This is a new page with an unusual subject matter, which I felt would be useful to add to my website. It can be difficult to find basic information when you get diagnosed in the early stages. More often than not you think of the questions to ask doctors after the appointment rather than during it. There is a whole new language to learn as 'heartspeak' contains a lot of terms which you have not heard before. I hope that my experiences may actually be helpful to somebody else faced with similar problems.
Contents
The Beginning
The Routine Medical
The Heart Specialist
The Next Stage - The Angiogram
Heart Surgery
Preparation for the Operation
The Operation
The Intensive Care Unit
Recovery - The Next Few Days
Back Home
Recuperation
Frequently Asked Questions
The Beginning
Many years ago, when I was in my teens, a routine visit to the doctor picked up a slight heart murmur. Basically, a murmur is an irregularity in the sound of the heart rhythm. After a number of tests it was diagnosed as a 'squeaky valve' - this was the actual terminology used by the doctors at the time. There was no effect on my lifestyle, at that age most young people believe they are fireproof anyhow and I soon took it for granted. I could just hear it in a quiet environment, particularly after any strenuous exercise (certainly a talking point after sex etc.). After a long time living with it I really did not have any particular concerns as it did not have any immediate affect on my general health.
I have been fairly healthy all my life and rarely needed to visit the doctor's surgery. I had appendicitis in my mid twenties and this did involve a week in hospital as it had burst. I had peritonitis, which I only learnt afterwards was quite life threatening. During all this time I cannot remember any of the doctors mentioning the heart murmur but I guess it was still there.
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The Routine Medical
In 1997 we were in the process of moving house and I had a routine medical for insurance purposes. The doctor who performed it did pick up the heart murmur this time. Although it had no effect on the insurance medical, he did ask how regularly I had it checked. The answer 'not since I was 16 years old' did not seem to impress him and he suggested it was prudent for my GP really should take a look. My GP was not overly worried, as the condition had clearly been stable for a number of years. He did check it out and thought it was either a valve or something called a PFO, which is a small hole left between heart chambers after birth, he referred me to a heart specialist at the Norfolk and Norwich hospital.
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The Heart Specialist
Back in the days when I first went to hospital, the diagnostic techniques were not so advanced as they are now. The sounds of the heart were the best clue, these being checked by stethoscope and the skill of the doctor. An ECG machine about the size of a large fridge backed up this information with a print out showing the electrical signals made by the muscles of the heart during each contraction. Nowadays, the ECG machine has shrunk to the size of a small portable unit not much bigger than a briefcase. A number of wires from it are connected to specific parts of the body via conductive pads and the output electrical signals are translated into a graph of the electrical activity of the heart. This can pick up a disturbance in the electrical activity and is a good indicator of a heart attack as these rhythms still show disturbance a long time afterwards. My ECG was clear showing a regular sinus heartbeat.
The next test used an echocardiogram machine; this showed the action of the valve and the flow of blood through it with a very detailed ultrasound picture. This machine also allows very accurate measurements to be taken of the process. With the information gained with these real time pictures of my heart working, the specialist diagnosed a floppy Mitral Valve. This is a two-leafed valve, which opens and closes to let blood from the upper to the lower left side of the heart.
The ligaments, which allow the valve to shut cleanly, are uneven and the resulting impaired valve action does cause some regurgitation of the blood, as it does not close completely after each pumping action. This swirling action can also lead to a danger of endocarditis. This means taking a course of antibiotics, before and after treatment, to protect against certain procedures that can generate quantities of bacteria in the bloodstream, such as dental work. This effectively prevents the bacteria sticking to the internal walls of the heart and causing infections to develop.
The heart specialist recommended annual check up visits to monitor progress but again he confirmed that there really is no need to change lifestyles as a result of the problem. Regular exercise is good for the heart and circulation and the thing that does seem quite odd when you are first told of the condition is that you do not need to make any special allowances for it.
