Health Chats
Ask the Heart Surgeon
Tuesday Feb 09, 2010, 12:00PM - 01:00PM (EST)
Staff Cardiac Surgeon
Cleveland Clinic Heart & Vascular Institute
Cardiac Surgery, Cleveland, OH
As one of the largest, most experienced cardiac and thoracic surgery groups in the world, the Cleveland Clinic Cardiovascular Surgery program cares for patients from all 50 states and around the world. Cleveland Clinic surgeons offer virtually every type of cardiac surgery including elective or emergency surgery for heart valve disease, aortic aneurysm, coronary artery disease, arrhythmias, heart failure, Marfan syndrome and other less common conditions. Even complex operations, such as second and third bypass operations and aortic and great vessel surgery, are routinely performed at Cleveland Clinic with excellent results. Dr. Johnston, a Cleveland Clinic cardiac surgeon will provide answers to your questions about heart surgery during this online chat.<br><br> Douglas Johnston, MD, is a staff cardiac surgeon at the Sydell and Arnold Miller Family Heart & Vascular Institute. Dr. Johnston specializes in adult cardiac surgery, surgery of the aortic valve and root, mitral and aortic valve repair, coronary artery surgery, reoperative cardiac surgery, and endovascular cardiac interventions. He is the author of numerous articles and abstracts published in leading scientific journals. Dr. Johnston is a member of the American College of Surgeons, the International Society for Heart and Lung Transplantation, the International Society for Minimally Invasive Cardiac Surgery, and the Society of Cardiac Computed Tomography.
Hello everyone. This health chat will begin at 12 pm Eastern / 9 am Pacific, but feel free to start submitting your questions now.
As a reminder, this is a moderated health chat, which means that questions are reviewed by a moderator and then submitted to Dr. Johnston.
Hello everyone and welcome to today's chat with Dr. Johnston,  a world-renowned cardiac surgeon with the Cleveland Clinic.
Welcome, Dr. Johnston. Thanks for joining us today.
Dr. Douglas Johnston:
Happy to be here.  Thanks for having me.
I had bypass (5 arteries) surgery on Feb. 16 '09. On 3/11 readmitted to the hospital for Atrial Flutter and underwent 5 hour ablation (successful). During Cardiac Rehab 4/1 discovered I had a frozen left shoulder (MRI). Physical Therapist said she has several heart surgery patients that had neck or shoulder problems after heart surgery. Since being released from the hospital after my ablation have had trouble with dizziness, balance and mild headaches. Have consulted 3 cardiologists who are guessing (their words) that it might be my low blood pressure (100-123). Recently ENT physician suspects I may have Superior Canal Dehiscence (hole in ear). Going to get CT scan. Are all these problems normal to have after bypass surgery?? I am 71 years old, 5'11'' and 170 lbs. Eat healthy and physically fit (work out 5 times per week at health club). Any other ideas about my dizziness?
Dr. Douglas Johnston:
Dizziness is always a tricky problem to find the answer to.  Some patients do have changes in their blood pressure after bypass surgery, though these usually resolve over the first few weeks.  This is the kind of problem that is usually best solved by sticking with one doctor with whom you have a good rapport.
I am diagnosed with Costochondritis and I get very bad chest pains, with pains in my upper ribs and up to my jaw. Everything came out normal EKG, bloodwork, chest x-ray, etc. I am on pain medications that are not working. I will be getting a cortisone injection in my chest eventually. I have Costochondritis for almost 2 months now.

I also had 5 episodes of trouble breathing and pressure in my chest. In fact, I woke up at 2 in the morning on Thursday and I had trouble breathing. My question is even though that it is Costochondritis, how do I know the episodes I am having are not from a heart attack?

Any advice would be greatly appreciated. Thank you.
Dr. Douglas Johnston:
Costochondritis is very common and can be very painful for patients to deal with.  The important thing is to be sure that heart problems have been excluded.  The fact that you have had trouble breathing is concerning.  I would recommend that you be seen by a doctor as soon as you can.
My husband will have his aortic valve replaced at Cleveland Clinic the beginning of March. I have been reading blogs and a big question keeps popping up on them. Does the surgeon actually do the surgery or does a resident perform the surgery and the surgeon supervise? Since he doesn't actually meet the surgeon until the day before the surgery, this is causing me great concern.
Dr. Douglas Johnston:
That is a very good question, one that we often receive.  Here at the Cleveland Clinic we work together with our residents and fellows to perform what are often very complex surgeries.  We feel that it is the level of excellence of the team as a whole, not one person, which determines the outcome.  A heart surgeon cannot operate successfully alone, so we rely on the entire team, not just the assistant, to give patients the best care.
