Bruce's Posts

Meeting the Surgeon Initially, I thought this valve could be repaired using GoreTex(TM) chordae tendineae ("heartstrings") replacements in open heart surgery. (Ah naivety) I read all the available literature about this repair process, prepped questions about details, and studied the study proposed for comparing this repair with the temporary catheter-placed clip (MitraClip) that was the alternative to the definitive repair. I thought I had a possible game plan, and I was willing to forgo the less invasive but non-definitive MitraClip for the longer recovery open heart direct repair of the chordae. I did not know the valve had so much calcium. This was discovered just 2 days before today's kickoff meeting and appeared in the heart CT angiogram. The cardiothoracic surgeon who would have done the repair ruled the calcium too much and in an unanticipated move, removed himself from the case! Unexpected? Yes! But that is the way biology and medicine operate. Just when you think you understand the situation there appears another factor. The Calcium What is this calcium which caused the surgeon to withdraw from the case? Not everyone knows, that the heart has a "skeleton". These are rings of fibrous tissue similar to cartilage that surround each of the valves giving them structure for the valve leaflets to attach to. That sounds like a good thing. But thinking back on embryonic development, our real skeleton starts out as cartilage, and over time calcium sets down within this fibrous matrix to create bones. You may be beginning to see a potential problem. How does biology know that calcium belongs to skeletal bone cartilage and not to heart cartilage? Well, it doesn't. I was awarded the "impressive" accolade by the surgeon. "I mean you have got some impressive ... look at that! ... that's 1 1/2 centimeters!" pointing to a bright white blob on the CT scan display. "That's my valve??" I said. "Oh yeah!". You may recall my regurgitation was "large". I have lost my taste for superlatives. The surgeon, a very personable, polite, considerate, and well-spoken young man explained that the mortality figures in the first month for direct repair that he does is 1-2% but reported repairs for a calcified valve, like mine, at more like 20% and he does not do them. What comes next?