Day 3 - The Surgery

To say what today was like would be quite simply..."awesome"

In the last post about Pre Admit clinic I explained two issues that needed to be addressed in today's surgery and that at the end of this whole procedure that the goal was to reduce the LVOT (Left Ventricular Outflow Tract) pressure.

The myectomy procedure was supposed to remove obstructive tissue in the left ventricle be reducing the septal wall thickness.  This is simply slicing off muscle to open up the chamber.  The second issue was the mitral valve.  Could it be repaired?  If it couldn't the valve would have to be replaced.

The test to see if all of this manipulation would be beneficial would be measuring the pressure in the heart once the surgery was concluded.

My conversation with Dr Ross following the surgery was interesting.  He explained that he did remove some septal wall but probably not a whole lot of material.  The interesting part of the surgery was the mitral valve.  Susan has some unique physiology.  Part of what allows the valve to operate is chordae which atttach to the leading edge of the mitral valve leaflet; that allow the valve to operate.  Susan's are fine.  The concern was that Susan has two additional chordae that are attached to the valve and are of such a size that they are interfering with the operation of the valve and also obstructing flow to the aortic valve which is in close proximity.  It is the equivalent of having a clogged drain.  Dr Ross simply removed these chordae which are not supposed to be there anyway.

So what did all of this do?  Susan went into this surgery which when her heart was put under load was reaching pressure gradient of about 100 mm/hg.  In a normal heart the pressure should be near 0.  Surgery to fix this pressure gradient is recommended above 30 mm/hg.

In Susan's surgery 7 years ago, they measured her LVOT pressure gradient (after surgery) in the vicinity of 15 mm/hg and they would have been happy with that result this time.  The readings that they got today were better than expected.  The pressure post op is near 0.  That is great...great news.

Our reason for not being all that excited about this surgery was based on the fact that doing a myectomy re-do is highly unusual.  We did this 7 years ago and now we have to do it again.  The prospect of doing this again in a few years in not appealing.  The good news coming out of this surgery is that the issue with the mitral valve will not return.  The symptoms that she was experiencing was not due to any of the septal wall growing back.  This means we now have a physiological reason for why we think we may have a longer lasting solution this time around.

Everything I have described is good news.  I am very happy...Susan is still too stoned to care at this point.  We do have a reality that Susan still has a congenital heart condition that still needs to be managed but this should provide some significant improvement to her quality of life.  We just have to wait and see how she feels once she recovers.

So now...we are concentrating on recovery and getting her home.