After Open Heart Surgery:Lingering Questions

To recap and update previous posts in this series,I am a patient with heart valve disease.Having had my mitral valve surgically repaired during open heart surgery in May,2011,perhaps that would be it,I thought.They did a good sewing job.I might be cured.Now,two and a half years later,that is clearly not the case.The disease process is still at work.There is residual mild to moderate blood leakage backward across the valve,a condition called mitral valve regurgitation.What is more,something new has gone wrong.The valve leaflets have stiffened,narrowing the valve opening and impeding blood flow.This is called mitral valve stenosis,and went from being mild to moderate over the course of a year.My upper left heart chamber,the left atrium,is moderately dilated,or enlarged,from the resulting pressure build-up.So I present with moderately abnormal heart function.
Complications of severe stenosis can be life threatening,including blood clots;atrial fibrillation;congestive heart failure;pulmonary edema;and pulmonary hypertension.That's the scary part.
So far,the situation is manageable with my current medication of an ACE inhibitor;a beta blocker;and an anticoagulant-baby aspirin.We are following a course of medication and monitoring.Should things worsen further from moderate to severe,other options are available.Sometimes a balloon valvuloplasty is performed,in which a balloon is attached to a catheter and threaded up to the valve through a blood vessel in an arm or leg.There,it is inflated to widen the valve.This may not be appropriate in my case,however,since I have regurgitation as well as stenosis.
A second option for relieving stenosis is a surgical repair such as scraping any calcification from the valve leaflets,thus restoring flexibility.In the end,most stenosis patients requiring surgery undergo a valve replacement,either with a natural or mechanical valve.
Even as I'm writing this,I'm having an optical migraine-a slight visual disturbance I have experienced since my surgery.It's like a shooting star across the visual field,but it doesn't hurt,thank God.My chest scar is barely visible any more-just a little red streak at the base.There is also a strand of wire embedded in my chest,and I swear it stings a bit to this day.
When I first read about the stenosis progression in my test reports,I got depressed for about an hour.Then my resilience kicked in and I am accepting things as they are.At least there are concrete steps we can take if things get really bad.It's not getting off scot-free,but it's better than having no options.
What causes heart valve disease?It's not caused by lifestyle,but rheumatic fever,a complication of strep throat,is a major cause of heart valve damage that may take years to manifest.Another possible cause is a congenital defect that,again,could take years to become apparent.Calcium deposits accumulating on the valve with age may also be at work.There are other rare causes such as side effects of radiation therapy or certain medications.
Your basline health does have a great impact on how you weather any treatment required,so clean living is highly recommended for these patients.










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After Open Heart Surgery:The Road Widens Out

Eighteen months after a signature event of my life,the surgical stopping of my heart so a valve repair could be made,the road is widening out.Although the facts of what occurred are permanently emblazoned on my soul,we have reached a medical plateau.There is no longer any need to intensively monitor my progress.I have joined the ranks of the majority of valve repair patients.Now only a yearly assessment of my heart's inner workings is required.
Things have gotten so quiet in there,there are quite frankly better things for my medical team to do with their time,patients who are much sicker than I for them to attend to.That being said,there are still a few reminders of what happened to me.Of course my daily medication regimen is one of them.I am permanently attached to the pharmacy now.A lot of the success may be attributed to the stress that has been relieved by these cardiovascular drugs.My blood vessels are widened to the point where my heart doesn't have to work very hard to pump blood.This helps facilitate the longevity of the valve repair.
Externally,the extensive chest scars are all but invisible now.I can still feel a stinging sensation every day,though,from the wire permanently embedded in my chest.This wire held my sternum together while it healed from being split during surgery.
There are also occasional optical migraines in the form of mild visual disturbances.These have the appearance of meteorites.How appropriate,since the entire experience of major surgery made me feel like an astronaut.It was truly a strange new frontier for me.
Emotionally,there is a freaking out process when the evaluation approaches.You may have to stay in hospital if they find something weird going on in there.Take your scripture with you just in case.
My heart had started to enlarge.I was on the narrow road to heart failure.Now I am on a wide path-for how long I cannot say,but it certainly is more refreshing.

