Aortic Heart Valve Replacement Surgery – Anyone Had Any Personal Experience?

[Mobi]

I have suffered from narrowing of my coronary arteries for more than 10 years, but never sufficiently bad enough to warrant the insertion of stents. This has always puzzled me as every time I complained of severe symptoms (arm and chest pains, high BP etc), I was given an angiogram and then effectively given an ‘all clear’.

I have been taking beta blockers and BP reducing drugs for years which generally, have succeeded in keeping my BP under control and my heart rate in the 50’s.

Then in mid-2010, I was admitted to a hospital for an operation on my wrist, and they did some stress checking on my heart and told me I had ‘moderate’ aortic stenosis.

Then towards the end of last year, I was having trouble in keeping my BP under control, despite the drugs, and I was also so unfit that even a short five minute stroll was enough to cause breathlessness, dizziness and arm and chest pains. So I went to see the heart specialist in Bangkok last December for the first time in 3 years.

She had planned to give me a stress test, but during the echocardiogram, prior to doing the stress test, they came to the conclusion that my the condition of my aortic valve deteriorated since they had last examined it and cardiologist told me that it looked like I was going to need a valve replacement. They didn’t even bother to do the stress test.

Anyway, she increased my BP drugs, told me to try to lose weight and get more exercise and see her again in early March, but warned me that if I had any repeat of the extreme symptoms (breathlessness, chest and arm pains) then I should make an immediate appointment to see her.

Since then, I have been getting myself much fitter, ( I can now walk briskly for around 50 minutes a day without any adverse reactions), I have lost about 10 kilos in weight and after a slow start, I have succeeded in getting my BP under better control.

However, I take my meds twice a day – morning and evening - what is happening is that after I take the meds, my BP comes right down (as low as 110/50) but gradually increases and by the time I come to take my next dose of meds the systolic is back up to well over 150.

When I see the doc next month, I am concerned that the she will tell me that I now need to replace the valve which will put me back around 1 million Baht – give or take - whether I have it done in Thailand or the UK.

Now I am fully aware that it is a foolish idea to get medical opinions over the internet and I fully plan to see what the doc says and then get a second medical opinion. But my fear is no one will be completely honest with me and they will all urge me to have the op, even though it may not be necessary, at least not yet.

I am 65 and a long term, insulin dependent diabetic, so major surgery will always be a risk.

So I would be grateful if anyone out there has had a similar experience to mine, (dodgy aortic valve, meds only working for a limited period ), and what was the prognosis? If nothing else, I may have some searching questions to ask the specialist when I do see her.

These days, a million Baht is a lot of money for me and I really don’t want to fork it out unless I absolutely have to, neither do I wish to subject my poor, ravaged old body to unnecessary risk.

So, anyone had any background on this sort of thing?

Thanks.

[Naam]

So, anyone had any background on this sort of thing?

i can only add some layman's info Mobi which might be relevant to your concern "surgery risk". three years ago i had open heart surgery (4 cardiac and 1 aorta bypass) in Munich, Germany. after an eight day stay in the hospital i spend another two weeks in a bavarian rehab center. there i met a former famous olympic gold medal winner and during small talk we found out that we had the same surgeon. what puzzled me most was that he had one of his valves replaced by non-invasive "surgery", id est the valve was put in place through an artery the same way stents are placed. could this be perhaps an alternative for you?

[Mobi]

Thanks for that Nam.

Yes, I had heard about that new alternative procedure, but as far as I have been able to determine, it is at least twice as costly as the standard op in the UK, presumably because it is very new???

This may or may not be correct and I will check further and also ask the good lady Doc when I see her.

[Naam]

Thanks for that Nam.

Yes, I had heard about that new alternative procedure, but as far as I have been able to determine, it is at least twice as costly as the standard op in the UK, presumably because it is very new???

This may or may not be correct and I will check further and also ask the good lady Doc when I see her.

can't imagine that it's twice as costly. no sawing up chest bone, no titanium wiring chest bone after surgery, no three days in intensive care wired and hosed up with a pump connected... and... and...

the procedure is not that new. just read that it is done since 2007.

[Naam]

the good lady Doc

are you referring to a lady cardiologist in PIH or BPH?

[Mobi]

the good lady Doc

are you referring to a lady cardiologist in PIH or BPH?

Neither: Bumrungrad.

I don't have much confidence in any hopsital in Thailand, as fas I am concerned, all Pattaya hospitals are no go areas. Not sure I would trust them with an ingrown toe nail.

