101 – Staying Alive, Part 1: 21 November 2024

 

Running Out of Puff

There were advantages and disadvantages to living with a woman who had been a nurse her whole working life. 

The major disadvantage was the impossibility of hiding any health issues I wanted to hide from Margaret. 

At some point during 2015, I told Margaret that I always “ran out of puff” whenever I walked uphill.  Margaret immediately understood the significance of this. 

She insisted I see a heart specialist to find out exactly what was wrong with my heart.  Dr Mark Sheppard diagnosed in January 2016 that I had a leaky mitral heart valve.

The Australian Heart Foundation says this about heart valves.

Your heart has four valves that keep blood flowing in the correct direction between its four chambers (two atria and two ventricles).   Each valve is like a one-way door. During each heartbeat, the valves open to let blood flow from their chambers and close to stop the blood flowing backwards. The four heart valves are the:  Tricuspid valve – This controls the blood flow between the right atrium and right ventricle Mitral valve – This controls the blood flow between the left atrium and left ventricle Pulmonary valve – This controls the right ventricle and the pulmonary artery, the blood vessel that carries blood from the heart to the lungs Aortic valve – This controls the left ventricle and the aorta Heart valve disease means that your heart valve or valves don't open or close properly. This can cause the blood flow through your heart to and from your body to be disrupted.  What are the types of heart valve disease?  There are a few types of heart valve disease. Some people may have a combination of more than one type of valve problem.  Regurgitation (or insufficiency) This is when your valve flaps are ‘leaky’ and don't close properly. This lets blood leak back through your valve and can make your heart work harder to circulate blood around your body.

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Me at Morialta in April 2020, 18 months after my Chain Saw operation.

 

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My mitral valve was “leaking”.  When the valve pumped blood into the left atrium and left ventricle of my heart, it did not close properly and blood leaked back into the right side of my heart.  My difficulty in walking uphill was caused by my heart’s inability to pump enough blood when I walked uphill - extra blood was always needed to walk uphill.  Given my leaking heart valve, it was not surprising that when I walked uphill; this slowed me down to a crawl.  Dr Sheppard was amazed that I could walk up the Morialta mountains at all.

Dr Sheppard said the options were open heart surgery to repair the vale and, as a temporary alternative, monitoring my heart to detect if the problem became worse.  Dr Sheppard said open heart surgery was an extremely difficult and recommended monitoring.  This would postpone the date when I needed surgery

Before the Chain Saw Operation

My leaky heart valve got worse. 

I had a Trans-oesophageal echocardiogram (TOE test) in the afternoon of Thursday 1 November 2018.  The Australian government website Health Direct says this about a TOE test.

A trans-oesophageal echocardiogram (TOE) is a procedure to look at your heart chambers and valves using a flexible telescope placed down your oesophagus (gullet). The telescope has an ultrasound scanner attached to it so your heart specialist can get close-up views of your heart.

I was given a local an anaesthetic and the monitoring device was inserted down my throat.  The urge to vomit was overwhelming while the device was down my throat and next to my heart.  The alternative to a local anaesthetic was a general anaesthetic.

The TOE confirmed that the leakage from my heart valve was very serious and the heart operation was urgently needed.

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I had an angiogram on Friday 2 November.  This was much easier than the TOE and anaesthetic was not necessary.  Health Direct says this about angiograms.

An angiogram is the image created by angiography. An angiograph is an imaging procedure to look at blood vessels in your body. A special dye called ‘liquid contrast agent’ is injected into your bloodstream to make your blood vessels visible on a scan. Conventional angiography uses x-rays and contrast agent to produce angiogram pictures. More recent techniques use CT scans or MRI scans. Angiography can be used to look at blood vessels in or around your: heart

The angiogram said three of my arteries were blocked.  Even if my heart valve had been operating normally, my heart would have still been unable to supply my body with enough blood.  An artery is “a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body.” (Wiki)

As well as repairing or replacing my mitral heart valve, I needed three bypasses so that my blood could circulate properly. 

This is what the Mayo Clinic says about bypass surgery.

Coronary artery bypass surgery creates a new path for blood to flow around a blocked or partially blocked artery in the heart. The surgery involves taking a healthy blood vessel from the chest or leg area. The vessel is connected below the blocked heart artery. The new pathway improves blood flow to the heart muscle.

To keep me alive, my heart operation needed to:

·         Repair (or replace) my mitral heart valve.

·         Find three separate lengths of unblocked arteries somewhere in my body; and

·         Insert the lengths of unblocked arteries in a way that allowed my blood supply to bypass the three blocked arteries near my heart.

To do this, the surgeon needed to use the equivalent of a chain saw to cut through my ribcage and get access to my heart.  Operating on my heart meant my heart had to be stopped and my blood supply had to be provided by a machine.  While the machine circulated my blood, the surgeon had to quickly do the repairs because if my heart stopped for too long, I would die. 

As well as repairing my very quickly to let my heart resume its intended function, the surgeon also had to find three unblocked arteries somewhere on my body, remove them from wherever they were and implant them to enable my blood supply to avoid the three separate arterial blockages.

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Once all this had been done, my chest had to be put back together again so that I could have a “normal” life if I survived the operation.