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The Next Stage - The Angiogram
The check ups continued for the following three years with the measurements and results looking very similar year to year and I had no problems with high blood pressure or irregular ECG trace. In March this year (2001) I went for the regular check up and there was a slight change picked up by the ultrasound check. As this was fairly untypical, my specialist recommended an angiogram be carried out to investigate further. The angiogram is a more invasive procedure. It involves inserting a thin tube called a catheter into an artery in the groin and threading this up into the heart chamber. A special iodine die is used to enable an x-ray to be taken while looking at successive views of the heart and surrounding blood vessels. This gives a very much clearer set of images showing the real-time function of the heart in operation. In my case the leakage seen was around 20%. This meant that only 80% of the oxygenated blood was going in the right direction. To compensate, my heart muscle had to do more work causing it to enlarge. Eventually, if left unchecked, it would put more stress on the muscles and the blood vessels, which feed them. Serious heart failure becomes more likely the longer the condition is left unchecked.
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Heart Surgery
Set against this background, my specialist recommended referral to a heart surgeon to repair or replace the mitral valve as appropriate. The date for the surgery has been set for June 15, 2001 and at the time of writing this page; I am reasonably calm and relaxed about the process. Open-heart surgery has risks, which cannot be underestimated, but the alternative is to wait until it gets worse. Delaying the decision will certainly reduce the odds of successful recovery.
The operation does involve opening the chest cavity and attaching a heart-lung machine to keep the blood circulating while the heart is stopped, opened and the valve checked and either repaired or replaced. This decision can only be made once the valve is exposed and the extent of the damage assessed. Repair is usually preferred but alternatively a replacement may be fitted. The replacement could be artificial or a porcine donor valve (from a kind piggy). A porcine donor valve could have a life of around ten years, which means a repeat operation would be required. An artificial valve will outlive the heart itself but could give rise to the formation of blood clots which again are life threatening. A blood-thinning agent will prevent clots and Warfarin (also used to kill rats!) in controlled doses is commonly used.
For the period immediately after the operation, the patient will be in an intensive care unit (ICU). The patient is allowed to recover at his own speed and much depends on the nature of the surgery. A respirator is used until the lungs can take over the breathing process and various catheters and intravenous lines are gradually removed as recovery takes place. The heart function does return to normal relatively soon after the operation, but the repair to the chest wall takes longer and does involve some discomfort. Physiotherapy and a gentle level of exercise is used and this is gradually built up over time. One of the biggest dangers is trying to do too much too soon and suffering a relapse. The structure of the blood can also be affected during the time on the heart lung machine. This can also lead to difficulty concentrating and making decisions more tiring. Frequent rest periods or short naps are inevitable. Return to work at around 6 to 8 weeks is possible by gradually increasing the level of exercise.
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Preparation for the Operation
I am writing this following my return to home and it is now incredibly only 10 days since I had the operation. I was admitted the afternoon prior to surgery, which is fairly common to get all the preparatory work completed first. As well as the usual paperwork the nice nurse also measured me for a pair of surgical stockings, which I would have to wear for around six weeks following the operation. These give support to the legs and help to prevent blood collecting in the lower regions and forming clots, which could be fatal. They are a heavy gauge white material and are guaranteed to make the average male wearer feel a total plonker.
The last two jobs of the evening were to shave all the areas which would either be operated on or have lines attached for the purpose of getting fluids into or out of the body. In my case this involved my chest and abdomen and both arms (by pass surgery uses 'spare' veins stripped from the legs which would also require shaving - thankfully, my angiogram showed the blood vessels to my heart as being in good shape so this was not needed). Finally, a complete shower using 'Hibiscrub', which is a special anti-bacterial soap, was needed to remove any traces of bacteria on my skin. This was repeated again for added safety the next morning. The lack of hair and freshly scrubbed appearance would minimise any possibility of infection around the operation wounds.
The following morning, final tests including chest X-Ray and ECG were performed again. The consent form was signed during the surgeon's visit the previous evening and he had again explained the possible procedures depending on what would be found when the heart was opened. An hour before surgery I was given a pre-med injection to relax me before being taken to the operating theatre. This gives a warm floating feeling, slightly light headed but leaves the back of the throat very dry. As I had not eaten or drunk since six am I was quite looking forward to getting it over with by now. The last stage is being wheeled down to a room just outside the operating theatre to meet the anesthetist and have the final drugs administered before being prepared for surgery. This is literally the last thing I remembered before drifting off.
