Adam's Heart Valve Surgery Blog – Page 73

Yesterday, I spoke with a patient who asked me, “Are cysts in the mitral valve common? Do they require surgery to be removed?”

I have to admit… I was intrigued. I had never heard this question before. That said, I did some Google’ing about medical conditions involving the mitral valve and cysts.

After reviewing several websites about cysts and heart valves, I learned that mitral valve cysts are rare. I found several write-ups that emphasized this point. Interestingly enough, I found two patient cases which identified blood cysts in the mitral valve and the surgical treatment used to remove them (mitral valve repair surgery).

CASE I (from Asian Cardiovascular And Thoracic Annals): A 68-year-old man underwent coronary angiography for postinfarction angina, which revealed right coronary artery stenosis and a mass in the left ventricle. Transesophageal echocardiography showed a large blood cyst originating from the anterior papillary muscle of the mitral valve. Coronary artery bypass grafting was performed and the cyst was successfully excised.

Case II (from American Heart Association): A 25-year-old, apparently healthy woman was referred to us with suspicion of left atrial myxoma found incidentally by echocardiography. Physical examination was unremarkable except for a diastolic plop sound on cardiac auscultation. Transthoracic echocardiography showed a large, very mobile cystic mass (23×25 mm) attached to the mitral valve and mild mitral regurgitation with normal ventricular size and function. At operation, a bluish cystic mass was seen attached to the anterior mitral valve leaflet with a broad base (pictured above). Resection of mitral cyst and mitral valve repair was performed successfully. Histological examination showed a blood-filled cystic cavity surrounded by a fibromyxoid wall with an internal lining of endothelial cells. The postoperative course was uneventful. Although small blood-filled cysts of the heart valves are sometimes found at postmortem examination of infants, a large cyst found in an adult is very rare. To learn more about mitral regurgitation, click here.

I hope that helps explain more about cysts in mitral heart valves.

Keep on tickin!
Adam

After two heart surgeries in six days (yes, you read that right), David Barnes has quite the tale to tell. That said, I thought you might like to hear more about this inspirational and educational patient success story.

Dear Adam,

I had my heart surgery on March 25, 2008 at Methodist Hospital in Indianapolis, Indiana. My surgeon, Dr. Fehrenbacher, replaced a dilated ascending aorta (5.3cm) and repaired an old descending aorta coarctation repair from 1972. I also had the David Procedure – aortic root replacement without replacement of the aortic valve.

On March 31st, just six days later, I required a second surgery (a Ross Procedure with a synergraft pulmonary valve from Cryolife), because the David Procedure failed.

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Earlier today, I was at Borders reading a fascinating book called “The Ultimate Question” by Fred Reichheld. The book claims that YOUR customer satisfaction is best measured by one simple question, “Would you recommend this product or service to a friend?”

When I stopped to think about it, I was amazed at all the different product and service recommendations I made during the last 24 hours. The list included everything from one-cup coffee machines (Keurig) to 7-inch digital photo frames (Philips) to attorneys (Valle Associates) to gardening centers (Lowes) to…. yes… you guessed it… HEART SURGEONS.

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There never seems to be a shortage of inspirational emails waiting for me in my inbox.

Recently, I exchanged emails with Robin, a fellow patient recently diagnosed with aortic stenosis. As you can read, this is the second major health issue for Robin. Several years ago Robin fought cancer (Hodgkin’s lymphoma).

In her note to me, Robin mentioned something that I had never heard before – the negative impact of radiation on heart valve function. Specifically, Robin noted that her medical team believes that her stenotic valve was caused by radiation treatments used to fight the cancer.

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It really is amazing to read and learn about all the new studies and research about heart surgery and heart valve disease.

You may have read my recent posts about minimally invasive aortic valve replacement, the use of statins to reduce complications post-operation, blood transfusion concerns or treating stenotic aortic valves with HDL-increasing drugs.

Well… Here’s another interesting study just released from the University of Michigan Health System.

According to Michigan researchers, nearly half of all heart surgery patients may experience blood sugar levels high enough to require temporary insulin treatment after their operation, even though they’ve never had diabetes. And a significant minority of those patients might need to take medicines for days or even weeks after they leave the hospital.