[Mobi]

Thanks for that Nam.

Yes, I had heard about that new alternative procedure, but as far as I have been able to determine, it is at least twice as costly as the standard op in the UK, presumably because it is very new???

This may or may not be correct and I will check further and also ask the good lady Doc when I see her.

can't imagine that it's twice as costly. no sawing up chest bone, no titanium wiring chest bone after surgery, no three days in intensive care wired and hosed up with a pump connected... and... and...

the procedure is not that new. just read that it is done since 2007.

I assume you are referring to Transcatheter Aortic-Valve Implantation (TAVI) .

One of the top Heart hospitals in the UK quoted me GBP36K for this as compared to GBP23K for a standard valve replacement. Another wanted a deposit of GBP 60kfor a TAVI as against 30K deposit for a standard op.

I think the valve (which sort of inflates) they insert is very Hi tech - hence the high cost.

Apparently it is for patients with severe aortic stenosis who are not candidates for surgery, due to extreme frailty and other illnesses, and I am not sure I quite qualify for that. I also read that the traditional op is still considered to be more effective for those fit enough to stand the operation.

[smokie36]

Its a difficult area to judge Mobi. Do get a second opinion for sure. One thing to also consider is that the valves may need replacing at a later stage, say 15 years down the line.

If you are reasonably well I would be looking at leaving it as long as possible. Of course that carries its own risks.

Best wishes whatever your decision.

[Naam]

the good lady Doc

are you referring to a lady cardiologist in PIH or BPH?

Neither: Bumrungrad.

I don't have much confidence in any hopsital in Thailand, as fas I am concerned, all Pattaya hospitals are no go areas. Not sure I would trust them with an ingrown toe nail.

heart surgery in Pattaya is done by BPH's Bangkok team. by the way, according to what my German surgeon told me Phyathai Hospital in BKK beats Bumrungrad hands down in heart surgery.

[meatboy]

hi mobi i have sent y a pm.as y see my posting is working.anyone else wants some info on aotic valve replacement i had surgery 2007.depending on your age y have a choice of animal flesh or a mechanical one.

[Mobi]

hi mobi i have sent y a pm.as y see my posting is working.anyone else wants some info on aotic valve replacement i had surgery 2007.depending on your age y have a choice of animal flesh or a mechanical one.

Hi meatboy, yes, I have read your PM and replied to it. Thank you.

[Mobi]

the good lady Doc

are you referring to a lady cardiologist in PIH or BPH?

Neither: Bumrungrad.

I don't have much confidence in any hopsital in Thailand, as fas I am concerned, all Pattaya hospitals are no go areas. Not sure I would trust them with an ingrown toe nail.

heart surgery in Pattaya is done by BPH's Bangkok team. by the way, according to what my German surgeon told me Phyathai Hospital in BKK beats Bumrungrad hands down in heart surgery.

I have no doubt the some of surgeons at BPH are eminently qualified - and yes I do know that many travel down from Bangkok - but unfortunately as soon as they hit the Pattaya environs they seem to see dollar signs on the faces of every patient. I just have a mega problem with the ethos of that hospital which has had so many adverse reports of 'screwing'; patients that they simply cannot all be false, and indeed I can relate several of my own experiences to add to the collection.

Of course all this is vehemently denied, and so desperate are they to neutralise this bad publicity that they have had, (and possibly still do have), farang members of staff writing re -joiners and defending the hospital on this and other forums.

You will always get people favouring one hopsital over another, and I am sure Phyathai does good work and I will be investigating that possibility in due course. I very much doubt whether I will have it done at Bumrungrad as - like BPH - they are extremely expensive. But I have been seeing the cardiologist there for a number of years and as she has my full history, including the results of previous stress tests, angiograms etc and their outpatient charges will not break the bank.

Anyway, she is quite cute....that's gotta be worth something.

I am also looking at the possibility of going to Chiang Mai, as I have had good reports about a couple of heart surgeons up there, and it will definitely be cheaper.

But right now, I am trying to determine if I actually need the op, and was hoping to hear from anyone about their symptoms and their BP record during the period leading up to the decision to operate.

Maybe I'll just see what the doc says when I see her next month and take it from there.