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The Operation
The operation as outlined above is a major piece of invasive surgery with the skills of the surgeon backed up by a team of people and very carefully controlled anaesthetic procedures while the patient is cooled, the heart and lung function is taken over by machine to allow the surgery to take place. In fact, this type of operation has only been perfected reasonably recently since the mid 1970s when the heart-lung machines became sufficiently sophisticated to achieve widespread use. Taking over the blood circulation involves far more than simply pumping blood. The machine has to re-supply the oxygen to the red cells at sufficient pressure to supply all the organs in the body, without damaging the white or red cells or the platelets carried by the circulating blood. As well as this re-plumbing job, the anaesthetics are used to induce drowsiness, block pain and relax the muscles, temporary amnesia is also caused so that the patient is not disturbed by a detailed recollection of the operation. Once full machine bypass is achieved, the surgeon has access to the heart to perform the surgery. After surgery, the process is reversed to allow the heart to restart and the patient to be able to breathe again for himself.
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The Intensive Care Unit
After the surgery, the patient is taken to the intensive care unit (ICU) where specially trained nurses give 100% cover. Once the patient can breathe for himself, the tube is removed from the throat, which has been used to feed the lungs directly from a respirator or breathing machine. I went for surgery at 1:30pm and was aware of being conscious at 10:40pm by which time I had not remembered this tube being removed. I was, however, fully alert at this time and managed to say hello to the nurse and ask for a sip of water. It tasted just great, even though I was only allowed to sip through a straw. All through the night my vital signs were being monitored. I did not feel tired now and had many small naps between requests for more water. The clock by the nurse's station moved incredibly slowly. I did joke with her to make sure it was working properly as it did not seem to be moving very fast.
I thought that during this phase I would be very sleepy and not quite with it. As far as I was concerned, I was quite OK. There was no real pain; a supply of morphine was keeping that under control. This was being fed to a line in my neck, I also had lines in both arms and a catheter to my bladder together with two drains fitted below the chest incision and near to these were my 'jump leads', two sets of wires which were connected to a pacemaker to keep the heart rhythm smooth. On top of all this I had an itchy nose and cheek, where the oxygen mask and nasal line was. Eventually I asked the nurse to scratch the area but she showed me that despite all these pipes, I could still reach with my own hand - Oh deep joy!
The night was long, there was always something being monitored but the nurses I met were absolutely fantastic and were careful to keep up conversation where I asked for it but let me sleep as much as possible. I tried very hard to breathe as deeply as possible but felt my breath was much more shallow than usual. During the night and into the following morning some of the various lines were disconnected as my fluid balance allowed. The only discomfort was removing the two drains to the chest cavity. These were 12mm surgical tubing up inside the chest. I was given Entinox (laughing gas) to breathe and after three breaths told to take one breath in and hold it while the tube was pulled out. Thinking about it again now I still cannot describe the sheer surprise as what seemed to be metres of the stuff kept coming out - OK it was about 300mm at most but it did not want to let go without a fight and I seemed to feel every single millimetre of pull. Perhaps the second one was worse but I already knew what to expect and had taken a very deep breath of gas before the tug of war started. To be honest, this was the only really uncomfortable part of the whole ICU experience. Shortly after this I was wheeled back to my room to sleep it off.
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Recovery - The Next Few Days
On the Tuesday morning, which was the day after the operation, I was encouraged to get out of bed with some assistance from the nurses and to sit up in the chair next to the bed. The Physiotherapist arrived to make sure I was already started on my breathing exercises and although these did stretch the rib cage were not too uncomfortable. By the time my wife arrived I felt pretty good and was pleased with the progress in such a short time. She did remark that I looked like shit - but I guess this was her way of making me feel better. The wound to the chest cavity ran from collarbone to below the sternum but looked very neat.