To read more about Michigan’s research, please click here.

Keep on tickin!
Adam

I don’t know about you…

But, as I went through the heart valve surgery process, I learned ALOT of interesting information about the heart – specifically, its anatomy and function.

I also learned there was a laundry list of Do’s and Dont’s specific to the recovery. In past posts, I’ve written about many of these recovery suggestions which include everything from not drinking coffee after surgery to using your incentive spirometer after heart surgery.

FYI, here is another little fact to remember during your recovery from heart valve repair or heart valve replacement surgery.

Do not spend time in a jacuzzi, wet sauna, dry sauna or extremely hot shower immediately after cardiac surgery. High temperatures force the heart to work harder to circulate blood throughout the body.

As The Practical Guide For Heart Health states, “Avoid working and exercising in extremely hot temperatures during your early recovery from heart surgery.”

Keep on tickin!
Adam

Every so often I receive a fantastic question that is impossible for me to answer.

For example, today I received a question from Jerry. He writes, “Adam: Thank you for your book. I am curious if you have any advice on how to speak to my kids about my upcoming heart valve surgery. I don’t want to scare them. However, I do want to give them some understanding of what might happen. If you have any advice, I would appreciate it.”

The reason I can’t answer this question is because I have no kids and therefore no personal experience to share. That said, I am hopeful that YOU might be able to help Jerry with this issue.

Do you have any thoughts or ideas for Jerry? If so, please ‘Leave A Reply’ below!!

In advance and on behalf of Jerry, thanks so much!!!

Keep on tickin!
Adam

The story of Vivien Thomas is extraordinary.

In fact, as Robyn (my wife) and I watched the HBO special on his life, we both found ourselves in tears.

The television movie is called “Something The Lord Made” and it premiered in May, 2004.

During his lifetime, Vivien Thomas faced prejudice, bigotry, wage discrimination and humiliation in the process of changing cardiac surgery forever. That said, after the replacement of my diseased aortic valve and pulmonary valve, I am DEEPLY INDEBTED to this man and his innovative colleague Dr. Blalock.

Here is Vivien Thomas’ Biography On Wikipedia.

If you have any interest in learning about one of the pioneers of heart surgery, I highly encourage you to watch or rent this movie.

Keep on tickin!
Adam

As for new advancements in heart surgery… Here is a recently released study regarding statin-use before heart surgery. The good news? It appears promising.

Medical News Today reported that people given cholesterol-fighting statin drugs before heart surgery are far less likely to die or suffer complications afterwards, German researchers said on Wednesday. The analysis of more than 31,000 patients provides some of the strongest evidence yet of the benefits of statins before heart surgery but it also found that too few doctors are prescribing them, they said in the European Heart Journal.

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Don’t get me wrong.

I really enjoy the television show Grey’s Anatomy (Thursdays, 9pm on ABC).

My wife (Robyn) really loves it. So, we always watch the weekly trials and tribulations of Meredith Grey, McDreamy, McSteamy, George, the Chief, Yang, Izzy and, lately, Dr. Erica Hahn – the head of cardiothoracic surgery at Seattle Grace.

That said, the title of this blog may be a little harsh for ABC’s hit series.

But, as a former open heart surgery patient, I’m getting a tad uncomfortable of the dramatic style by which Grey’s Anatomy depicts life in a heart surgery ward.

• Last week, the show depicted a three-way sexual innuendo among the operating physicians during cardiac surgery.
• A few weeks before that, a patient showed little-to-no signs of physical trauma following heart valve surgery.
• Recently, Dr. Hahn (played by Brooke Smith) failed to inspire and encourage her talented resident (Yang) to participate in a cardiac procedure.

I know. I know.

Maybe I’m a little sensitive.

It is a television show designed to win fans, ratings and ultimately advertisers.

I guess I just want future patients and caregivers to know what life is really like in a hospital. Especially, considering that Grey’s Anatomy’s viewers may be scheduled for surgery the next day, the next week or the next month. For that reason, I wish the writers and producers of the show would enhance their portrayal of hospital life for heart surgery patients.