[meatboy]

hi mobi,it all started with high bp.then a cholestral check,high bp,colestral,and feeling out of breath,trouble walking,worst after food,left arm feeling as if a ton weight was hanging on it,so it was keeping me awke all night.i was overweight,used to eat all the wrong foods this i had done for 50years,so i was lucky i have 2daughters that work for surgeons,so i got a private appointment with a consultant.i wrote everything down what i was experiancing,and without any tests he was spot on,blocked arteries and a leaking valve.then followed 2years of testing,echo grams will find any abnormalities with the heart,stress tests on a treadmill,and a cardiogram where they insert a tube[groin]and pump floresant liquid through your veins to see if there are any blockages,in my case i also had a double by-pass[that explains the cost]one thing i didnt get was servere pains in the chest just tightness.i was made to loose 20kilo's before they would operate and this for me was the worst part,i have always been frightned of the dentist,my teeth were in a right mess had to have 13out.for 5years in total that i suffered umpteen tabs,but since the surgery i feel like a new man.mobi if you had to have surgery couldnt you go back to the uk.mine was done at the universaty hospital of wales[cardiff]

[meatboy]

sorry mobi its an angiogram that is done to look at your blood vessals.

[Sheryl]

With aortic stenosis, surgical valve replacement is basically unavoidable. How urgently it needs to be done depends on the severity. Leaving it too long risks permanent damage to the heart muscle i.e. you could end up needing more than just a valve replacement (or dead).

See http://www.mayoclini...tenosis/DS00418

You do not have to pay a million baht if you are willing to put up with the red tape and inconveniences of a government hospital. The best one for this -- and the one that has bene doing open heart surgery the longest in Thailand -- is Rajawithi Hospital, right at Victory Monument. I helped a Cambodian friend through a valve replacement there and not only checked it out thoroughly but was with her throughout pre and post op period. The mortality rate their for this procedure is around 1% (excellent by international standards), the surgical care impecable. Nursing care is good for what really matters but of course low on amenities and speed of response for non-urgent things can be very slow. (This is for the ward -- last 2 things probably far better in a "hing piset" but at least the 1st 24 hrs you are safer in the ward.

Burearocratic hurdles to jump to get on the schedule there - h=no matter what paperwork you have in hand from other hospitals you have to start at square one: register, be seen by a GP intern, then sent to the cardiologist, then sent for various tests, each of these steps involving long waits and needing a Thai speaker to help you navigate.Took us about 4 days (of daily visits) to get to face to face with the cardiac surgeon and then a couple weeks wait to get an echocardiogram done (wouldn't take report from elsewhere - surgeon who will operate wants to see for himself) then more wait to get in the OR schedule.

Once admitted, smooth sailing all the way and as long as one views it in medical rather than hotel terms, nothing to fault in the care. And being as she was in an open ward I saw not just the care she got but what all the patients got, how the nurses responded to emergencies etc...and my standards are high.

In exchange for putting up with the initial aggravations and red tape, you'll save many hundreds of thousands of baht. Prices will have gone up since then (this was 10 years ago) but at the time my friend had this done, cost at the big private hosps was around 500,000 baht (without complications) and cost at Rajawithi (paying full fee) was around 100,000...so 5 fold difference.

Whether the savings are worth it, only you can decide.

[Mobi]

Thanks for all that Sheryl, which is most illuminating, including the link to the Mayo clinic which tells me just about everything I need to know.

I will certainly look into the possibility of going to the Rajawithi Hospital – if I can save all that money I will be happy to go through any slight inconvenience – the main thing is the quality of the surgery and aftercare.

Right now, I am trying to assess the severity of the stenosis. Before I went to see the doc in December I had all the classic symptoms, including arm and chest pains, breathlessness, fatigue and even feeling feint, but since I have been working on my daily walking, these symptoms have got a lot better.

However, I stopped walking for a couple of days and today some of the arm and chest pains returned, but not very severe as before. I was quite surprised , as I have been virtually pain free since early January.

As I mentioned in my earlier post, my meds ,(Ramipril 15mg, Atenolol 100Mg, Amlodipine 10 mg, Doxazosin 4 Mg) ,are split into 2 daily doses, morning and evening and reduce my BP considerably, but the BP slowly increases during the day and by the time I have to take my next dose, the systolic is back up in the 150’s.( I always take an average of three readings.)

I called the hospital some time back to get a copy of my echocardiogram and the doc’s report but they failed to send me anything, and I just decided I could wait till I go to see her in March and get all the reports then.

After reading your post, you have got me a bit worried and I am now wondering if I should bring forward my appointment to sometime this month. What do you think?

