Do I need surgery or aspirin?

[MaryMaryO]

I am an extremely healthy, active 45-year-old woman.  My only problems: I was born with a congenital eye defect leaving me blind in my left eye as well as what had been diagnosed as "ophthalmic migraines" where I would have episodes of loss of partial vision in my right eye for approximately 30-45 minutes, occasionally with some headache and rarely with some loss of speech (I know what I want to say but can't find the words).  I've lived with this since puberty. There are times in my life when it is more frequent than others. At one point, as often as 3-4 times a week.  As of late, it occurs approx. 3-4 times per year.  In May, during what I thought was another "migraine", I lost partial vision again, but this time it was 5 days before I started to regain my vision. Trips to a retina specialist and neuro opthalmologist revealed "cotton wool spots".  Now we had to look into this further.  They did a brain scan as well as a TEE.  The TEE revealed a good-sized ASA with an associated bi-directional ASD.  Two doctors say that I need these repaired.  It has been suggested that the "migraines" I've had all my life may not have been migraines after all but tiny strokes.  I found out I am not a candidate for the occluder device because I only had one documented "stroke" and the FDA's criteria is for two.  These two doctors are recommending open heart surgery. A third doctor says that aspirin for life should do the trick.  These two choices seem like they are on complete opposite sides of the spectrum.  I hear that ASD and PFO closures are "fad" and not necessary.  But I've also been told that because of the associated aneurysm (as a source of collection and of blood and a place for it to clot) as well as the infarction in my eye, that the risk of stroke is too high not to have this done.  Do I hear a fourth opinion?  Please help.  I've never had surgery before, I exercise daily, I do not think of myself as someone who would ever need something like this and I'm scared and confused.

[Sweetwaterguy]

Of course, we all wish for luck, but luck is not what we really need--it is a competent medical team who have the skills to do all you ask of them.  It sounds like you have found the right place.  Despite the apprehension, please have confidence they know what to do--and they do.
I, too, have never had surgery--at least since tonsils at age 4 which I don't remember.  I have had a catheter ablation for a afib and a procedure to blast kidney stones.  Both required general anesthetic.  That part was a little scary, but the good news is you go quickly to sleep and wake up as though you had simply dozed and wonder when they are going to do the procedure when it has already occured.  
   It is understandable you want to have this done after your daughter's big event.  I would guess if you did it tomorrow, you would also be dancing at her wedding.  I think you will be surprised at how quickly and easily you will recover.   The preparations for her wedding will occupy your thoughts and ease the nervousness.  Both events are great adventures and opportunities to grow.  It sounds like you have figured it out.


  

[MaryMaryO]

Thanks, sweetwaterguy.  And you're right... I did go to Johns Hopkins.  They recommended the surgery as well... and sooner rather than later.  The doctor there is actually going to do a minimally invasive open heart where he won't have to crack my sternum open.  He's going to use the robitocs route (through my side, between my ribs) without actually using the robot.  He feels that the robot would take more time setting up and getting fit to me which would mean more time on the heart lung machine.  He's got some specialty equipment that can get through my ribs (pushing them apart some) without breaking them.  It would also mean a quicker recovery.  I'm still scared, but I've resigned myself that this needs to be done.  Again, you're right, going to the best is really important.  Johns Hopkins was my last stop and they made the most sense.  I was afraid of the time it takes for robotics and of the recovery time of tradition open heart.  This is a fair compromise.  My surgery is scheduled for Nov. 13.. I talked them into waiting.  My daughter gets married Nov 9th and I need to dance every dance!  Wish me luck!  

[Sweetwaterguy]

wow!  I don't blame you for feeling scared when the choices are so different.  How can you feel confident you are doing the right thing?  One suggestion is to go straight to the top for another opinion--which means  at the best diagnostic clinic or teaching hospital you can find.  Mayo, Johns Hopkins, Cleveland, etc. come to mind.