The new Mechanical-Prosthetic Aortic Valve has been fitted

Natalie's operation, in the Trent Cardiac Centre, went ahead as planned, on Wednesday morning (9th), starting at approximately 08:00 hrs.

I received a telephone call from the Cardiac Surgeon, Mr. Naik, at about 2:20pm to let me know that he had done his work; the new valve is seated OK; and that Natalie was being transferred to the Cardiac Intensive Care Unit. The operation was more complicated and had taken longer than usual for an aortic valve replacement because it was a re-do, as they call it, mechanical-prosthetic replacing failed bioprosthetic. He advised me to wait until the early evening to check-up on her condition. I telephoned the CU at about 19:45 hrs. The nurse allocated to looking after her confirmed that Natalie had woken up from the anaesthetic and that the ventilator tube had been removed. The nurse suggested it wasn't necessary for me to drive to Nottingham last night.

I visited this afternoon. I was very pleased to see that, because of her satisfactory progress and downgrade of risk, Natalie had been transferred from ICU to the High Dependency Unit. A move in the right direction. She is obviously feeling very uncomfortable and in some pain but this is being controlled with morphine, initially, and then less potent drugs, tramadol and paracetamol, backed up with a reduced level of morphine if the other two are not strong enough on occasions. The medical staff are pleased with her condition at this time. She may be transferred back to the normal cardiac ward on Friday or Saturday.

I believe she is coping better this time round than she did in 2006.

She dozed-off (resting her eyes she called it) a couple of times whilst I was with her: it's not surprising given the stress and drugs.

That's all the news for the moment.

Follow-up article: Home from Hospital

© Elliot Sampford 2014

Transfer to the Trent Cardiac Centre.

Natalie's transfer from Lincoln City Hospital to the Trent Cardiac Centre in Nottingham City Hospital took place today – eventually.

I mentioned in my previous article 'My Wife's Bovine Pericardial Aortic Valve has only lasted 8 years!' that the Consultant Cardiologist in Lincoln had sent a priority request to the Trent Cardiac Centre at Nottingham City Hospital for an operation to replace the faulty bioprosthetic aortic valve that is neither opening or closing properly.

We received confirmation a few days ago that the 'Re-do' operation, as it is termed in official correspondence, is to take place on the 9th April, and that she would be transferred today, although we didn't believe it was written in stone. She has remained as an inpatient in the cardiac department of Lincoln Hospital until now.

It was not until 09:50 hrs. this morning that Natalie was informed that the move would definitely take place today. She was told then because I had telephoned the ward to enquire if and when the transfer was to happen and the nursing staff let her tell me.

When I popped in at 11:00 hrs., to collect any laundry and other items that she didn't want to take to Nottingham, she was already to go, bed space tidied and bags packed, and waiting for transport to be arranged.

Transport Fiasco

Transport eventually arrived approximately 6 hours and 30 minutes after she was told she was going. She left Lincoln at about 18:15 hrs. and arrived in Nottingham at 19:45 hrs.

It is important that patients with heart problems are not subjected to unnecessary stressful situations. Today's transfer and transport fiasco certainly hasn't helped Natalie's stress level. I think there has been an appalling failure in the management of the situation. This is not the first time this week that a cardiac-patient has been kept waiting until the early evening before being subjected to a long drive from Lincoln to another hospital; on that occasion a journey of probably two hours.

The one redeeming factor of today was that at 21:30 hrs. the nursing staff at the Trent Cardiac Centre allowed Natalie to use their telephone to let me know she had arrived safely, had a few basic tests carried out, and been settled in. I have not been able to visit, and give moral support to her this evening, because of the ultimately very late arrival.

 Follow-up article: The new Prosthetic Aortic Valve has been fitted

© Elliot Sampford 2014.

My Wife's Bovine Pericardial Aortic Valve has only lasted 8 years!

Wikimedia

On the morning of Friday 14th March 2014 I had to call the Emergency Ambulance Service because my wife, Natalie, had a seizure at home.

No Warning.

The day started as normal without any warning of what was to come.

On returning home from the weekly trip to the local Sainsburys supermarket we put the shopping away and relaxed whilst we drank our mid-morning mug of milky coffee. After our drink we went upstairs to put a few toiletries away.

We were in the bedroom when Natalie said: “I feel dizzy, I think I'll sit on the bed for a minute.” As I turned to leave the room suddenly she suffered what seemed to be a seizure.