[Sheryl]

Not knowing the severity of the problem I really can't say.

Pretty much certain that you will have to have the surgery though, and while your diabetes etc does add to surgical risk, waiting isn't going to reduce risk, and may do the opposite.

Furthermore if you go the Rajawithi route it is not fast as there is usually a waiting list for surgery. So you'd do well to initiate the process sooner rather than later.

(I am assuming of course that you've been correctly diagnosed).

[Mobi]

Well a number of doctors have diagnosed my aortic stenosis, including a heart specialist at BPH in 2010, my diabetic specialist and finally the Bumrungrad cardiologist so I think I can assume it is correct. I also know I have had a heart murmur for many years, which is another classic symptom.

The only question is the severity? Maybe I will try again to get the report from Bumrungrad.

As far as Rajawithi Hospital is concerned, do I contact them as a private patient?

[meatboy]

what sheryl says about getting it done as soon as possible is right,the last 2years that i had to wait it got worse but then the nhs.uk is always under presure on heart ops.when i went to see the surgeon in may 2007 he had looked at my record and said it must be done before oct.or i could die.me and the wife looked at each other and wondered why they had been dragging their feet.even when i went into hospital i was sent home twice,on the first time i had even been given my pre.med so dont wait much longer.i had some good info from the british heart foundation,they have a web site so y should be able to down load it.good luck.

[Sheryl]

Well a number of doctors have diagnosed my aortic stenosis, including a heart specialist at BPH in 2010, my diabetic specialist and finally the Bumrungrad cardiologist so I think I can assume it is correct. I also know I have had a heart murmur for many years, which is another classic symptom.

The only question is the severity? Maybe I will try again to get the report from Bumrungrad.

As far as Rajawithi Hospital is concerned, do I contact them as a private patient?

Unless they have established something new, there isn't a channel for that. You have to just go in with the masses. You'll be private in that you'll be paying full fee, which virtually no one else there will be (Thais covered under either the gold card or SS scheme).

As some government hospitals have opened up a private/semi-private sort of channel in the past few years, it doesn't hurt to ask if this has also been introduced there. You'll want to have a Thai accompany you anyhow so she should definitely ask about this. Sometimes referred to as "clinic nawk wela"

Chulalonghorn definitely does have such an arrangement and that could be an option. It's a very good hospital, I just prefer to recommend Rajawithi because they have been doing open heart surgery (mostly valve replacements) this the longest and are the main teaching hospital for it in Thailand (train all the perfusionist teams etc) and I have thoroughly researched them.

As the Chula private clinic operates after hours (I think 4 pm onward) and you can't get much of anything done in the outptatient dept of Rajawithi after 4, you might try both i.e. go to Rajawithi, initiate the process then go over to Chula and book an appointment with a cardiac surgeon in their private/after hours clinic (I believe 13th floor). If nothi9ng else it could get you a second opinion re urgency.

Just to clarify, the risk is that due to the stenosis your heart is being strained trying to pump blood through a narrowed opening and this can lead to damage to the heart muscle itself. It can also lead to a back up blood in the heart leading to congestive heart failure as the back-up floods your lungs.

Angiogram is indicated only for suspected coronary artery disease which would be indicated by ischemic changes on EKG (either at rest or during stress test). Nothing at all to do with valve problems, the diagnostic test there is an echocardiogram.

s.

[Mobi]

Thanks for all that. Rajawithi and Chulalongkorn sound certainly worth looking into.

I have again requested a copy of my echo cardiogram report today from Bumrungrad. Lets hope this time I will be more successful. Once I have that to hand I may try to get a second opinion to try and determine the urgency,and take it from there.

[Mobi]

Its miracle! I received the full report by return email!

The diagnosis is moderate to severe aterial stenosis.

The echocardiagram results all show deterioration since the last one in 2010, as far as I am able to determine.

I might take a trip to bkk next week and get a 2nd opinion.

Posted with Thaivisa App http://apps.thaivisa.com

[Sheryl]

You can get all the opinions you want but bottom line won't change.

You need surgery and the sooner the better, delay will increase the risks and may lead to other permanent damage to your heart.

Especially if you are going to go government hospital route, where there will likely be at least a 1 month lead time (maybe more) before the actual surgery, you should start the process now.

[Mobi]

You can get all the opinions you want but bottom line won't change.

You need surgery and the sooner the better, delay will increase the risks and may lead to other permanent damage to your heart.