HA 9/05 stent 5/06 two more stents. I feel fine, no pain or short of breath. I do about 30 mins on TM. No problem since my HA. My heartrate is 50bpm goes to 43 bpm. I don't feel sick. My BP on hot days stay 116/66/51bpm-44. I did not pass nuclearer stress test. I take 25mg atenolol +5mg amlodipine +20mg zocor+100mg allopurinol+bayer 81. How do I get my heart rate up? I suffer from depression, panic attacks, real bad fear got the best of me. I am 76 years old. One doctor told if you don't get dizzy or fall don't worry. I hope that I could find a cure for low pulse or get rid of my fears without meds.
Dr. Douglas Johnston:
It may be that your low heart rate is related to your medication (Atenolol) which is a beta blocker, though there are a number of other reasons to have a heart rate this low.  If a doctor has reviewed your test results and is following you closely, that is the most important thing.  Low heart rate alone is not necessarily a worrisome condition.
I had an MI a year ago and received 2 stents. After a year of rehab, loss of 35 lbs, no red meat or saturated fats, regular cardio exercise and statins, I developed chest pains. An angiogram shows further deterioration at site of stents and in other arteries. I will receive angioplasty and 2 more stents in next couple of weeks. My question is what strategies should I adopt after this intervention? Higher dose statins? more exercise? different diet? I would add that my father and both paternal grandparent died young of heart disease. I guess it is possible that nothing can beat heredity?
Dr. Douglas Johnston:
Heredity is certainly important in terms of the risk of coronary disease, but clearly diet, lifestyle, and medications have a major impact on the outcome in patients who already have the disease.  You are doing all of the right things.  I would recommend talking with your doctor about where you are in your progress, and what medication changes if any are recommended
Had ablation for WPW (R post septal pathway with antegrade/retro conduction Nov 2008. Successful -- the pattern disappeared on ECG. Chest pressure, tightness since. BP is erratic from 90's to 140's, usually with pulse over 100. Fatigue. 59 yo female, 125 lbs. plenty exercise -ballet dancer. Raynaud's, slight venus insuff. ECHO stress test Dec09, indicating mild tricuspid regurg and trace regurg at mitral and aortic valves. Was told the ECHO was normal. But I still have symptoms. EP told me that the accessory pathway caused one chamber to inefficiently fill and empty prior to ablation. Also had recent gallium scan to ck kidneys due to chronic UTIs for more than 2 years (edema in abdomen, legs, improves in am, worse at night). Scan did not indicate kidney infection, but report was: slightly prominent gallium activity in both pulmonary hila (probably located in hilar lymph nodes). Any connection? WPW ablation-edema-hila-valves?
Dr. Douglas Johnston:
This is an excellent question, which requires some review and a more thorough answer.  We will be in touch offline to provide a more complex answer than the chat allows.
My father had open heart surgery a few years ago to put an O-ring around his valve to make it smaller. From what he told me, the valve was too big and his heart was working extra hard to pump blood. This eventually would have led to an enlarged heart, but the doctors caught it early. Everything seems fine since the surgery, but are there any signs we should look for in terms of the need for a follow-up surgery? Also, is this genetic? Should my sister and I get checked for the same condition?
Dr. Douglas Johnston:
Good questions.  Any patient who has had a mitral valve repair, especially one for the reasons you described, should have regular follow-up by echocardiography to see how well the valve is working, and how the heart is responding.  Not all causes of valve disease are genetic, but some are.  I would speak to your father's doctor about getting checked.
My 11 year old son had subaortic membrane removal at age 5 by Dr. Thomas Spray at CHOP. His left chamber measured mild to moderate (they could not fix all regurgitation during surgery) since surgery and now measures moderate. He is started on 5 mg. enalapril per day. He plays competitive, travel ice hockey, which now seems to be up in the air pending a stress test. (His stress test a year ago was stellar.) As a mother, I am at my wit's end - what are the chances/expectations of this change stabilizing and he lives with the regurgitation vs. needing valvoplasty and a Ross procedure and what is the worst case for when that might happen? I'm trying to dig through the clinical data online but I need a consultation or someone to explain the data, but doctors today don't have the time...I'm trying to find a resource to help me understand where we're headed. Or better, where we might be headed. My son's z score was 1.67 in 2008, 1.67 in 2009 and 2.3 in 2010 (mildly dilated).
