Complications Following My Second Heart Surgery
Greetings, At the age of 25, I underwent my second aortic valve replacement. My first surgery occurred nine years prior when I was just 16, during which I received a trifecta tissue valve. Before my recent procedure, I was faced with a pivotal choice: to opt for a mechanical valve, which might prevent future surgeries, or to select a bioprosthetic valve that could lead to another surgical intervention down the road. Given my active lifestyle that includes vigorous activities like skiing and skateboarding, I ruled out the mechanical valve mainly because of the blood-thinning medication required and its impact on my daily life. During the surgery, my surgeon discovered unexpected complications stemming from my initial procedure. Instead of a straightforward valve replacement, there was a partial graft on my aorta necessary for fitting the tissue valve. This anomaly resulted in a complete heart block, compelling me to rely on a pacemaker for life. Moreover, my future surgeries will be significantly more challenging due to the need for a graft on a section of my aorta and the presence of considerable scar tissue. To postpone further surgery, I plan to pursue one or two TAVR (Transcatheter Aortic Valve Replacement) procedures. Now, nearly four weeks post-surgery, I had a follow-up with my surgeon, who conveyed that had he been aware of the complications from my first operation, he would have recommended a mechanical valve. I inquired why these complications were not documented, and he informed me that the hospital records provided to him lacked this crucial information. Moreover, he indicated that he did not receive the complete operation notes from my initial surgery, which likely contained details about those complications. This raises an important question: Is it not standard practice to secure comprehensive operation notes from a preceding heart surgery before proceeding with a second one? Had my surgeon been privy to the complete documentation, I might have opted for the mechanical valve and circumvented the risk of future surgeries. Instead of receiving thorough notes, he only had access to minimal information regarding the type of valve implanted, with no mention of the complications or modifications that occurred during that first surgery. Is this a common occurrence, or is it unusual to operate for a second time without having a full set of notes from the first surgery?
Answers (1)
3/19/2025, 6:50:47 PM
OpenHealth AI
It sounds like you're facing a challenging situation following your recent heart surgery, and I appreciate you sharing your experience. You've raised significant concerns about the quality of information shared between surgeries, and it's completely understandable to seek clarity on these matters.
Main Points:
- Surgeon Documentation and Communication: It is generally expected that thorough surgical notes and patient histories be available before a second operation, especially in complex cases like yours.
- Decision on Valve Type: Your situation illustrates the importance of informed decision-making based on complete medical histories.
- Future Management and Monitoring: Moving forward, ensuring your care team has all necessary information will be crucial for your ongoing health.
Explanation: Surgeons typically rely on comprehensive surgical notes for follow-up procedures. This documentation allows them to understand any previous complications, anatomical challenges, and specific conditions that may influence surgical strategies. While lapses can occur, especially if records from previous surgeries are not fully accessible, it is concerning that essential details about your first surgery were missing.
In your case, having complete information might have influenced your decision on the type of valve to choose, especially considering the implications for future surgeries. Always ensure that medical providers obtain all relevant pre-operative histories, as it forms the foundation for safe and effective surgical care.
Next Steps:
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Request Detailed Records: Contact the hospitals involved in both your surgeries to obtain the complete surgical notes and records. Having detailed documentation will empower you in discussions about your future care.
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Discuss Comprehensive Care Plans: Schedule a follow-up appointment with your current heart surgeon to discuss the implications of the missing information on your care. Inquire about any additional strategies or assessments that might benefit your situation moving forward.
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Stay Informed: Educate yourself about TAVR procedures and any other upcoming interventions you might consider. Understanding your options can help you feel more in control and confident about your care.
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Establish a Care Team: Consider assembling a multidisciplinary team that includes a cardiologist, surgeon, and possibly a patient advocate. This team can coordinate your care and ensure all your needs and concerns are addressed.
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Regular Monitoring: As you adjust to living with a pacemaker, keep a close watch on your symptoms and heart health. Regular follow-ups with your healthcare providers will assist in managing your condition optimally.
Please know that it’s important to advocate for your health and maintain open communication with your healthcare team. If you have more questions or need support through this process, feel free to ask.
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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.