Adam's Heart Valve Surgery Blog – Page 68

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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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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