After Open Heart Surgery:Some Reflections at the One Year Mark

My seven-inch long scar from open heart surgery has all but disappeared a year after the event.Just a little red streak remains at the bottom two inches of the scar.The crusty effect vanished long ago.Between the scar and my belly button,the two chest drain slits are still visible,not entirely filled in.When I bend over,I can still feel the wire embedded permanently in my chest that held my split sternum together.It stings a bit.I think the way things have settled in is a tribute to the surgeon's skill. The optical migraines that manifested themselves after surgery,which are brief visual disturbances,still occur on a daily basis in the form of fireflies or meteorites.This doesn't hinder me;it's just a little reminder.There are also occasional heart palpitations,but they have been determined to be harmless. At times of exertion,my heart can pound quite hard and fast-not something I really want to happen,as it may stress the heart valve repair.If my heart starts pounding that way,I ease up immediately.One is not scot-free for the rest of one's life by any means.You're not going to just forget about it;indeed,it would be dangerous to do so.Constant informal and formal monitoring are the order of your life's day. In my particular case,there was a small amount of residual valvular leakage.This bears special attention over the years ahead.It can reduce event-free long term survival. All in all,I don't regret having the surgeon repair my heart to the best of his great ability.It surely has given me a second chance for as long as clinically possible with the disease process in question.

After Open Heart Surgery:Six Months On The Path

At the six month way point on my surgical path,many judicious thoughts occur to me.The giddy waves of promotion are sternly resisted in these quarters.
The medical secretary wants to know how the conventional heart valve surgery patient is doing.The patient says he is almost better.In fact,this may be as well as it will be possible to be,given all that has happened to me.I have been hit by a surgical truck,after all.
The after affects are still with me.Optical migraines are not as frequent,but these visual disturbances continue to flash from time to time.The large incision itself does still sting a bit on most days.It has fully healed at the top,but the bottom of the scar remains prominent,along with the chest drain scars.
You may think that minimally invasive surgery,including the robotic approach,will soon be available to all.Though widely available now,it may not be suitable for all.The most seriously ill patients could require the traditional big incision.Perhaps it still provides the most comprehensive access to the heart.
A tiny leak from the repaired valve might seem inconsequential.Given the laws of physics,though,even a small post-surgical leak must be monitored closely for the rest of a patient's life.Any leakage from anything tends to worsen over time.
The new anticoagulant drug Pradaxa is being heavily promoted on television,but hasn't been approved for patients with significant heart valve disease.At least four deaths in New Zealand are being attributed to the medication.As well,it is many times more expensive than the old standby Warfarin.In addition,no antidote for the new blood-thinner is currently available,while there are several for Warfarin.Plainly,Pradaxa has not had the benefit of an extensive history.
With such considerations,I have been dealing with some of the issues of these medical times.

After Open Heart Surgery:Searching For Right Words

It was amazing to me that,even when I was in the hospital and unable to post for a while,people were still visiting the blog.That was most appreciated.
"A form of PTSD," or post-traumatic stress disorder,is what occurs to me when I try to characterize the post-operative feelings of open heart surgery patients.Many of them sustain long term physical and psychological impacts from the drastic and complex procedure which they have undergone.To be sure,most of them are glad to be alive,given the seriousness of their health problems.They have a second chance now,imperfect as it may be for a number of them.
In my own case,the valve repair was not totally effective.With some degree of emotion,I lay there one night realizing I was not perfectly whole.The diseased valve is still mildly defective,leaking a little blood.It had been nearly destroyed by illness,so that result wasn't too surprising for me.Sometimes the lesions are so severe,it isn't possible to fully reconstitute the valve,though making it strong enough to last at least as long as an artificial replacement.
The emotional aspect of the procedure cannot be overstated.A heightened sense of fragility is a permanent reminder to the patient of everything they've gone through,and,indeed,may be encountering again in their future years.
The sheer length of recovery is in itself remarkable.The incision alone may take up to a year to fully heal.It may itch and sting a bit until that time,and bears careful attention by both the patient and medical team.
For possibly years into the future,the patient,according to the anecdotal literature,may experience ocular migraines,or visual disturbances with or without headaches.Vertigo and lightheadedness may also be felt sporadically for a long duration of time.The exact causes of this are not well-understood.Usually further testing doesn't explain such continuing discomfort.That is why "a form of PTSD" may be an apt description of the elusive phenomena.
Eventually,most patients will resume the full range of their activities,but it must be emphasized that this may take far longer than anyone had envisioned.As well,their souls may be tinged with blue from time to time as they reflect upon their most unusual pathway through the busy world.