Do you watch the show? What do you think?

Keep on tickin!
Adam

As I wrote earlier about the first mechanical heart valves, doctors could do little to help people with failing heart valves until 1960, when Portland heart surgeon Dr. Albert Starr and engineer Lowell Edwards introduced their mechanical heart valve. Here is a picture of a replica of the first ball-in-cage heart valve replacement that was given to me by Edwards Lifesciences.

One of the key questions patients ask me is, “How long did the early mechanical heart valves last?”

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The vice chairman of the state Senate minority caucus, Republican Dan Swecker of Rochester, is in the hospital with a heart problem. Swecker’s staff say he was taken to Providence St. Peter Hospital in Olympia, Washington by ambulance after what seemed to be a heart attack Saturday night.

According to a news release Tuesday, tests show Swecker has a congenital heart valve abnormality (potentially a bicuspid heart valve). An operation to fix the problem is planned for this week. According to the news release, Dan Swecker is in critical care but stable condition.

Swecker joins a long list of public personalities to have heart valve surgery including Arnold Schwarzenegger, Jim Lehrer, Jessie Helms, Charlie Rose and Rodney Dangerfield.

All the best for a speedy recovery Senator Swecker!

Keep on tickin!
Adam

I first met Ali, from Northern California, a few months ago. Her mother had been diagnosed with severe aortic stenosis and needed heart valve replacement. To learn more about narrowed heart valves, click here.

I could tell right-away that Ali was going to be a phenomenal caregiver through this experience. Ali and I spoke on the phone for thirty minutes about her mom, her health and the next steps for aortic heart valve replacement. One of the big questions for Ali’s mother was, “Should I go to Cleveland Clinic? Or, should I have the surgery done locally by Dr. Gaudiani?”

 

Ali’s Mom and Ali’s Son

Last week, I received an update from Ali. I thought you might like to read this email to get a very unique glimpse into the caregiver’s perception of heart valve surgery.

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Tammy, from Florida, just wrote me a curious question that reads, “Hi Adam – You note that there are about 250,000 heart valve surgeries performed around the world each year. By chance, do you know how many heart valve surgeries are performed in the United States each year?”

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This just came in from Nicole after a very, very, very, very complex heart valve surgery.

Adam,

My husband, Jason, and I recently purchased your book to get a new perspective on our experience. I am five weeks post mitral valve repair, tricuspid valve repair, pulmonary valve replacement and a “maze-type” procedure. Unfortunately, my surgery was complicated by the need for a pacemaker approximately 3 weeks ago. This was not my heart first surgery as I had an atrial septal repair some 25 years prior (I am 28 years old now).

In reading your book, I had some additional questions that maybe you could answer:

1) How long were you actually in pain for? I know you mentioned that 7 weeks out you were still taking vicodin and then you started the cardio rehab. After 5 weeks, I still take 3 Percocets a day and still am in pain.

2) When were you able to resume driving? My doctors had originally told me 6 weeks but I am still in a lot of pain when I turn my head so I couldn’t imagine being able to manipulate a car in any sort of a safe manner.

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Ever wonder why a stent is used in many forms of biological heart valve replacements?

I just received a question from Keith that reads, “I will be going in for heart valve replacement next month. I have opted for a tissue valve replacement. My surgeon referenced a pig valve replacement with a stent. What does this mean?”

Good question Keith! A stent is used to support a replacement heart valve when positioned in the heart. Specifically, a stented tissue valve includes a frame (the stent) on which the valve is mounted. Ultimately, the stent supports the leaflet tissue (e.g. mitral valve leaflets) that opens-and-closes as blood flows through the heart.

In many valves, the stent is covered by a fabric ring, known as the sewing ring. The surgeon implants the valve by suturing the sewing ring into the patient’s heart.

Above you can see an example of the Medtronic Hancock® II heart valve replacement device which uses a stent.

