Open Heart Surgery Recovery Process

[ttech]

43yo 170lb cauc male, no hypertension, no CAD (confirmed via cardiac cath), h/o strep carditis as infant, murmur since birth, prophylactic antibios until adolescence, no significant family history of CHD, otherwise good health.

Notice lots of palps (late 12/03) and went in to Dr. Dr. noted enlarged heart on Xray.  Followup with cardio via echo confirmed enlarged RV and ASD, valves OK. Dr recommended closure. Cardiac cath showed 3:1 Qp/Qs ratio. Open heart surgery performed 3/25/04, surgeon noted ASD was approx. 3x3.5 cm and he rerouted a pulmonary vein.  I have a followup next week with the surgeon.

Questions:

1.  Are there any specific questions I should ask the surgeon regarding my surgery which may be important later in life?

2. I was 'on pump' for ~35 minutes. I have read some reports of long term effects, especially regarding memory.  Are these reports significant/true?

3.  I was told this was a rather large ASD, and I was largely asymptomatic other than the PVCs and some mild/intermittent shortness of breath. Should this size ASD have been causing more noticable symptoms?  (My cardio seemed surprised I didn't have more shortness of breath problems)

4. It is hard to understand the medical jargon regarding the surgery's effect on lifespan. I was under the impression this surgery would lower risk of heart failure and/or pulmonary problems. Does this type of surgery have an effect on predicted lifespan?

5. I was told one valve is bicuspid (I don't remember which). Other than monitoring yearly, any significance?

Thx,
ttec

[Mavila]

Dear Doctor,

My son (3.7 years old) underwent ICR for ToF in India, today is 15th post-operative day still he is in ITU.  He face so many problems after surgery, now he could not breathe properly so that the Doctor advised us the child need one more surgery in his throat so as to breathe properly, three days before throat surgery also underwent until now he is not stable and he could not breathe smoothly therefore the ventilator is not removed.  Could you please let me know what are the problems going on? He will be OK?

Abdulla Mavila
Kuwait

[sadformom]

my father-in-law had bypass surgery four weeks ago, during the past four weeks he had been in four hospitals and now in a mental care unit, he just four weeks ago baby-sit my granddaugher weekly and after his surgery he now is unable to communicate with the family , that is carrying on a one to one converstion, it is so sad to see him in this state, doctor can quit explain what happen if anyone can please help, may he wasn't given enough oxygen during surgery doctors have said, at first they said dementiga(sp), please help!

[Equus]

Been right where you are today only with a couple of exceptions.  I was 52, (good shape trim and active) when I had surgery and a stroke from a clot slipping through the ASD was how they found the heart defect.  First of all you must be doing pretty good to be posting on the Medhelp so soon after your surgery.  But hey, during recovery what else is there to do but read and watch the tube and be thankful you're alive.

First, never look back upon an ASD closure with regret.  Lots of mounting evidence of more severe consequences in people of all ages who didn't know they had the ASD or elected not to have it closed which is certainly a personal decision (but with measureable risks)with each case being different.  We're both just darn lucky that we had some non-fatal warning that we had the ASD.  Having said that, recovery can be tough so my heart goes out to you buddy (no pun intended).  I had a couple of bouts with pericarditis which slowed things down but have to confess, while the intense recovery phase was only about 4-6 weeks, it was fully a year before I felt fully and consistently human again.  Even now 4 years later I have occasional physical/emotional reminders but they are far outweighed by thankfulness to be here and much hope for a great and long future...so in that way the reminders are a good thing.

Congitive impairment (AKA pump head) is controversial and not a welcome topic of discussion for physicians because - and righfully so - the evidence is mixed and complicated by other patient sample issues, and they fear it will dissuade people from necessary open heart surgery.  Most of the information is from bypass patients because that is so much more common than ASD closure, but that's OK because it does appear that its being on the "pump" that may cause problems (if any occur) more than the type of surgery.  Anyway if you enter "cognitive impairment after heart surgery" into your search engine a few fairly good articles will come up. If you want my opinion, and that's all it is, you should concentrate on physical recovery and not expect too much of yourself too soon.  Heart surgery is a tough enough go after which all of us have some down days and feel really disconnected.  Just like everytime we forget a person's name or the author of the last book we read isn't a confirmation of Alzheimer's, stressed disconnect after heart surgery isn't necessarily permanant memory loss.  

Take care !

[ttech]

equus:

Thanks for the info - it is interesting to hear of other people and their experiences with the recovery.  I guess I'm pretty lucky ... I went into the hospital on Thursday morning and was discharged the following Monday - I just reached 2 weeks post-op today.

It sounds as if you went through (and I am too) good days and some not-so-good days.  I'm pretty positive about the whole thing, so it isn't too tough getting through the bad ones.  My biggest complaint right now is getting decent sleep, which I (rightly or wrongly) ascribe to the normal pain/inflammation healing process as well as 'pump head'.  I don't think the brain and our other organs like the pump too much but I haven't noticed any cognitive impairment.

As far as my decision making process with the surgery, I don't regret it at all.  My "adventure" started late last year and every doctor I spoke to pretty much said "get it fixed" after it was diagnosed.  The only things that seemed to be a choice was to have the hole fixed with a device via a catheter, or via the "standard of care" which is the surgery.  I opted for the surgery, and it turned out my ASD was one of the rarer ones (a sinus venosus ASD) which also required a pulmonary vein reroute, so a device couldn't have been used.

I was hoping this was just benign PVCs when this all started (and I was reading this forum a lot before I was diagnosed, so I became very knowledgeable about PVCs), but I followed through with the doctors recommendations (including one of my best friend, who is also a surgeon) and went through the EKG, X-ray, echo, cardiac cath processes prior to the surgery.

And yes, on good days, it is easy to do too much too early and be sore and cranky later in the day, so I have to remind myself to take things slowly for the next few weeks.

Thanks for the positive and well written comments.

- ttech

[CCF-M.D.-RCJ]

ttec,

Thanks for the post.

Q1:"Are there any specific questions I should ask the surgeon regarding my surgery which may be important later in life?"

Just whether or not the ASD was completely closed.

Q2:"I was 'on pump' for ~35 minutes. I have read some reports of long term effects, especially regarding memory. Are these reports significant/true?"

The available evidence shows that cognitive differences in on-pump versus off-pump heart surgeries normalizes by approximately one years time.

Q3:"Should this size ASD have been causing more noticable symptoms?"

Apparently not for you.  Everyone responds differently.  For whatever reason, you were fortunate enough to not have severe symptoms.

Q4:"I was under the impression this surgery would lower risk of heart failure and/or pulmonary problems. Does this type of surgery have an effect on predicted lifespan?

An ASD associated with enlargement of the RV and a 3:1 shunt will likely lead to RV failure and subsequent clinical heart failure if surgery is no performed.

Q5:"I was told one valve is bicuspid (I don't remember which). Other than monitoring yearly, any significance?"

The aortic valve would almost certainly be the valve. A bicuspid valve is inherently abnormal and can become stenotic or regurgitant.  Periodic follow-up with your cardiologist is a good idea.