The Background
Back in February I went to see my cardiologist. I'm supposed to go every year for a checkup but I'd put it off this time. I have this heart condition I was born with called Transposition of the Great Arteries, with a Ventricular Septal Defect and Pulmonary Stenosis, or TGA/VSD/PS for short. This is the sort of thing that shows up right after birth, and when I was 6 days old they did a temporary fix, because in 1964 they didn't really know how operate on it. Nowadays they do a full correction with an arterial switch in infancy, but I had to wait until I was 15 for a correction called a Rastelli Procedure, pictured as complete. The Rastelli operation was first done in the late 60s, 1969 I believe, so they hadn't even learned how to fix me until I was 5.
post-op
Now my surgeon, Denton A. Cooley, M.D. is the best in the world. He did a great job, but all patients with this correction have to have lifelong care under an experienced cardiologist, and typically end up needing a conduit replacement at some time. I had mine replaced in 1989, again by Dr. Cooley.
Today
Getting back to my most recent visit in February, the cardiologist typically has an echocardiogram, done. Basically an ultrasound of the heart. This time Dr. McAnulty saw something that concerned him. He had me scheduled for a cardiac catherization. This is an interesting procedure, in that they thread a catheter up from the groin area through the femoral artery and into the heart. They do this with the patient conscious with a local anesthetic on the incision site. It's really quite a unique experience, I'll have to post about it another time.
Anyway, the result of the cath was that the pulmonary conduit is showing some narrowing again. The blood pressure in my right ventricle is twice normal and there's some enlargement. Dr. McAnulty and the surgeons up here at OHSU recommended surgery. Of course, with my history, I really wanted to get back to the Texas Heart Institute and see what the docs there had to say. OHSU has some world-class surgeons, but I wanted to go where I had a history, and also, my family is all in Houston and they can support me better there.
THI again
Last week, then, I flew down to Houston to consult with Dr. Leachman, my old cardiologist. He and I met briefly (he'd already reviewed copies of my test results that I'd sent ahead), and he concurred with surgery. He then asked me to wait a bit while he made a few phone calls. When he came back he said he'd gotten me an appointment with Dr. Cooley later that same day! Star treatment. Cooley is a great man, whenever I get a chance to be around him he makes me feel very comfortable and well cared-for. He looked at my old file (40 years his patient!) and reminisced a bit while we discussed options.
Upcoming
As a result of all this prodding and consulting, we reached a decision to schedule a 3rd open-heart surgery (4th operation -- the first was not open-heart) to replace the conduit. I'm starting to think of these as my 100,000 tune-ups. The surgery will be done by Dr. Cooley in Houston on May 4th, at which time he will be 84. I'll have about a week to tens days in the hospital post-op, and then 6 weeks convalescing after that. My dad and sister have both said they will have me as a guest -- probably at my dad's for the first week or so after I get out, then my sister's for the rest of the time.
Thoughts
Yes, this is major surgery, and there are risks. But I have the best doctors at the best facility, and open-heart surgey has become common, if not routine. I expect to go through the operation and be back hiking the trails of Mt. Hood by the end of 2004. I've already survived well beyond what I would have had I not been operated on, and as I am of the age of the earliest patients ever to have this, there's no real long-term certainty about what will happen. Certainly I am at risk for things like arrythmia and cardiac arrest, but at 40 I'm getting into those years where all men start to have a higher risk of that. I just plan as if I'm going to keep doing what I do for a normal lifespan, and if I outlive my doctors (some of them I already have) and my parents, then what's to complain about?