Alternatively, a stentless valve is often an actual heart valve taken from either a human donor (homograft) or a pig. The Medtronic Freestyle® aortic root bioprosthesis is a stentless valve consisting of the porcine aortic valve and a portion of the pig’s aortic root. This valve contains the “natural” leaflets found in the animal’s original heart valve. A stentless valve is sewn directly into the heart to take the place of the patient’s valve.

I hope this helps explain a little more about stents in heart valve replacements.

Keep on tickin!
Adam

In the past, we have discussed blood bank safety and concern about blood transfusions during heart surgery.

The Epoch Times just reported, “Mounting evidence that routinely giving blood transfusions to patients could actually increase their risk of death or other heart surgery complications has prompted calls for medical staff to be more cautious about who they administer transfusions to.”

The U.K. study of almost 9,000 heart surgery patients between 1996 and 2003 supports this finding, and indicates a six-fold increase in the risk of death after 30 days with a three-fold increase in the risk within one year following surgery. Transfusions were also associated with more infections and higher incidences of stroke, heart attack, and kidney failure. These complications were usually linked to a lack of oxygen to body tissues.

This is important for patients and caregivers to consider because patients typically have the option of donating their own blood (in advance of the operation) or using the hospital blood bank if a transfusion is required during your surgery.

That said, I found this information very interesting.

Keep on tickin!
Adam

After four opinions regarding his defective mitral valve, John finally had minimally invasive mitral valve repair at the skilled hands of Doctor William Ryan in Texas. Here is John’s latest update:

Dear Adam,

I have contacted you a couple of times about heart valve surgery. I first ordered and read your book – that helped me a lot.

Before that, I had been urged by four doctors to have my mitral valve repaired because of severe mitral valve regurgitation. I finally relented but wanted it to be done by the right surgeon and the right hospital. I live in Tulsa, Oklahoma and wanted minimally invasive surgery that I could not get in Oklahoma.

I found Dr. William H. Ryan at The Heart Hospital At Plano Texas and asked you if you had heard of him. You replied that you had heard of a few people (including Doug Atkins and Melissa Causey) receiving heart valve surgery from him all with good results.

Dr. Ryan operated on me with the a keyhole surgery on April 29, 2008. I stayed in the hospital for four days. I am now at home recovering. I can not praise Dr. William Ryan enough. The Heart Hospital At Plano is the best. If anyone needs info about Dr. Ryan, please give them my e-mail, I will be happy to provide information. Thank you Adam.

John

I just received an interesting question from Mia. Her email reads, “How I am going to change after open heart surgery?”

As we all know, emotions of fear can accompany the unknown. Ultimately, I think it is the unknown of heart surgery that stimulates thoughts like, “How will I be different after my operation?”, “Will my physical abilities change after heart surgery?” and “Will I experience mental changes after bypass- like pumphead?”

That said, I have to be honest with you and every other person who reads this blog. In my opinion, there is no single response that encapsulates the potential changes that patients face as they experience open heart surgery.

After my experiences with aortic valve replacement procedures, I will be the first to share with you that the recovery can be difficult – full of daily changes, weekly changes and monthly changes. However, there are many patients, that experience no relative, long-term changes after open heart surgery.
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This deserves a “Wow!”

I could ramble on about how neat this is… Instead, I’ll simply let Geoff explain. Here is Geoff’s email:

Hi Adam,

I am home from my surgery!!

The mitral valve repair was performed last Tuesday morning. I left Duke Medical Center, five days later, on Saturday morning at 9:45 am!

I am fairly weak and somewhat sore. But, overall I am doing great. I spent the first night after heart surgery in the intensive care unit (ICU). The breathing tube and TEE were removed in the first few hours after surgery. I had tubes coming out of me from many places – an IV in my neck, left arm artery, left arm near elbow and right arm.

I can’t say enough good things about the staff at Duke Medical Center. My surgeon, Doctor Donald Glower, was able to repair the valve so that there was 0% mitral regurgitation. If you are interested, I have attached the before and after pics. (To learn more about mitral regurgitation, click here.)

Thank you for your heart valve book, and all the blog members, for their stories and insight. Heart surgery truly is an emotional journey. My fiancee, Lisa, and I are very happy to be through it.

Thanks… Geoff