Most of the time for the next few days I spent napping in between waking spells. The intravenous lines were all out by the Wednesday. This meant the pain would be controlled by taking tablets as necessary. I also had the chance to take my first shower instead of the bed baths I had had up to now. This was another one of those blissful moments and I also shaved for the first time in several days, which again made me look slightly more human.
There were regular ECG checks most mornings together with another chest X-ray to make sure everything was clear and back in the right places. The physiotherapy added short walks and very soon I was out in the garden or walking around the corridors whenever possible. One of the other points the physio wanted to ensure was that the lungs were being expanded properly and a technique called 'huffing and coughing' was being used to bring up any phlegm. This involved holding the chest with crossed arms while making huffing noises to clear the bottom of the lungs - a very short cough was then used to complete the process. Unfortunately, if you forget and cough normally it feels like all the stitches will come apart at once and makes your eyes water as somebody seems to be trying to ram a hot poker from the inside out - the lesson is learnt quite quickly anyhow. To further expand the lungs I had been given a small blower with a piston which rose dependent on the amount of breath expelled. On the night before the operation I managed a high score of 4,000, which was maximum. By the day after the operation this was as low as 1,000 so I had plenty of practice to gradually bring the score up as the days progressed.
I have to admit that I was feeling very good despite the limitations that were obvious due to the chest discomfort and each day saw some new improvement. I had brought plenty to read but found concentration really difficult so tended to do this in short bursts. My appetite was also completely non-existent and eating more than a bowl of soup and some ice cream or sorbet to follow was hard. I also preferred to drink water rather than coffee or hot drinks. By Thursday another landmark as my bowels had opened for the first time since the operation. I sat there smug and quite content as my body was getting back to normal. The target in the days after the operation is to show you are capable of being released from hospital. As well as the blood pressure, X-Ray and physical checks, the phisiotherapist does advise on basic exercise and the simple things such as being able to climb stairs safely. The doseage of Warfarin is also adjusted with daily blood checks to measure clotting properties. Once this is stable, a two-weekly check at the doctor's surgery is used to keep the balance.
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Back Home
Following the busy routine of the hospital, being back home was positively restful. During the first few days, I got into a routine of short walks with my wife, gradually building up the distance each time. The other thing I noticed was the feeling of tiredness. This is quite usual after any major surgery and I found myself having regular naps morings and afternoons. The weather in late June was very warm and sunny, but even sitting in the garden was tiring.
First thing in the mornings we would have the ritual of dressing me in the surgical stockings. My wife found this a complete struggle, compared to the nurses in hospital, who were much more practiced in the routine. It was the cause of much hilarity and the resulting laughter brought tears to my eyes as I had to hold my chest to avoid pulling the stitches. Despite the warm weather, I tended to wear loose trousers rather than shorts to hide my lily-white stocking-clad legs.
Despite the relative severity of the chest opening, there was not any real pain during the time in hospital. At home, discomfort could be managed by taking over-the-counter pain-killers. I found co-codamol (paracetamol and codeine) soluble tablets to be the best for me. These must be limited to 4 doses in 24 hours which I found to be sufficient.
Three common things did cause sudden eye-watering discomfort: coughing; sneezing and laughing. In the hospital you are taught how to hold the chest by crossing your forearms with hands on the shoulders and elbows down by the waist. This braces the chest and stops the wound pulling. In fact the breast bone is held together by stainless steel wires which keep the two halves in place as the bone knits back together. The skin is stitched together underneath the surface by sutures which will eventually disolve. There is no danger of bursting the wound but without the chest bracing position the discomfort can be quite sudden and bring tears to the eyes. Coughing and laughing do have some forethought so not such a problem, but sneezing can catch you unawares and this was really not at all nice.
Sleeping during the day was all very well but it was difficult at first to get a good nights sleep - particularly as I usually sleep on my side. The pressure this put on the breast bone was very uncomfortable and it took several weeks before I was able to sleep right through without waking after a roll over in bed. During my stay in hospital I did ask for a sleeping tablet one night. This seemed to have no effect so I did not bother when I got home. I did find that a dose of painkiller before going to bed did the trick. The X-Ray picture to the left is a sideways view of my chest taken 7 weeks after the operation. I could not get the whole film on my scanner but several features can be seen quite well. This shows the wire loops which hold the breast bone together very clearly. It is also possible to make out the diagonal line of the ribcage and my spine to the right side of the picture.
