In April 1998, I was diagnosed with an ascending aorta aneurysm and aortic
regurgitation (leaky valve) at age 33. My aorta was almost twice normal size
and could rupture, surgery was not urgent but was indicated. I talked to a
surgeon who gave me the following options: mechanical valve with a Dacron tube
graft, pig valve and graft, homograft (human cadaver valve) or the ?Ross?
procedure. The mechanical valve will last a long time, possibly for life but
requires anticoagulation therapy (blood thinners). The pig valves last 10 ?15
years, less in younger patients like me. The homograft may last 15 ? 20 years.
The Ross procedure switches your aortic valve with your pulmonary valve and
replaces the pulmonary valve with a homograft. The homograft should last longer
in the pulmonary position but this surgery is very complicated, and involves two
valves and was not recommended. The advantage of the biological valves is there
is no need for ?blood thinners? and the restrictions and risks associated with
them. The surgeon indicated that he would choose the mechanical valve but both
my wife and I were leaning towards the homograft.
My wife and last supervisor encouraged me to do some research, I thought ?what
am I going to tell a heart surgeon?? I?m glad I finally did do some research.
I went to Wayne State Medical Library and wondered up and down the current
medical journal aisles, there were hundreds of journals and I just looked for
anything that had to do with heart or cardiovascular. I found a few journals
and looked through the titles for ?aortic valve,? ?homograft,? ?Ross
Procedure,? etc. I found an article titles ?Valve-sparing Procedure for
Aneurysms of the Ascending Aorta.? This sounded pretty good from the title
since replacing my valve would lead either to life long blood thinners or other
surgeries. I read the article and it seemed to have my name written all over
it, basically replacing the aneurysm with a Dacron graft and sparing the valve
often in younger patients.
I went back to the first surgeon regarding several issues and to discuss sparing
my valve. He seemed somewhat put out by me handing him a surgical journal
article and said that aortic valve repair rarely works and I would need surgery
again in a few years after that. I was scheduled for a second opinion and was
given basically the same options. I presented the article and he did not seem
too thrilled either and said it was not a good option and that not everyone was
getting as good of results as this guy in Toronto. I did not know who he was
referring to since the article was written by a surgeon in England. Both my
wife and I got the impression that this ?guy in Toronto? was maybe not totally
honest with his results. Needless to say my bubble was burst. I preceded to
get ready for surgery (homograft) with the first surgeon. I needed to be
scheduled for a TEE, an echocardiogram (ultrasound) where they put the
transducer down your throat so that they can get a good look and measurement of
the valve. This got me to thinking that the surgeons have written off my valve
without having a good look at it. I reviewed the article and found in the
comments section a comment and question by a Dr. Tirone David from Toronto ?
this must be the ?guy from Toronto.? I found his number on the internet and
decided to call, I really did not know what to say to his assistant so I just
explained my situation and she said to send my medical reports with an
explanation. Also, get a tape of my TEE and send that when it is done I did
that and the next day Dr. David faxed me a letter saying that I was a good
candidate, if you want to schedule surgery, it would have to be after his 2 week
vacation. I was happy with the response but I had a lot of big questions. The
Friday before he was to return from vacation, I faxed him ten questions ranging
from what is the chance my valve will be spared, what are my options if you find
you have to replace my valve and how much will this cost because I may have to
pay for it myself. That Monday, his first day back, he called me back and left
a message, we talked on Tuesday. I was impressed by this, he is one of the
busiest heart surgeons in the world, he performs 450 open heart surgeries a year
and sits on several surgical journal boards and committees. He gave me detailed
answers and even referred me to other journal articles to review. The answers
made up mine and my wife?s mind that this was the way to go. Would our HMO pay
or would we have to pay for this ourselves? My primary care and cardiologist
were supportive of my decision and after some phone calls and questions and a
couple of weeks Blue Care Network decided to pay. I scheduled surgery for
September 9, 1998 at the Toronto General Hospital.
The surgery was a success, he spared my valve and everything looked good. I was
in the intensive care the day of surgery. The next day I was moved to my room
and could stand and later walk (slowly with a walker). I was in the hospital
for five days, each day was better than the last. I walked back to the Hotel
where my family was staying. 3 weeks post op I was walking a few miles a day,
by 8 weeks I started some light weights and jogged 2 miles(slowly) and returned
to work. At 12 weeks I was back playing hockey. My wife thought that I could
have waited a little longer to start playing hockey. Its now been almost 2
years and I feel great, run 15 to 20 miles a week, swim, play hockey and am
enjoying life. I get yearly echocardiograms and so far so good. I may need
surgery in the future but possibly not. Recent updates on Dr. David?s results
on patients like me re-enforce that this was the best option for me
A couple of points ? this whole ordeal is at least as hard if not harder on your
spouse (especially in our case with 2 small children, 2.5 years and 9 months at
the time of surgery!). Being informed is very important with major health
issues. Doctors are people too, and have biases just like everyone else, some
are better than others in dealing with patients. Coworkers can make a
difference, some came to visit me at home, my office was going to set up a
collection if I had to pay for the surgery myself, and everyone was concerned
and supportive.
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