Heart Valve Replacement Surgery

[fishhooks]

A Thai family member just under 50 years of age has been advised, after a number of tests at Bangkok Hospital Korat, to have this operation.

Any members here have any experience with hospitals or this procedure here. Cost is estimated at approx 415,000 Baht, including some new type of treatment for irregular heart beat.

[fishhooks]

BTW The odd 15,000 on top of the 400,000 was for a CT Scan prior to the operation to get a Calcium score.

[dumball]

I can only advise you to go to BNH for heart related work , knowledgeable staff and doctors that care , book an appointment with Doctor Wiwat , he is fabulous . I was under hin for my second heart attack , after a year of medication , with his advise and recomendations , I have been drug free for over three years with no problems , walk up stairs to my fourth floor apartment with no stress .

[ballbreaker]

Something this major always get a second opinion.

[fishhooks]

Thanks for the above advice.

The Surgeon we saw at BKK Hospital Korat yesterday, is the one mentioned here in another topic in this section of the forum.

********************

It looks suspiciously to me like you have something besides atrial fibrillation going on. Not being a doctor, I won't even speculate what it may be.

There is a new cardiologist at the Bangkok hospital in Korat. He is only there on Wednesday and Thursday from 0800-1600. His name is Dr. Warin Arora. He trained for his MD and cardiology specialty in the US, and so speaks good English. They brought him in to help establish a cardiac care center at the Bangkok Hospital here. So I am told by the International liaision, Weena.

[Naam]

A Thai family member just under 50 years of age has been advised, after a number of tests at Bangkok Hospital Korat, to have this operation.

Any members here have any experience with hospitals or this procedure here. Cost is estimated at approx 415,000 Baht, including some new type of treatment for irregular heart beat.

i can't imagine that this low amount can cover open heart surgery, a few days ICU and a week in the hospital. i had recently a quadruple bypass which would have cost me in Bangkok nearly 3 million Baht but had it done in Germany for nearly 4 million. i am not a medic but conclude that a valve replacement is at least as or more difficult and expensive than a multiple bypass.

[Sheryl]

Actually, the government hospitals have more experience in valve replacements than the private - reason being that valvular disease is much more prevalent among the less affluent. Which is not to say that Bangkok Korat can't do a decent job, just that I would not rule out having it done at a (major) government hospital.

I helped a Cambodian lady get a mitral valve replacement in Rajawithi Hospital in Bkk around 8 years ago. Lots of bureacracy and delays in the initial processing but the care itself was superb. Cost around $2,000; before we went the govt hosp route priced varioous private hospitals which were all at around $10,000. These are 8 year old prices so will have gone up everywhere, but just to give you an idea.

If he is in otherwise good health and nothing goes wrong, only a 1 night stay in recovery before back to the regular ward and just a few days after that before discharge. Will have to take anti-coagulants for the rest of his life, but then he should already be on them if he is in A-fib.

Certainly get a second opinion, bringing results of the echocardiogram with you. While you are at it look at the results yourself, among the various vaklues given will be a percentage for LVEF, which is the left ventricle ejection fraction, this gives the best idea of the seriousness of the situation i.e. how urgently he needs this done.

A very important consideration in selecting surgeon and hospital for this procedure ( or any other type of surgery -- but most especially open heart) is the numebr of similiar procedures done annually and the mortality rate. Ask about both and also how many years they have been doing this procedure at that hospital.

I normally say "choose the surgeon, not the hospital" but in the case of open heart surgery you need to consider both, as the skill of not only the surgeon but the perfusionist and nurses is very critical.

The new procedure they are talking about for the A-fib is ablation. Success rates for this vary with the specific technique and will also vary with the skill and experience of the doctor performing it. There are doctors in Thailand with a lot of experience in it, but few. Ask specifically about this as well as number of valce replacements that the prospective (a) surgeon and ( hospital have done.

Some links on ablation procedure:

http://www.medscape.com/viewarticle/558370

http://www.medscape.com/viewarticle/532503_3

[fishhooks]

The surgeon as noted before, Dr Warin Arora, and in a previous thread (http://www.thaivisa.com/forum/Atrial-Fibrillation-Story-t196496.html) speaks perfect English and told me that the hospital here (Bangkok Hospital Korat) is having a special package for heart operations, one reason being that they are a bit quiet on this front at the moment and they have a largish Heart Clinic, which they want to keep busy.

