Atrial fibrillation -

10 years ago, my husband, David,(33yr) had an aortic anerysm causing damage to his valve.  It was replaced (which valve?)with a metal one.  It has been working fine for 10 yrs. even with a slight murmur.  The problem now, (last month), is he is in AF, 110 beats and very irregular.  He has been on Atenol since '89 but Dr. have now changed to a new med (name?) that should bring his heart back to normal.  They want to do Cardioversion but due to his size (420lbs, 6'2" and short neck), they need to do it in an OR.  He is very tired these days, and it's the fear that is stressing him out.  Apparently there is a shunt that was formed between the right & left side 10 yrs ago, and they think that is the problem.  He has left leg edema (2yr)(water pills for that) and now more on the right.  Right side of his heart is enlarged.  He is also on Coumadin for 10 yrs and Lithium Carbonate (Manic Depression since he was 18). As noted in other forums both have been inherited from his father's family.  We also think he has sleep apnea (discovered Jan99)for he falls asleep anytime, more pronounce in the last month.

I'm not sure why I'm asking what kind of prognosis this is.  Why there is a shunt in his heart and what they are going to do with him.  They already mentioned the possiblity of surgury and I read your pages on AF and the gentleman who was going to have surgury again and the problems with scar tissue and changes in heart done before.  He had a Tee ultrasound and his valve still looks ok but the shunt is not as visable.  Not only does he feel his heart beating fast but we all can hear it because of the ticking sound of the valve.  What kind of procedure do you think they might perform on him and his prognosis for success? Thank you!

[CCF CARDIO MD - DLB]

The first step will be to see if they can convert him back to a normal rhythm. Then a determination can be made of how large the shunt is. If it is quite large and if it is indeed what is causing his symptoms, he will likely need surgery for this. His large size will make repeat surgery even higher risk than usual, though it can be done.