Heard From The Cardiologist This Evening

The problem is the aortic valve is narrowed, which prevents the heart from pumping enough blood, and back pressure into the alevoli is what is causing the breathlessness.  The good news is that it isn't severe enough to require replacement immediately.  He explained that this is one of the few surgeries where getting older is an advantage, because the older you are, the longer bioprosthetic valves last.  Young people that need the aortic valve replaced get mechanical valves that last forever, but require them to take blood thinners for life.  He also indicated that the steady improvements in bioprosthetic valves mean that if I can put this off for a few more years, what they put in may actually be lifetime.

The downside is that this is an open your chest up surgery -- but there is a new procedure called Transcatheter Aortic Valve Replacement (TAVR) where they install the new aortic valve rather like the way that they do angiograms and angioplasty -- through an artery.  This sounds like it is roughly equivalent to replacing the valves in your engine by going up the tailpipe, through the exhaust manifold, and then through the open valve!  The downside of TAVR is that while they don't have to open up your chest, it is currently about three times more likely to cause a stroke than the traditional approach.  He also says that only about 10,000 of these TAVRs have been done so far, and he would feel more comfortable that the procedures and tools have been perfected when they reach the million operation mark.  Yet another advantage of being able to put off this operation.

In the meantime, he wants to do an adenosine stress test so that they can run radioactive dye through my heart and see which arteries seem to be blocked or restricted.  This is apparently a first step to figure out if you have blockages bad enough to justify the considerably more intrusive angiogram, which would lead perhaps to an angioplasty to clean out any blockages.  He doesn't have much hope that an arterial blockage is the cause of my left nerve branch block, but he admitted that it was possible that the electrical failure was caused by lack of blood supply.  At a minimum, it would be good to make sure that there are not any cardiac arteries that might suddenly preempt the need for aortic valve replacement in a few years.

It could be worse.  It could be better.  In the meantime, he encourages me to stay at the treadmill.  He doesn't believe that it could actually help the aortic valve narrowing, and he even finds it hard to imagine that the improvement that I am feeling on the breathlessness symptoms could be related to improved cardiovascular fitness, because the improvement is too quick.  But it won't hurt me, and the more fit I am, when surgery is required, the better I will recover.