Her body went rigid; her back arched; her head tilted back; her mouth opened; her arms went stiff, stretched out at a forty-five degrees angle to her body; her eyes went blank and staring; she was moaning; she was having difficulty breathing; she was unresponsive. In a controlled panic I called 999.

Accident & Emergency.

After about five minutes, and at the same times as the LIVES (Lincolnshire Integrated Voluntary EmergencyService) volunteer arrived, Natalie started to return to some degree of lucidity. Within less than two more minutes the paramedic manned ambulance arrived.

She was quickly connected to an ECG(Electrocardiogram) machine to monitor her heart rhythm. Although the reading showed a regular heart beat the medics decided she needed to be taken to the Accident and Emergency department of Lincoln CountyHospital for further tests. Following her admission she had more ECG s, a blood test, an X-ray, and a CT (Computerised Tomography) scan of her head, in case she had suffered a stroke or fit with possible damage to her brain. The result of the scan was clear.

Inpatient.

The Doctor decided that as the cause of the seizure was not apparent, and because he could also hear a loud heart murmur, Natalie was admitted to the MEAU (Medical Emergency Assessment Unit) ward for further observation and tests.

The following morning (Saturday) the duty Consultant visited Natalie and reviewed the various test results available. He was of the opinion that the seizure type incident was probably an extreme reaction to a faint due to an insufficient flow of blood and oxygen to the brain. He was concerned about the loud murmur coming from her prosthetic aortic valve and therefore ordered an Echocardiogram (An ultrasound scan used to obtain a detailed image of the heart). This can often detect abnormalities with the shape and movement of the heart's valves.

The test was carried out on Sunday morning using a portable, therefore limited, machine as this was the quickest option. The preliminary results indicated that the valve is not opening correctly. A further test was requested on the main, more sophisticated, larger ECG machine so as to get better indications as to what is happening with the valve.

Natalie was transferred from the MEAU to a surgical ward at 22:00 hrs. on Sunday night.

The 'Echo' test was repeated on Tuesday morning. It confirmed that the artificial valve is not functioning correctly. It is not fully opening so the blood flow from the ventricle into the aorta artery is restricted. There was also concern that there could be some back-flow of blood into the heart chamber.

The Cardiologist, looking after Natalie, wanted her transferred to the Cardiac Unit ward as soon as possible, to make it easier to monitor her condition. She was moved on Wednesday evening.

Coronary Angiogram.

She was informed that it was necessary for a Coronary Angiogram (a type of X-ray that uses a special dye which helps the blood vessels of the heart show up clearly on an X-ray scan) to be carried out to ascertain the overall condition of her heart and arteries. The procedure was carried out during the morning of Friday 21st March, a week after her admission into hospital.

The results confirmed our worst fears. The Bovine Pericardial Aortic Valve (the Perimount Magna 3000 model, manufactured by Carpentier-Edwards), fitted in January 2006, has failed. It is suspected to be due to SVD (Structural Valve Deterioration). This could be as a result of calcification of the three leaves of the valve, or a tear in one of them.

She is suffering with severe aortic-stenosis (the valve opening is narrowed and obstructing a normal blood-flow through it) and severe aortic-regurgitation (the valve is leaking and a substantial quantity of blood is flowing back through it into the left ventricle) as the valve is neither opening or closing properly.

Open Heart Surgery.

The only remedial treatment is open heart surgery to replace the faulty prosthesis. A repeat of the operation Natalie went through just eight years ago.

The Consultant Cardiologist in Lincoln has sent a priority request to the Trent Cardiac Centre at Nottingham City Hospital for an operation. A report has been sent to the Cardiac Surgeon who carried out the first replacement operation. There is some surprise and concern as to the short period of time of the effective working of the current bovine-valve. The advice we were given in January 2006 was that we could anticipate a longevity of the bioprothesis of fifteen years, possibly more.

What of the future.

Natalie is to remain in hospital until the essential operation is undertaken because the severity of the valve malfunction requires constant monitoring of her heart's status. When will the surgery take place?

Not only does she have the fear of the outcome of another operation but she also has the worry as to which type of valve to have fitted this time. Should she choose a mechanical valve or another stented bioprothesis? Will she have a choice or will the decision be made by the surgeon based on the condition of the aortic root connection to her heart, as this will be the second Aortic valve replacement?

Follow-up article: Transfer to the Trent Cardiac Centre

© Elliot Sampford 2014