The following weeks were spent gradually increasing my physical activity and keeping up the breathing exercises. Walking distance got futher day by day until I could do a complete lap of our village which is just over 1.5 miles. After I knew I could do this comfortably, I started timimg myself so it became a brisk walk instead of a leisurely stroll. Once the wound had healed externally, after being home for a fortnight, I also started swimming once a week. This did feel great as being in the water made me feel more mobile and obviously supports the body weight while giving the muscles a stretch. I did find that my lung capacity was reduced and I could not hold my breath under water so well. This was a result of the effects of the operation and the process of being hooked up to the heart lung machine. The blower device I had to exercise the lungs was still only showing a score of 2,500 two weeks after returning from hospital. This was getting better and provided a good indication of my lung capacity. Before the operation I could hold my breath for around 2 minutes, afterwards this had dropped to 30 seconds. I felt it was mainly due to the automatic carbon dioxide triggering the need to breathe rather than lack of oxygen intake. This was something I could work on gradually so did not worry me too much. I wanted to return to diving in the future and although scuba diving does not involve breath holding, efficient lung function does mean lower air consumption and more relaxed diving.
The secret to recovery was not to overdo anything. It was easy to feel over confident one day and do too much, only to suffer the next day with an extra dose of naps due to tiredness. This was frustrating by 4/5 weeks after the operation when I was feeling much better in myself but I had to take it steady and learn to relax. I did find reading to be difficult in the first few weeks as it was not easy to concentrate for long periods. This gradually got better over the weeks to follow and I did manage to build this up. Writing these pages was also theraputic although I have had to go back over the passages written in the early stages to correct spelling and gramatic errors. I hope that I did manage to correct most of these by now.
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Recuperation
The weeks that followed included lots more walking and gradually building up my strength. As the summer progressed I also spent a lot of time visiting the beach with my wife. Mostly, the children stayed at home so it was good to spend time together. The walks were usually of an hour or two duration covering many miles. Sunbathing was not so comfortable, the weather was great but sitting in the sun was tiring and I had been warned that the effect of too much sun on a fresh scar could harden the tissue. After 4 weeks, I was allowed to drive again which was great for my confidence. The break in my chest bone had not fully healed by this time so too much steering had to be avoided and most of the journeys were short hops anyhow. It did give me the feeling that I was returning to normal activities.
I did make the most of the best of the weather of the summer and did start to cycle after around 7 weeks once my chest bone had started to knit together and the pain had reduced to a dull ache at worst. Swimming was also helping and I felt very pleased with progress after 8 weeks when I returned to the heart surgeon for a check up and further X-ray. I was sure he would sign me back to work the following week and although he was also pleased with my progress, he wanted me to take the full 12 weeks before going back. At first, I was disappointed because I really thought that I was ready for work again, however he did tell me that returning too soon could undo the recovery process and set me back. He also advised me to lose a few pounds (OK maybe 30 or 40 pounds) to seriously increase my life span for the future - good advice but harder to follow. More importantly he confirmed that I could stop taking the warfarin tablets and that I did not need to wear the surgical stockings any more. They had been hard work, particularly in the heat of the summer as I could not go out with shorts on.
By the end of the summer another milestone was my first scuba dive. I did this in an inland lake site and had three very enjoyable dives during the day, taking things very steady at first. I was pleased that my air consumption was still OK and the sheer exhilaration of being back in the water was a great tonic. The heart surgeon had agreed that I could start again when I felt up to it. In fact before my operation I was regularly diving with a heart operating well below normal capacity. The greater efficiency of the valve would ensure a better heart performance rather than being something to worry about.