After Open Heart Surgery,Part 2:Problems and Progress

Six weeks out from conventional open heart surgery,the 7-inch incision is still prominent.It continues to sting a little.I still stop to think before I do anything strenuous.
The visual disturbances have receded quite a bit.Only the meteoric illusion remains,which looks like meteorites streaking across your field of view.The double vision and blind spots,or eclipse effect,have been absent for some time.
As well,my taste buds have recovered significantly-at least to 90% of their former aptitude.True,most of the post-op medication has run out or been canceled because of sinus bradycardia.That is,my heart was beating way too slowly.Its rate was down into the 40s.Now it is up to the 50s.
I am able to drive short distances.I can also do grocery shopping,although this resulted in near-exhaustion.There is clearly a way to go on this involved journey.
The cardiologist on my surgical team informed me that,although my heart is working much better than before the operation,there was some residual leakage shown on the transesophageal echocardiogram,a scan in which an ultrasound probe is sent down the anesthetized patient's throat for a close examination of the heart in the operating room,both before and after surgery.
In short,it appears to me,at this point,that the mitral valve repair was not 100% successful.This is a relatively rare occurrence,affecting only a fraction of the repair patients.A transthoracic echocardiogram,which is externally administered,has been scheduled for a further assessment.
Another chapter in the medical annals unfolds.I had some time ago realized you are a heart patient for life-to a greater or lesser extent,depending upon the individual circumstances.It need not be depressing;it's just the challenge you've been
given.It's a part of your new job description while you are on this earth.

After Open Heart Surgery:An Appreciable Journey

For one who has had conventional,chest-splitting open heart surgery,expectations should be tempered by reality.This person is not going to be able to leap back into their previous life all at once.Healing from such a major intervention is a gradual,multi-dimensional process.
Visual disturbances are a signature event for many open heart patients.Whether attributable to the large number of medications being taken,the after-effects of anesthesia or being on the heart-lung machine for several hours,this can be one of the most disconcerting aspects of recovery.These patients may experience auras or silent migraines,which are bright spots,double vision,or a combination of visual effects-possibly for months.
Auras or silent migraines are often referred to as ocular migraines.Most often,they are not accompanied by headaches in the open heart patient.Such migraines without pain are also referred to as acephalgic migraines.The patient may be referred to a number of specialists,according to the anecdotal literature,but end up with little to show for it.
Another effect the open heart patient must accept is attacks of fatigue.Of a sudden,they feel an overwhelming need for a nap,which they are best advised to accede to.These fatigue episodes,like ocular migraines,may alarm the patient,but are signs that the wounded body needs to focus on regrouping itself,rather than on a slate of activities the patient may have planned for the day.
For an extended period,the main job of the open heart patient is the restoration of health in itself.Other considerations need to be set aside so the patient may be successfully reconstituted.

Back Home From Open Heart Surgery

I was discharged from the hospital Tuesday,having had the traditional chest-splitting for heart valve repair.I have an artificial annuloplasty ring in my heart now.
The first night at home was strange.I felt as though my bedroom was high off the ground,though it really wasn't.Everything was somehow altered.Then there were the firefly hallucinations.I still have them.
I also arrived home with a metallic taste in my mouth.That seemed to fade today when I ate some pastry,but then resurged.It is possibly caused by ACE inhibitor drugs such as ramipril,which lower blood pressure,as there are anecdotes to that effect on the Internet.The burning sensation from the breathing tube down my throat has receded permanently.
I am working hard to re-establish normalcy.