Heart to heart talk

Mom had a cardiac catheterization and coronary angiogram today. According to the Mayo Clinic, during a cardiac catheterization, a long, thin, flexible plastic tube (catheter) is inserted into the body. Dye is injected into the blood vessels of your heart. The dye is visible by X-ray machine. The machine rapidly takes a series of X-ray images (angiograms), offering a detailed look at your heart arteries to determine if you need coronary artery bypass at the same time as your valve surgery. Pressures in the heart's chambers may be measured. Mom was in surgery for about an hour. The surgeon actually said the paperwork he had to do took as long as the procedure, itself. She started surgery about 9 a.m. and was home before 3 p.m.

We already knew that she had Mitral valve prolapse (MVP). It occurs when the valve between your heart's left upper chamber (left atrium) and the left lower chamber (left ventricle) doesn't close properly. When the left ventricle contracts, the valve's leaflets bulge (prolapse) upward or back into the atrium. Mitral valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation. Mitral valve regurgitation (mitral insufficiency) is a condition in which the valve is particularly leaky and allows excessive blood back into the left atrium. If the regurgitation is severe, surgery may be recommended to repair or even replace the valve in order to prevent the development of complications, such as heart failure.

What the doctor said is that one side of mom's heart is calcified and "hard as a rock" and the other side is one and one-half times larger than it should be because where the valve is flappy and not opening and closing as it should, blood flow is backwashing into the one side and causing it to enlarge to compensate for the additional blood flow. The doctor said the heart is compensating and in good shape despite the problem.

He has recommended an echo cardiogram in about two weeks. He'll put an ultrasound device down her throat and do a sonogram of the back of her heart from her throat. With that information, coupled with what they did today, he will go to a surgeon. He is recommending open heart surgery and valve replacement at this point. There will be no bypasses and her arteries had no blockages at all.

He said the valve problem is "moderately severe." While her heart is accommodating now, he said that without surgery in one to two years, the heart would likely fail and she'd deteriorate rapidly at that point. With the open heart surgery, they would do a valve replacement. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. The two types of artificial valves are mechanical and tissue. Mechanical valves, which are made of metal, may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke. The doctor said she is not a likely candidate for a mechanical valve. I'm guessing because of her past stroke and/or her age. Tissue valves are made from biologic tissue such as a pig's heart valve. These kinds of valves are called bioprostheses. They may wear out over time and need replacement. However, an advantage of the tissue valve is that you don't have to use long-term anticoagulant medication.

The doctor said he would rather do this procedure now while her heart is still strong because her recovery would be better than to wait until her heart begins to fail. Makes sense.

Open heart surgery is done under general anesthesia (God, I would hope so!) Through an incision, usually through your breastbone (sternum), your heart is exposed and connected to a heart-lung machine that assumes your breathing and blood circulation functions during the procedure. Your surgeon then replaces or repairs the valve. After the operation, you'll spend one or more days in an intensive care unit, where your heart function and general recovery are closely monitored.

So, there we are. I'm still not sure what I'm feeling. I'm glad she made it through so well today and maybe we'll see some relief for her weakness and fatigue when it is all said and done.