I returned to work after 11 weeks, working mornings only for the first week to break myself in slowly. This was not too bad but the thinking time was more tiring than I had expected and I promised my wife not to over exert myself with the 12 to 14 hour days that I had been doing prior to the operation.
After 4 months, I returned to the original heart specialist for ECG and echocardiogram scans. These were very positive. The echocardiogram showed no leaking whatsoever. As I had been used to seeing the patterns of blood swirling from the defective valve for the previous examinations, this was very reassuring. Blood pressure and ECG traces were also normal but I was advised to continue with yearly check-ups to monitor performance for the future. I have no real worries about this and after my experiences I am sure that it would be better to pick up any problems before they got too serious. Looking back, if I had to undergo heart surgery again I would not hesitate. I have enough confidence in the skills of the surgeon and particularly the back-up of a first class medical team to know that I would be in good hands.
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Frequently Asked Questions
To finish this page I thought I would share some of the questions that I have been asked over the past few months, as the answers may be helpful to anyone else in the same situation. Looking back now, some 7 months after the operation, I have been fortunate to follow the medical advice at various steps along the way and my general level of fitness seems much better than it has for years. I have just completed training to PADI Divemaster level early in 2002. This included some difficult stamina tests including timed swims over 400m, 800m snorkel swim and tired diver tow of 100m with full scuba kit on. My times were not at the upper end of the scale, but the performance, together with other training and theoretical exams was good enough to earn me the qualification. The challenge was doubly pleasing considering the fact that I have had major heart surgery. It does show that this should not be seen as the start of a sedentary lifestyle, if anything, I am getting more out of life now than ever before.
1.What physical symptoms did you have prior to the operation.......was it shortness of breath, or chest pains?
My symptoms were not very self evident at all, maybe I was finding it easier to become short of breath towards the end but the symtoms had developed over thirty years and perhaps I was making adjustments for them.
2.Why was the decision taken to have the operation now and not later?
After a routine medical picked up the condition 4 1/2 years ago my GP sent me to a heart specialist at the local hospital. This was an annual check up. As well as ECG, I had an echocardiogram which showed the condition getting worse over time. The first few years, the measurements were very similar but March 2001 they noticed a bigger jump in the movement and this lead the specialist to recommend an angiogram. This showed the leakage was around 25%, for every pumping action of my heart, only 75% of the blood was flowing the right way. To compensate this my heart muscles were starting to enlarge. The arteries were not blocked but over time would have difficulty supplying enough blood for the heart to work. As well as pumping the blood around the body these arteries have to supply enough oxygenated blood to allow the heart to function. I could have left the operation a couple of years but the risk of heart attack would have increased over time. The specialist recommended the operation while I was younger and fit enough to get over it, rather than later when the risks become greater.
3. What are the success rates of these operations... and what is the risk of death?!!!!
Ha! - in the UK you might find a series of small red booklets published by the British Heart Foundation in most heart departments in your local hospital. One of these described the success rate for mitral valve repair as 94% - or as my wife put it 6 out of every 100 people die! When we discussed this with the heart surgeon he took great care to explain that these were national averages across a wide range of age groups. He felt that for someone in my condition, at his hospital, the chances of survival were better than 99%. I always look on the positive side and even at 94% I would have gone ahead with the operation.
When I was laying in the aesthetic preparation room just before the operation it did give me the chance to come face to face with my own mortality but looking back, this has given me an even stronger positive outlook now. When you have been through this experience it puts the mundane problems of work etc. into their proper perspective!
4. How long does the repair last, are you aware of any research into how long the repair lasts or whether by having this operation your life expectancy is now reduced?
Overall, the repair has given me a longer life span than ignoring the problem would have done. Regular annual check ups should show how effective this will be. My first echocardiogram showed not even a slightest leak so I have no reason to expect it to fail suddenly. If it does degrade it will happen over time so it will give me a chance to decide what might happen next. According to the heart surgeon, he did not expect to have to go back in for a second time if this helps answer your question.
5. Are you now able to engage in all your activities or do you have to curtail some?
Absolutely not - if anything I feel ready to take some new challenges.
