{"id":3988,"date":"2023-11-07T14:25:30","date_gmt":"2023-11-07T14:25:30","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=3988"},"modified":"2023-11-07T16:52:30","modified_gmt":"2023-11-07T16:52:30","slug":"watchful-waiting-stress-test","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/watchful-waiting-stress-test\/","title":{"rendered":"Surgeon Q&#038;A: Stress Tests &#038; Watchful Waiting"},"content":{"rendered":"<p>We just received a great question from Nikki about watchful waiting, stress tests and the progression of heart valve disease. In her email, Nikki asks, \u201cMy 16-year-old son has a bicuspid aortic valve with severe aortic stenosis. He experiences chest pain. He is currently in what they call \u2018watchful waiting.\u2019 Is a stress test the best and most accurate method to determine when surgery is necessary to replace the valve?\u201d<\/p>\n<p>To provide Nikki an expert response, we were lucky to interview <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Douglas-Johnston-Chicago-Illinois.php\">Dr. Doug Johnston<\/a>,the Chief of Cardiac Surgery at Northwestern Medicine in Chicago, Illinois. During his extraordinary career, Dr. Johnston has performed over 3,000 heart valve operations.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/gDVXgPyJsaQ?si=iOEoxWW_tXjT9GD3\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Learnings About Watchful Waiting &amp; Stress Tests<\/h2>\n<p>Many patients are in the \u2018watchful waiting limbo:<\/p>\n<ul>\n<li>Before addressing Nikki\u2019s son\u2019s case, Dr. Johnston wanted to point out that stress tests can be beneficial in determining how the heart is doing. \u201cThere\u2019s very good data to say if your stress test is positive, you\u2019ll do worse, and if your stress test is negative, your heart will be okay for a little while,\u201d Dr. Johnston said.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Douglas-Johnston-Chicago-Illinois.php\"><picture><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full\" src=\"https:\/\/www.heart-valve-surgery.com\/profileImages\/301_129_151.jpg\" alt=\"Dr Douglas Johnston\" width=\"129\" height=\"151\" \/><\/picture><\/a><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Douglas-Johnston-Chicago-Illinois.php\">Dr. Douglas Johnston<\/a><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>However, Dr. Johnston would want more information to answer Nikki&#8217;s question. \u201cIn your son\u2019s case,\u201d he said. \u201cIt sounds like he has symptoms, and I would want to know a lot more about the echocardiogram because if you already have chest pain, a stress test may not be the right study. There is some risk to doing a stress test with somebody already symptomatic from aortic stenosis.\u201d Getting the heart team involved, talking with a surgeon and cardiologist, and even getting a second opinion, according to Dr. Johnston, is the best way to figure out where her son is on the spectrum of disease. \u201cIt may be time to think about an intervention if he\u2019s symptomatic, so this is a time to spread the net wide and talk to a lot of different people.\u201d<\/li>\n<\/ul>\n<p>The challenges for young patients and their parents when thinking about lifetime management of heart disease:<\/p>\n<ul>\n<li>Dr. Johnston has extensive experience working with young patients who have aortic valve disease. \u201cIn the 16-year-old age range, with few exceptions, the best option is probably going to be a <a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/ross-procedure\/\">Ross operation<\/a>,\u201d Dr. Johnston said. \u201cIt\u2019s a little scary for people to hear how complex that procedure is, but there\u2019s very good data from our center and others on the safety of this kind of operation, especially in this age group.\u201d Dr. Johnston also said the Ross operation is not only an excellent option for younger patients like Nikki\u2019s son but also for patients in their 40s and 50s. \u201cIt\u2019s very consistent with normal lifestyle and activity,\u201d he said.<\/li>\n<li>\u201cWe don\u2019t want to commit your son to something that is going to be lifestyle-limiting at age 16,\u201d he said. Dr. Johnston believes there are many options, but finding a center or a surgeon familiar with the Ross operation to get an opinion is a great place to start. \u201cEven if they say, \u2018Hey, we can wait. You\u2019re not ready,\u2019 at least you\u2019ll know more about the surgical options,\u201d he said.<\/li>\n<\/ul>\n<p>Adam\u2019s amazing aortic and pulmonary valves:<\/p>\n<ul>\n<li>For those in the community who didn\u2019t know, Adam Pick, the patient who started HeartValveSurgery.com, had a Ross procedure in 2006. Since then, Adam has not had any issues with either his aortic or pulmonary valves which were replaced during the operation.\u00a0 The last time Adam had an echocardiogram, his cardiologist said, \u201cThis is amazing! Your aortic valve looks perfect!\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Thanks Dr. Johnston and Northwestern Medicine!<\/h2>\n<p>On behalf of Nikki and our community, many thanks to <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Douglas-Johnston-Chicago-Illinois.php\">Dr. Doug Johnston<\/a> for sharing his wisdom and insight about watchful waiting, stress tests, and the Ross operation for young heart valve patients. Also, we want to thank <a href=\"https:\/\/www.heart-valve-surgery.com\/hospital\/northwestern-memorial-valve-program\">Northwestern Medicine<\/a> for taking great care of our heart valve patients!<\/p>\n<p>Related Links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/echocardiogram-stress-doppler-tee.php\">Echocardiogram Uses For Heart Valve Disease Diagnosis<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/lifetime-management-of-heart-valve-disease\/\">Patient Webinar: Lifetime Management of Heart Valve Disease with Dr. Douglas Johnston<\/a><\/li>\n<\/ul>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n<p>P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of this interview below.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[8],"class_list":["post-3988","page","type-page","status-publish","hentry","category-before-surgery"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/3988","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=3988"}],"version-history":[{"count":18,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/3988\/revisions"}],"predecessor-version":[{"id":4017,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/3988\/revisions\/4017"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=3988"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=3988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}