Especially if you are going to go government hospital route, where there will likely be at least a 1 month lead time (maybe more) before the actual surgery, you should start the process now.

The '2nd opinion' I was planning to obtain was at Rajawithi.

[petewan]

Hi , I have had a aortic valve replaced and a double by pass while they were in there in feb 2010. The problem started on my second trip to Thailand. I had decided i wanted to retire here and so i tried to get insurance to cover just in case although i was i thought in good health. I had to have a medical which revealed my blood presure was very high . When i went back to UK i visited my doctor who after the usual tests at hospital gave me tablets to conrol my blood presure and some for collesterol. As everything was under control and i still felt well i decided to spend as much time as possible in thailand but keep my base as UK in case of problems. I met and married a thai girl and all was going well then i started to get chest pains. The doc sent me for a treadmill test at the hospital but before the test listened to my heart and said the beat was iregular and could be a problem so no stress test and see a heart specialist. I saw the specialist at hull hospital in the UK

and he said i needed a new valve urgent and while i was in he would check if a bypass was needed.

I had it done ,went for my check up, got the all clear and am now back in thailand. It is not a pleasent

op but if its needed you have no option . Best of luck .... pete

[FBN]

In case you still consider Bumrungrad, Dr. Samphant Ponvilawan is probably one of the best Cardiothoracic surgeons around.

Check his credentials on the Bumrungrad website; he specialises in valve surgery..

An angiogram may need to be done pre-op as it is just about routine for valve replacement surgery but the echocardiogram is the essential one to establish urgency..

[Mobi]

I now have two echocardiagrams to hand - the one done in June 2010 states 'moderate aortic stenosis' and the one at Bumrungrad in December 2011 states 'moderate to severe aortic stenosis'

I have studied my results and genned up on the the Doppler calculations and have concluded that while my condition is nowhere near as bad as some, it is clearly deteriorating to the point where surgery will be required quite soon.

I am going to go to Rajawithi hospital and see how I get on there as I really don't want to shell out 1million Baht if I can get away with much less, with no lowering in the quality of treatment, but just having to be an 'ordinary' patient rather than a '5 star' patient.

But who knows, I may end up at Bumrungrad, so thanks for the info, just in case I need it.

[Mobi]

Just to update those who may interested and haven’t read the ‘blow by blow account in my blog.

I went to Rajawithi hospital at the crack of dawn on Wednesday, and as Sheryl indicated, it was quite a hassle to get through all the bureaucracy, form filling, and being sent from pillar to post etc., before I got to see a doctor some 5 hours later.

I actually lucked out, as when I first registered they thought my echocardiogram report from Bumrungrad was a GP referral letter, so I was processed to see the heart specialist rather than a GP as Sheryl had said would be the case.

Later in the process, a bright nurse did realise that I didn’t have the requisite referral but let me go through anyway.

The Doc was non-committal and insisted in having a new echocardiogram done before ‘evaluating’ my case, but he did tell my GF in Thai that he would discuss my case with his boss and determine how much I would have to pay for the op, so I am assuming that will probably be the end result.

The doc told me it would take two weeks to have the cardio test but it turned out to be 4 weeks so nothing will happen for another month, at least.

Meanwhile, I haven’t been feeling that great and my evening walks seem to be taking more out of me, so I guess my condition is gradually deteriorating. I think I will cut back on the exercise.

[Sheryl]

Yes, they always insist on doing the echo themselves and there is always a wait for that unless it is a life and death emergency.

You're faring better than my friend did. Took us literally 2 weeks to get to the cardiac surgeon...but she did manage to get the echo in only 2 weeks as a concession to the fact that she didn't live in Thailand and had travelled from abroad.

i must warn that once you have had the echo, there will be a further wait to be scheduled for the op.

Do be guided by how you feel in terms of taking it easy, and if before you are able to get the surgery at Rajawithi it gets to where normal exertion is leaving you short of breath you may have to bite the bullet cost wise and go the private route.

[Mobi]

Thank you Sheryl. I am scheduled for an appointment with the heart and diabetes specialists at Bumrungrad on 12 March, so I think I will keep those appointments and then have the new echocardio done at Rajawithi on 15th March.

That way I will be able to hear the up to date views from two doctors and make a final decision on all this. This is a major step for me, and I want to cover all bases.

All things being equal, and assuming I don't have to wait too long, I will go the Rajawithi route.

In the meantime, I am not feeling too bad, although my walks are taking more out of me than they were even a month ago, so I am cutting back a bit on that.