6. Are you on any medication ..blood thinners etc.?
Blood anticoagulants in the form of Warfarin (the active ingredient in rat poison) was taken for 8 weeks after the operation. This is normal and it is monitored by regular check-up with the nurse at the local doctor's surgery. Depending on the weekly results the dose is increased or decreased until it stabilises. If I had needed an artificial valve then this would have been for life. A side effect would be difficulty stopping bleeding from cuts bruises etc. and would have stopped me diving for sure. This was why I preferred the repair rather than replacement and this is what the surgeon would normally try to do.
7. I believe you have to take antibiotics for dental work...do you take this before and after or when.......what dosage..etc..?
As soon as the mitral valve problem was diagnosed I was told to use antibiotics for any dental work, even routine clean and polish. I was given a card to carry to show the dentist. This involves taking 4 antibiotic tablets 1 hour before treatment. I have been told that the thinking on this is gradually changing but they work on the 'better safe than sorry' rule.
8. How long was it before you could drive again?
4 solid weeks of being driven cautiously by my wife!! I could not wait to get back behind the wheel but I would not have gone on a long journey until 7/8 weeks until my chest had healed properly.
9. How long was it before you felt "normal" again!!?
Apart from the first few weeks post operation tiredness I felt 'normal' within 6/7 weeks. You are told not to do certain things while the chest bone heals but other than these everything else is 'when you feel ready for it'. To give you an idea, 'gentle sex' (i.e. me lying back and not doing too much work) was within 2 weeks of the operation - that made me feel well on the road to being 'normal'!!!
10. I,m told from the echo done on me that my regugitation is level 3 out of 4; with 4 being most severe.........do you know your level prior to operation?
Sorry I cannot answer this one, as I said above they gave me a percentage of leaking amount, it would be worth asking this question of your specialist again.
11. Do you have a heart murmur now?
Not at all. I could actually hear the murmur myself before the operation - it was a bit spooky at first when I realised it was not there any more.
12. Do you know what caused your problem and did it deterioate with time?
I think it was hereditary, I also read that over 5% of the population have some form of valve defect although these may never develop into a severe condition. I was told that exercise was good for the heart and not to curtail any physical activity in the early stages but that regular checks would determine what action would be needed for the future. The heart specialist did not even mention the possible need for an operation but the girl who performed the echocardiogram became much more chatty on this subject as I got to know her over the past 4 years.
13.I have had an angiogram which states arteries are ok...so have been advised to have another echo in 6 months............did your echos show deterioration over time?
My angiogram also showed normal arteries. The reason they checked this is that once they have you 'opened up' it is easier to do both jobs at once. If there was any doubt, they would have done a by-pass at the same time. Most of the other patients I met in hospital were in for by-pass rather than more complicated surgery like valve repair.
14. Whats your future prognosis and how often do you now need to have a check up?
The annual check up is what they have recommended. As long as everything is OK this will continue. If it gets worse again these might become every 6 months.
15. Are you aware of any minimally invasive procedures for this operation?
My background is engineering and I read every bit of info, watched every documentary and talked to lots of people before and after the operation. If your valve is defective then open heart surgery is the most common and is a well understood procedure. There are robot arms which can be directed by a surgeon sitting at a console through smaller holes in the chest wall. You may find some reference to this on some USA web sites. The biggest problem is one of access. By chopping a hole through the breastbone, the heart is fully exposed, even though there are risks involved the surgery is almost routine now. The aftercare is truly excellent and the recovery period is not too traumatic.
The operation itself is painless - you are asleep while it all goes on. You have a morphine drip to dull any sensation when you wake up and within a few days you will be sitting up in bed with nothing more than paracetamol needed for any discomfort. There are a few weeks of tenderness but no worse than an accidental broken bone would cause. It does take a few weeks to regain strength and I got to the stage of walking 3 miles a day within 3/4 weeks. I was ready to return to work in 8 weeks but was told to take the full 12 weeks to ensure I did not do too much too soon and put myself back as a result.
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Copyright © Graham Curran 2001-2002, Changes last made to this page
on: Sunday, February 3, 2002 10:12 GMT