They actually have a brochure: Basic Open Heart Surgery, 250,000B.

Cost of Valve, 40,000B

Cost of this new treatment, 70,000B (I think it is called "Ablation")

The above includes up to a 7 day stay in the hospital with everything included excepting of course any unforeseen circumstances.

I'm absolutely no expert with anything to do with Medical Practice, but I would hope even here in Thailand where a large hospital organization is involved in this type of procedure, that it would be above board.

Dr Arora is head of this unit and spent nearly an hour with us yesterday explaining everything possible to our understanding.

I believe in second opinions myself and we are at present trying to arrange to go down that path.

Edited February 21, 2009 by fishhooks

[fishhooks]

Thanks so much Sheryl, I hadn't seen your post but it must have popped up as I was typing mine.

[BAYBOY]

Re costs for heart by pass. I had a quadruple bypass done at Phiyathai 2, Bangkok in 2002. Total cost (included 10 days stay after the operation and full care) was just over 300.000 baht . Find a charge mentioned of 3 million baht very hard to believe even though costs have risen...............but that much?

Also must mention that the whole procedure was top quality throughout.Help, explaining clearly what, Specialists, nurses, rooms, service, etc etc.

Only hic-cup was the op had to be delayed for 2 days as there was a shortage of blood in my blood group in Bangkok at that time. No charges were made to me for the 2 days that I stayed there waiting for the operation.

Can't speak highly enough of that Hospital as they looked after me so well.Health since then 100%, every fortnight mow 5 rai of grass by rotary mower, and aged 63.

[Sheryl]

The surgeon as noted before, Dr Warin Arora, and in a previous thread (http://www.thaivisa.com/forum/Atrial-Fibrillation-Story-t196496.html) speaks perfect English and told me that the hospital here (Bangkok Hospital Korat) is having a special package for heart operations, one reason being that they are a bit quiet on this front at the moment and they have a largish Heart Clinic, which they want to keep busy.

They actually have a brochure: Basic Open Heart Surgery, 250,000B.

Cost of Valve, 40,000B

Cost of this new treatment, 70,000B (I think it is called "Ablation")

The above includes up to a 7 day stay in the hospital with everything included excepting of course any unforeseen circumstances.

I'm absolutely no expert with anything to do with Medical Practice, but I would hope even here in Thailand where a large hospital organization is involved in this type of procedure, that it would be above board.

I'm sure it is "above board", but the fact that they are not doing a lot of cases (hence the promotion package) rings alarm bells in my mind a bit. As I explained, experience is all important, and not only the experience of the surgeon but of the entire team: perfusionists, specially trained nurses etc.

The surgeon, especially if he also works at a government hospital, may have adequate experience but speaking as a former head nurse of an open heart ICU I would really hesitate to have this done in a place where the nurses might not.

Odds are he'd do fine, but in the interestes of caution, if it were me I'd head for where the largest volume of cases has been done for the longest time. In Thailand as a whole that is Ratchatewi (the very first hospital to ever do this type of surgery in Thailand and now site of the country's only perfusionist training program) but regional hospitals might also by this point be doing a large volume. The Bangkok-based large international hospitals do a oretty good volume of oopen heart surgery although probabkly not as many valve replacements as other procedures.

As for ablation, for sure I would not have it done exceopt by a surgeon with considerable experience in it. It is something of a craze, everyone is jumping on the bandwagon to start doing them, but the odds of success depend a lot on the surgeon's experience in the procedure.

Have you found out what the LVEF is yet? And which valve are we talking about?

BTW, for benefit of other posters, valve replacement and bypass are entirely different procedures for entirely different problems so does not make sense to compare costs of one to the other.

[fishhooks]

Thanks once again Sheryl , should have more info by mid to end of this week and have taken on-board all of your excellent advice.

One other thing springs to mind;

Are one's Medical Records portable in this country, thus if you have already completed a number of vital tests with documented answers, even say a CT or MRI, can you ask/ 'demand' these files should you move institutions?

