Phil's Journal

I met with Dr. Shemin on 11/9 and had 2 pages worth of questions answered! He'll do a mini-sternotomy and replace my defective AV with a bovine tissue valve from Edwards Lifesciences. He uses their Magna-Ease which you can see here: http://www.edwards.com/devices/heart-valves/aortic-pericardial. The "only" heart problems I have is a stenotic bicuspid AV and an enlarged heart. With the valve replaced, the heart should return to its normal size in 3 months or so. I was very relieved to find out that I didn't have any other valve problems or aortic aneurysm. My arteries are also clear and in good shape. Dr. Shemin showed me my angiogram which showed clear arteries.. That was the good news. He also showed me my latest echocardiogram and the AV leaflets are barely moving. That explains why I've been feeling so lousy and fatigued over the last month. To give you an idea on how rapidly the stenosis progresses, the echo at the beginning of August showed a peak differential pressure of 51 (in/hg). It took 62 years to get to that point. The echo that was done at the end of October shows that the pressure is now over 70! Dr. Shemin said that the turbulent blood flow as a result of poor valve opening causes the calcium to deposit at a more rapid rate. I asked him about sizing the replacement valve and he had some interesting comments. All manufacturers provide ring-sizers on a wand that is used to gauge the opening after the defective valve is removed. He stated that many times, using these sizers will result in applying an undersized valve for the patient. As the AV becomes stenotic, the base of the valve can and will get smaller. When the defective valve is removed, this base is left intact to sew the replacement valve in. He sizes the replacement valve based on a multitude of factors. If the base is too small, he cuts a radial slot to open it up and then applies a patch to cover the pie-shaped slit. This ensures that the proper sized valve is applied to the heart to accommodate the patient's body mass and need for blood flow. I found his comments interesting as I had not found this technique described anywhere in my research. I'm now looking forward to my surgery on December 12th. As far as I'm concerned, it can't happen quickly enough. The anticipation and fatigue are far worse than the fix. Even with the mini-sterotomy, its still an 8 week recovery. I have the chest X-ray, EKG, carotid artery ultrasound and blood chemistry done this week, so now I'm just waiting. At my brother's urging, I've put my affairs in order. I worked with my attorney on estate planning and have all the accounts and records organized. I certainly hoping for the best but preparing for the worse. By the grace of God, I'll have more time in this life. I believe in Dr. Shemin's skill. I'm in good hands.

Dear Jesus You walked on earth and witnessed the broken world, yet also rose from death unto a resurrected life. We know that through you, all things are possible. You said, through your servant John (16:23), ''I assure you, most solemnly I tell you, that My Father will grant you whatever you ask in my name.” and again, through your servant Mathew (18:19) “Again I say unto you, that if two of you shall agree on earth as touching anything that they shall ask, it shall be done for them of my Father which is in heaven.” Therefore, please hear our petitions. We pray for those in need of healing, that they would be held in your loving arms. Bring the power of your resurrected life into their frail bodies. Bless the work of the doctors, surgeons and hospital staff that their gift of skill and comfort which came from you, may heal and care for those in need. Come fill those that are broken with your restorative Spirit. May your resurrected life bring healing and wellness into their being. May your grace carry them through their needed healing and restore their bodies and ease their suffering into a new season filled with hope and joy. We humbly ask this of God our Father in your name. Amen.

After all the prep work - 2 echos, angiogram and CTA, I finally have an appointment with Dr. Richard Shemin at UCLA Medical Center on Wednesday, November 1st. I'm hoping I'm a candidate for the da Vinci robotic surgery.

I knew this day was coming. I have a congenital heart valve defect - a bicuspid aortic valve. I've been monitored every six months by my cardiologist for the last 10+ years. He's been tracking my aortic valve as it gets tighter and tighter. My last echocardiogram (8/8/2017) showed a jump in the mean pressure gradient from 38 to 51, which lands me in the "severe" category. I had an angiogram (8/18/17) to confirm the echo findings. My heart is also mildly enlarged since it's working harder. My next appointment with my cardiologist is 10/10/17 to discuss the next steps. In the mean-time, I'm using Adam's sight to find a surgeon or two to discuss my options. I'm hoping that I'm a good candidate for a minimally invasive valve replacement. The good news is that I'm in LA which has a number of world-class valve replacement specialists.