Preparing for Open Heart Surgery

 I have a severely leaking mitral valve. Every time my heart beats much of the blood pumped from this valve between the left atrium and left ventricle flows backwards, requiring my heart to exert itself much more than it should. The left atrium receives oxygen-rich blood from the lungs and pumps it to the left ventricle through the mitral valve. The left ventricle pumps the oxygen-rich blood through the aortic valve out to the rest of the body. This would explain why  throughout my life my body never felt fresh and energetic. There is a significant murmur and I am now very fatigued, sometimes dizzy and have long-lasting palpitations. I have been told I need Open Heart Surgery now. Here are the things you need to prepare for Open Heart Surgery.

 A little over three months ago I had a meeting with the cardio-thoracic surgeon who would be sawing through my ribcage, putting me on bypass and stopping my heart to replace the defective valve. I was told I would need to choose between a mechanical or a tissue valve. Both options have post-op issues. Originally leaning towards a mechanical valve I changed my mind after doing considerable research. I have since signed the consent form for this, had an angiogram, spent a fortune on drafting a new will and enduring powers of attorney, and compiled an Advance Directive with the support of my GP in case things go wrong now and in the future. I have discussed all this with my daughter so she can understand what decisions to make on my behalf, if necessary. I hope she never has to use these documents (all except my will are available to medical staff throughout NZ to refer to) but we should all be responsible parents to help our children deal with bad things that inevitably come along. I considered contemplating my possible demise or incapacity part of my pre-op preparation.

I also met various surgical registrars including the one who will be wiring my chest back together and sewing me up, as well as a number of nursing specialists.

In addition, you must have a clearance letter from a dentist confirming there are no outstanding treatments such as cleaning, fillings, loose teeth, gum disease likely in the next six months as dental issues can result in serious cardiac consequences including death. I have done everything possible to be ready for surgery at any time.

Another part of the prep was having lots of blood tests, height, weight and blood pressure regularly recorded and also undergoing a transoesophageal echocardiogram

TOE or TEE transesophageal echocardiogram is done by inserting a probe with a transducer down the esophagus. This provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. Echo shows the size and shape of the heart and how well the heart chambers and valves are working. Echo can pinpoint areas of heart muscle that aren't contracting well, detect blood clots and guide treatment for arrhythmias (abnormal heartbeats) and many other heart conditions.

Risks

• Damage to the esophagus, including bleeding or a tear (very rare)
• Reaction to the medication used to relax patients during the procedure, including nausea and difficulty breathing (see my recollections below)
  
• Sore throat after the procedure
   

  Before the procedure 
• The doctor will explain the procedure and offer the opportunity to ask any questions about the procedure
• You will be asked to sign a consent form that gives permission to do the test.
• Fasting prior to the procedure is required. 
  
• Notify the doctor if you are allergic to or sensitive to medications, local anesthesia, or latex
• Notify the doctor of all medications (prescription and over-the-counter) and herbal supplements patients are taking
• Notify the doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of these medications prior to the procedure
• The doctor will require a blood test prior to the procedure to determine how long it takes the blood to clot. Other blood tests may be done as well
• Notify the doctor if you have heart valve disease, a congenital heart condition, or a history of endocarditis (infection of the heart valves) as you may need to receive an antibiotic prior to the procedure
• You receive a sedative prior to the procedure to help with relaxation. Patients need to arrange transportation after the procedure

My recollections are as follows: 

A luer or IV was inserted in my arm. I was wheeled to a small room where I was asked to hold a very viscous liquid in my mouth for at least 2 minutes and to gargle where possible, after they had already sprayed the back of my throat with an anaesthetic. I was then told to very slowly allow the gluggy stuff to slide down my oesophagus. 

I had to then turn onto my left side and a plastic mouth piece with a hole in the middle was inserted into my mouth. This can make you feel anxious, claustrophobic or make you want to gag because you know what's coming next. Fortunately they have the strong sedative kick in at this point. A tube with an ultrasound transducer is then pushed all the way down your throat and food pipe until it lies behind the heart (see links to detailed videos below).

I gradually woke up in the cath lab. I expected to be able to go home around lunchtime. Ha! They gave me a sandwich and a cup of tea. That was great as I hadn't had anything to eat for 15 hours. They took out the IV line. The registrar simply said that doctors were debating now whether to repair or replace the valve. Hey? I said I had always been told it was too severe a situation for repair and that I did not want a repair that would only last a few months or a year before I would be opened up again. " We wouldn't do that to you," said the registrar. But I know perfectly well repairs don't always hold well even though a good repair is preferable to replacement. I have received no details on my TOE/TEE at all. 

As I stood up to get dressed I became very dizzy and disoriented and vomitted rather violently. Nursing staff said no way could I go home like that as I was having a bad reaction to the anaesthesia. The nurses said I must have a new IV put in (I hate those painful things) so they could pump liquids into me asap to flush out the toxic sedatives and rehydrate me. After five additional hours I was wheeled down to the hospital entrance to be picked up and taken home, clutching a plastic container for my nausea. Sick as a dog it took about 48 hours to come right at home.

Open heart surgery is not for the 'faint-of-heart'. Yeah, silly joke but true. I have joined the Zipper Club on Facebook which is a group of people having OHS or their loved ones are living through it. While it may seem routine major surgery these days things go wrong more often than you would think and there can be some distressing ongoing consequences for some patients. I am pretty clued-up now on these.

Living alone as I do with no deep emotional relationship to lean on nor family nearby, spending most days of the week without human contact makes dealing with such a major event emotionally challenging. I have still not received a date for the surgery which I would have expected by now. I cannot plan to do anything, no-one feels they can count on me being around to play my bass and as a result musical opportunities (my lifeline) have evaporated. I am in limbo, indefinitely is how it feels. I try to see each day of this current life as a bonus and enjoy my sternum being pain free with no massive scar but I can't humanly keep that thinking 24/7. This situation is certainly one of the biggies for me.
Very quick snapshot https://medmovie.com/library_id/3190/topic/cvml_0186i/

For those of you interested in medical/scientific  details   https://www.youtube.com/watch?v=IU3TRfnO7tI