to stabilize.

If you have a moment, please wish Tracey a great, big healthy prayer.

Keep on tickin!
Adam

I’ll never forget the first time I heard the phrase “Pumphead”. I was interviewing a former patient about her heart valve surgery experience for my book.

She was discussing the short-term mental impact of open heart bypass surgery. Specifically, she was remembering a challenging time during her recovery when she suffered from cardiac depression.

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