I'm writing as my husband Steve Williams is in the Operating Room at Swedish Medical Center/Cherry Hill. He's getting a new aortic valve and a coronary artery bypass graft. We expect the surgery will take eight hours!
Here's the story:
Steve had a coronary artery stent placed in November He had been progressing well in Cardiac Rehab. Then, over the last week or so, he began having angina (chest pain) at the close of each dialysis run...during the rinse-back stage which returns an infusion of about 150 cc of blood back into the patient's circulation. Each episode was treatable by nitroglycerine, but it was definitely a new pattern. His cardiologist admitted him to the hospital. She took him to Cardiac Catheterization Laboratory and re-stented the vessel in question.. But his chest pain persisted unrelentingly at a level of eight out of ten.
Dr. Ali then placed an intra-aortic balloon pump into Steve's thoracic aorta by way of a catheter in the groin. The intent was to reduce the workload of the heart and to augment the filling of the coronary vessels. And Steve had decidely less pain. But an echocardiogram (sound wave picture of the heart) taken the next day showed that Steve's mildly narrowed aortic valve had worsened significantly. It was now categorized as Aortic Stenosis of a critical degree. It would have to be fixed. Either by a balloon valvuloplasty, which would be temporary, or by an open-heart aortic valve replacement. Steve and I were not enthusiastic about a temporizing measure.
The cardiac surgeon, in evaluating Steve's case, reiterated that the expected course of Aortic Stenosis is that of progression. But Steve had "accomplished" five years' worth of worsening in roughly five months!
The relationship between ESRD and ischemic heart disease, i.e. coronary artery blockages, is well known.
I think fewer people appreciate the relationship of ESRD and Aortic Stenosis - and the fact that the stenosis progresses more rapidly in ESRD patients.
So, this afternoon, with hundreds of blessings from friends and family, Steve is undergoing open-heart surgery. The atheist and agnostic prayers get extra credit.
So, how does Steve feel about all this? Well, "no other options" is a significant motivator!
Besides, to keep Steve on the Kidney Transplant Track, the valve replacement and bypass "update" would have been an absolute requirement.
Take care. Linda Gromko, MD
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