When the unexpected happens in surgery

Judy wasn’t worried about her aortic valve replacement – it wasn’t an uncommon operation and there was every indication that recovery would be straightforward. This is her story, in her own words.

My father died suddenly of a heart attack while out tramping – he was only 70. I was 40 at the time and decided I should have a “heart check” just in case there were hereditary problems looming. 

Cholesterol was not something I had heard much about but tests revealed that I had very high levels, inherited from my mother actually, not my father. My GP also commented, “Did you know you have a heart murmur?”

“No… what’s that?”

His short explanation was followed by “not something you need to worry about yet – but you need to be aware that you do have one”.

Nearly 20 years later I noticed I was getting puffed climbing hills whereas previously a friend described me as a “mountain goat”. An angiogram was conducted and a two-year follow-up noted. I was informed that within the next 10 years, though, I would probably need to have a valve replacement. I immediately put this out of my mind as in “the future”.

Hill-climbing soon became a little more difficult and often avoided, but otherwise life continued as per normal with a CAT scan in the diary every two years. 

I began playing tennis again a year ago after a break of many years. I loved the increased activity again and could certainly keep up with others on the court. I was walking briskly for half-an-hour on the days I wasn’t playing tennis and was very active around our extensive house repairs and up and down our spiral staircase.

First appointment with cardiologist

I had a scheduled CAT scan in August last year and, for the first time, was called in to see the cardiologist following this scan. She explained just what my heart murmur actually was: my aortic valve was bicuspid rather than a normal tricuspid valve. It was probably a congenital defect. 

This meant that the valve was not beating as efficiently as it should and therefore it had to work harder and was wearing out earlier than a normal tricuspid valve. I was advised that I could continue playing tennis and doing my normal activities but would be rescheduled for a further scan in six months or sooner if I noticed I was getting breathless...

I noticed, while on holiday in January, that any activity that involved exerting a little energy (climbing up even small sand hills, for example) was more of a struggle although I continued to cope well with tennis. 

Then in February I had another scan and this time was advised to stop playing tennis. I would be scheduled for an aortic valve replacement within four months.

I’d had an appointment for ‘semi-urgent’ gynaecological surgery in February but the surgeon took one look at my cardio report and said, “We won’t be touching you until you’ve had your heart surgery!” I began to believe that this was serious.

Early in March I was called to the hospital for my “pre-op” and informed that surgery would take place the following Thursday in a private hospital. When I arrived home I received a phone call saying it was actually Wednesday I was scheduled for! Help! Not much time to worry….

Not concerned about surgery

I was not at all concerned (well, only moderately) regarding my operation – I was otherwise fit and healthy, it was certainly not an uncommon operation. Information regarding recovery was well-covered and I could see there were plenty of support structures in place. 

When my husband, Jim, took me hospital on Tuesday evening he was told he could see me after the operation the following morning and would be eating breakfast with me on Thursday.

The operation was successful, and while in ICU for recovery the surgeon rang Jim to tell him he could come and visit in an hour or so when I should be coming out of the anaesthetic.

But then, a complication

While Jim was waiting to see me he was called into a room to speak with the surgeon. He was told I had been taken back to the operating theatre as my blood pressure had dropped dangerously low and a re-opening of my chest was necessary to alleviate the problem – there was bleeding into the pericardial chamber surrounding the heart. At some point I also went into cardiac shock and my lungs filled with fluid. 

The cause of these events? A wire had penetrated a blood vessel while my sternum was being stitched together. When my blood warmed up after the operation, the blood from the wound flowed into the cavity and there wasn’t room left for my heart to beat effectively.

And the consequences? I was kept under sedation in ICU for seven days while healing took place and many family members and friends were left wondering what had happened - why I was still unconscious and if I would really make a full recovery. I’m not sure if I was actually kept under sedation or just didn’t “want” to wake up, but I was given a brain scan as there was concern that I had suffered a stroke while out to it – so yet another thing for family and friends to worry about.

Confusion and recovery

When I eventually regained consciousness my brain cells were as fuzzy as the rest of me. I asked why I had had my operation in Bluff, wondered why I had a nurse sitting at the end of my bed all the time instead of attending to other patients and became quite frustrated with the tubes and other paraphernalia entering and exiting my body (and keeping me alive, no doubt!).

My son told me that he and his wife had been to my property and redesigned a garden which was on my “to-do” list. The viewing of this new garden was my focus for the next couple of days – as each tube was removed I thought “now I can get up and go home to see my garden”.

Nurses fed me until I gained enough strength and co-ordination to feed myself. And I soon realised dignity wasn’t an option as I was toileted and bathed with the assistance of the wonderful nursing staff. Once I was not in need of my 24/7 nurses my bed was moved and turned around so I could look out the window and “watch the world go by”. Although I know this part of Christchurch well, I still wasn’t able to orientate myself to my whereabouts.

Three days after my regained consciousness, I was able to toilet and bathe myself to some extent and other “vitals” were stable so I was wheeled off to the cardiothoracic ward. Oh, the joy to be making such progress!

Once again, the staff were fantastic. I was still very “brain fuzzy”. I am an avid reader and love word puzzles and card games but I could read about one page of my novel and answer just one word in a crossword puzzle before my brain gave up. However, determination and a desire to sleep in my own bed kicked in and I managed to walk the required distance without a frame, and to toilet and shower myself and climb the dreaded steps unaided within three more days.

Once home, I progressed quickly and took the prescribed rests and daily walks. Three months later I returned to the tennis court (until my gynaecology surgery laid me low again for a further three months).

Subsequent discussions with my surgeon and cardiologist revealed that I had the operation “in good time” – a heart attack within the next year was a very likely outcome if I hadn’t undergone the replacement.

I was fit and healthy (apart from the faulty valve) so the recovery period was quick and the valve was “very tight”. The unfortunate sequence of events immediately after surgery was not to be expected, but thanks to specialist staff and modern medicine I suffer no ongoing problems.

 

Shared November 2016

Please note: the views and opinions of the storyteller and related comments may not necessarily reflect those of the Heart Foundation NZ.

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