[Sheryl]

Yes, by law a patient's records, including films, scans etc, must be given to him or her on demand. Patient usually has to go in person to receive and sign for them, but that's about all.

[fishhooks]

Hi Sheryl;

Okay, no problem with the records, today Dr Arora has given us all of the tests etc that BH Korat did last week and a detailed letter from himself.

He did further blood tests and examinations himself today also.

The two left hand side valves need to be replaced, that's how he explained it to me, obviously there is a more medically termed explanation.

The LVEF is 50%.

He has given us a couple of options, knowing that to have the procedure done at BH Korat is beyond our means.

One is to go back to the local Amphur at Thepsahtit (Chaiyaphum) and have them refer on to a Government Hospital in say Khon Kaen or Korat, under the existing medical system that the Thai's have. Only problem with this maybe the waiting time, but he said that is quite above board to offer to pay a bit more than the standard charges to move up the queue.

Second option if the above doesn't work out is to go back to him and he will refer us on to a Government Hospital in Bangkok, problem being the wait again, but can be sped up as before by offering to 'up' the payment.

To my mind, this guy is really doing the right thing by us. As explained in the other topic (the A Fib Story), he is more or less very much part of the "Heart" Clinic at BH Korat, but can look beyond his ties there to help out where he can.

I've now had a couple of chats with him in perfect english and have found him extremely helpful and comfortable to deal with.

[Sheryl]

Those would be the mitral and aortic valves, and with an LVEF of 50% he does indeed need surgery. This means that with each heart beat only half of the blood that is in the left ventricle gets pumped out into the body, with half remaining. It will cause a back up of blood into the lungs as well as, of course, decreased blood supply (and therefopre oxygen) to the body. If he has not already, he will develop damage to the left ventricvle of the heart, and once this happens it does not always correct after valve replacement so while it is not a super urgent emergency, I wouldn't advise waiting long.

Since he is going to have to travel anyhow and go the government route anyhow, I would suggest having the doctor (whi sounds wonderful!) refer him to Rajawithi Hosp in Bangkok, by far the most experienced open heart surgical facility in the country. They can also do ablation if indicated.

Good luck

[Naam]

Re costs for heart by pass. I had a quadruple bypass done at Phiyathai 2, Bangkok in 2002. Total cost (included 10 days stay after the operation and full care) was just over 300.000 baht . Find a charge mentioned of 3 million baht very hard to believe even though costs have risen...............but that much?

interesting! Phiyathai quoted in my case just for a katheter 125,000 Baht, additional 100,000 Baht for each stent if needed and for quadruple bypass done by open heart surgery 2.8 m Baht (end of october 2008). are you really talking about open heart surgery? recently i realised that there was a misunderstanding betweenn an old american friend an me. he kept on talking about his triple bypass, that he spent only two days in the hospital and not a single hour in ICU. later it turned out that he received three stents.

[BAYBOY]

NAAM. Yes it was a quadruple by pass I had in 2002. Have the tell tale scar down the left leg and the scar on the chest. From memory had about 36 hours in I.C.U. afterwards then 6 days in private room.

First heart attack 21 years ago, then angio-plasty 2 years later. Nothing till 2002 when I felt unwell and had the quadruple. Not a worry since. Though a little slower these days, still keep very active in the garden and our orchard and teach 5 and a half days a week.

Cheers

[Naam]

NAAM. Yes it was a quadruple by pass I had in 2002. Have the tell tale scar down the left leg and the scar on the chest. From memory had about 36 hours in I.C.U. afterwards then 6 days in private room.

First heart attack 21 years ago, then angio-plasty 2 years later. Nothing till 2002 when I felt unwell and had the quadruple. Not a worry since. Though a little slower these days, still keep very active in the garden and our orchard and teach 5 and a half days a week.

Cheers

cheers to you too Bayboy! i am just about to recover completely, plan to hang my punching bag and do a little kickboxing again. as it is out of the range of the present topic would you mind if i ask some questions which you might be able to answer based on your experience?

[BAYBOY]

NAAM.

By all means, only to happy to give some answers ( if possible) not too medical I hope!!!

Feel free to PM me if you want to, or may be open a new thread, as others may wish to offer some answers as well.

regards

BAYBOY