Dr. Douglas Johnston:
This is an excellent question and you ahve clearly done your homework.  To get to the bottom of a complex case like this we would need to review the chart thoroughly.  We would be happy to do that for you and will be in touch offline with the contact information.
What are the latest advancements in valve repair and replacement ? And what do you see happening in the near future?
Dr. Douglas Johnston:
There are a lot of exciting things going on in this area.  Most exciting is the possibility of repairing or replacing valves from the inside of the heart with catheter-based devices.  There are some experimental devices available now, and I anticipate in the next few years we'll be able to treat many more patients this way.
If I have MVP and thousands of PVCs a day, mostly at rest or while asleep and definitely when I'm on my left side or supine, can an ablation help, or is there a better alternative? I'm 48, female, an RN, and otherwise in good health. PVCs started to bombard me in December, after being sick with a fever for about 7 weeks, and possible having H1N1 that my daughter had. I see a cardiologist and an electrophysiologist. My MVP hasn't been diagnosed. Echo showed MV redundancy and MVR, and PVR. I hear a mid or late systolic very loud click with my stethoscope (I'm an RN), when I'm leaning left or partially on my left side. Tried Coreg for 2 weeks, but my BP fell to 70/30, as I already have a low BP of 90/60 or less, so I don't think beta-blockers are for me. The EP wants me on Flecainide, but it scares me, so what should I do?
Dr. Douglas Johnston:
In general an ECHO is the best test for mitral valve disease.  Since auscultation with the stethoscope can be difficult to interpret espectially when someone has PVCs or other arrhythmias, the heart sounds can be misleading.  Working with a good EP is essential because often patients will need to try different medications before finding the right combination, as you've found.  Don't be discouraged, though.  Usually a good match can be found.
I had a mitral valve repair in Nov 2007, and my enlarged left atrium is continuing to shrink in size. I am 70 years old, can I expect to see further shrinkage toward normal size?
Dr. Douglas Johnston:
Most often the left atrium will shrink some, but not all the way to normal size.  The most important outcome, though, is how the left ventricle is working and how you feel.
Had an ablattion for Lone Afib on 11/6/09 (92 days ago). Prior Stress test & Catheterization confirm no other structural heart issues & I was extremely athletic/fit. . The very day after the ablation was disgnosed with gastritis in stomach. I have been experinecing about 2,000 up to 7,000 PVC/ PAC daily? Never had either condition before. EP Caroiologist is trying to tell me this is unrelated to procedure? Many posts on Medhelp reference potential Vagus Nerve damage during ablation? Is this possible? If so, how can it be diagnosed & what can be done to fix this condition?
Dr. Douglas Johnston:
That is a very interesting question.  While I do surgical ablation for atrial fibrillation, I'm not an electrophysiologist, and I'm not as versed in this area as I should be to answer your question well.  I think you would benefit from a second opinion from an experienced EP.  We'd be happy to help you with this if you'd like.
Sandy M:
My husband has and implanted defibrillator. One of the leads was bad and the electrophysiologist tried to remove it. In removing the lead, he damaged my husband's tricuspid valve - which is now leaking. His cardiologist said that he doesn't want to do any repairs, unless my husband needs some other type of major heart surgery. Does this seem reasonable? Why wouldn't the cardiologist want to repair the leaky valve?
Dr. Douglas Johnston:
That's a very good question.  Because leads from defibrillators and pacemakers usually pass through the tricuspid valve, there is always a potential for the valve to leak with the leads in place or when they are removed.  In general, patients with leaking tricuspid valves tolerate this very well, and don't need surgery unless the leak is very severe or longlasting, in which case patients will develop symptoms of right heart failure, lower leg swelling for example.
Dr. Johnston, I am a 52 yr. old female whose last 2 echoes were as follows- 2nd last one: mod.- severe aortic reg., mild-mod. pulm. reg., trace tricus. reg. - EF 40-45%, heart enlarged for my frame - 5'1", 115 lbs. The last one in Dec. 2009 is as follows: mild-mod. aort. reg., mild-mod. pulm. regurg., trace tricusp. regurg., and trace mitral regurg., EF 45-50% - no mention of heart enlargement. I've recently been experiencing yawnathons: every few seconds: one lasted approx. 1/2 hour, last one an hour and a half. The last week I've had to sleep sitting up, due to chest pain when I lie down. The doctors (cardiologist and surgeon) say it's not yet time for surgery, however, every time I see the cardiologist, he emphasizes how terribly expensive this surgery is, although I'm in Canada and we have coverage.