Pain in muscles following surgery

[Sonia Alemagno]

Hello.  My husband had an aortic valve repair done by Dr. Cosgrove three years ago.  It was "minimally invasive" and involed an incision about four inches across the chestbone.

All has been fine, but recently he has developed what can be described as a pulling and sometimes clicking in this area.  After swimming or other exercise, there are muscle spasms in this area.  Sometimes, it would seem like the symptoms are cardiac, but his blood pressure is fine and the pain is relieved somewhat with rest and with Tylenol.  

Is this common?  Can anything be done for this?  Should he consult a cardiologist or some other type of physician?  Does he need a chest x-ray at the incision point?

Please advise.  We do not want to follow-up with a non-CCF physician here, since many do not understand this type of surgery.

Thank you.

[CCF CARDIO MD - DLB]

The surgical incision can sometimes be associated with the problems that you describe. Typically, these problems occur in the months after surgery, not several years later. I would recommend an evaluation by a cardiologist, to first determine whether there is any chance that the pain is cardiac. If it is not cardiac, the next step would be to determine if there is any problem with fracture of the wires that may have been used to close up the incision - this evaluation would best be done by a cardiac surgeon. Depending on how far away you are, this could be done by your local doctors.

[shannon]

Hi -- your description of your husband's pain sounds very much like my experience, when at nine weeks post op from mitral repair, I did indeed fracture two sets of the wires.  They were removed a few weeks later, after trying some anti-inflammatories which helped a bit but not enough.

But, if the minimally invasive procedure was used, were wires even put in?  My surgery started as minimally invasive and was converted to a median sternotomy when an additional problem showed up, and my minimally invasive incision has no wires underneath.

Anyway, ultimately all of my wires were removed, (the last three sets at nearly 6 months post op), because they all hurt with different kinds of motion. One particular pain only showed up after skating, and I generally spend 10-12 hours a week figure skating!  So I had that pain a lot.  Another set only hurt in the morning after I'd slept on my side.  They all hurt after I'd had to drive for more than 15 or 20 minutes.

I think my wire pain is relatively uncommon, but if your husband has recently increased his physical work-outs or changed them, it makes sense to me that the wires could be either damaged or hurting him.


Just my two cents.

Shannon

[CCF CARDIO MD - DLB]

Fracture of the wires is a possibility. However, this is often seen on x-ray on patients who have had certain cardiac incisions, but in some cases does not produce symptoms.

[ed]

Is placement of wires a routine practice in open heart surgery?  Do they stay in indefinitely, or are they usually removed?  When?

[CCF CARDIO MD - DLB]

If the sternum (breastbone) is cut open, wires are used to close it and help it heal. These wires stay in permanently, unless there are problems with infection or severe pain.

[Ted]

when minimaly invasive surgery is employed... how much of the sternum is left attached.. half? a third?  and is that enough that wires are not needed at all?  

I have heard a lot of troubles with the wires... is it fairly common?

[CCF CARDIO MD - DLB]

Trouble with wires is not common.

Minimally invasive incisions often avoid cutting the sternum altogether.

[djweeks2r1]

A related discussion, sternum pain 6 years after heart surgery was started.