Not really a Porsche topic, but something I hope can be useful to anyone out there who is faced with similar circumstances...
I was born in 1958 (46 in 2004), and have been fit and skinny all my life (6' tall, about 155 lbs). I raced bicycles as a teenager and again in my 30's, at a pretty decent amateur level, training about 20 hours/week. Since 1996 I have ridden more recreationally, about 3,000 miles per year. I have also watched my diet and cholesterol levels, which have always been low (e.g. as low as 117 when I was racing a lot). I have had some minor arrhythmia issues (paroxysmal atrial tachycardia, or PVST) that I've managed without drugs since I was 15. My family history is crappy, with my dad dying at 61 from an MI, and my mom dying at 74 from a post-operative arrhythmia (probably ventricular fibrillation) about 8 weeks after being stented to resolve a small MI.
I had a physical in late 2003, I'd had some premature atrial contractions (PAC's) that had been bugging me when sleeping, so I got my GP to get me a referral to a cardiologist to check it out (Dr. Klee). He heard a bit of a murmur (which I'd been previously diagnosed with) , so he wanted to do an echocardiogram. The PAC's he said were nothing to worry about and would likely resolve on their own, a 24-hr Holter monitor showed nothing unusual. My EKG was normal, showing the left axis deviation I'd been diagnosed with at 15, not a real problem. I had the echo done and waited for the results. Note that I had never had an echo done before, despite seeing several cardiologists since I was 15.
Dr. Klee found that my murmur was due to some tricuspid valve regurgitation, nothing to worry about. But the echo showed that my aortic root was dilated to about 5.3 cm, a normal dimension is about 2.6 cm. I had no idea of what this meant, but as an engineer, it didn't sound good to me. A CT with contrast was ordered. I went home and looked on the web - uh, oh, 5.3 cm is definitely NOT GOOD. Such a dilation inevitably leads to aortic dissection, where blood gets between the inner and outer layers of the aorta, excruciatingly painful and causing rapid death without immediate surgery. The dilation, or aneurysm, in my case, is in the ascending portion of the aorta, which connects to the arch (where the great arteries branch off), then to the thoracic aorta, and finally to the abdominal aorta, which splits off into the femoral arteries. From what I could tell, if the CT verified the results, I'd need surgery to replace the aneurysm with a graft, and possibly need aortic valve surgery if the aneurysm had pulled apart the aortic valve leaflets. I immediately contacted a close, long-time friend of mine, who is a perfusion technologist (heart-lung machine operator), who recommended to me a top specialist in this type of cardiothoracic surgery, Dr. Vincent Gaudiani, in Redwood City, CA.
Note that I was totally asymptomatic for this condition, and would have never known I had a problem until I had a dissection - which is what happens to thousands of people every year, such as the actor John Ritter, who died. I was very lucky this was caught!
The CT showed a 5x5 cm dilation of the ascending aorta, the rest of the aorta looked normal, as did my other organs. The decision was to operate, and I chose Dr. Gaudiani and his team for the procedure. I met him for a consult in late Janurary where he reviewed my CT and echo tape. He said I'd be a "chip shot" for him, and he indicated I would make a complete recovery and be able to do what I wanted once I recovered from the surgery. My long-term prognosis was no future need for follow-up surgery (i.e. the graft should last the remainder of my normal lifespan) and a normal lifespan. I do not have Marfan's Syndrome, which is often associated with aneurysms of the ascending aorta (my aneurysm was tubular and non-Marfenoid in appearance, which Dr. Gaudiani believes is a congenital condition in my case). I will need yearly CT's or MRI's to assess the aorta for any complications or further aneurysms (which, I'll get repaired the same way if the need arises).
The procedure was to do a mini-sternotomy (about a 4" incision through the top of my sternum) and replace my ascending aorta with a Dacron graft (Hemashield Platinum) which would be sized during the sugery. My aortic valve looked good, and only during surgery would they be able to tell if it was necessary to reimplant my coronary arteries into the graft. Dr. Gaudiani has done over 6000 cardiac surgeries, and as my friend informed me, is extremely skilled and fast, as much as twice as fast as other surgeons she's worked with. I would only be on perfusion for about 30 minutes, and given that increased time on pump is correlated with increased complications, that sounded good to me. I would also have a pre-op cardiac catheterization to look at my coronaries to see if there are any blockages that would need to be dealt with.
I live in Phoenix, so we stayed with friends in CA while I was in the hospital (Sequoia Hospital). I went in on Feb 2nd (2004) for the cath, with surgery on the 3rd. The cath is an interesting procedure. You go into a large radiology room, the put you on a table where you can see the monitor. You're administered a mild sedative, and are conscious throughout the procedure. A small incision is made where your leg and torso meet, and a catheter, which is a long tube, is inserted into your femoral artery. While watching on the X-ray, the cardiologist routes the catheter up into your aorta, around the arch, and positions it next to your coronary arteries, which are connected to your aorta close to your heart. He then injects a squirt of iodine contrast dye, which is taken up by the coronaries, outlining them on the exterior of your heart. My cath showed no blockages, glad about that, no need for bypass surgery in addition to the graft. After the cath, the assistant held a sandbag firmly on the incision for about 30 minutes, to make sure the bleeding stopped and that I didn't throw a clot. I had to remain prone for six more hours after the procedure, time to watch TV and sleep.
Next morning, I was up early and off to surgery. I took a Betadine shower the night before, and was prepped (shaved) in the morning after being wheeled in. My memories past this point are pretty dim. I remember being wheeled into the room, then waking up in the ICU, that's about it. I was pretty loopy for hours after waking, I'm sure I said some strange stuff to my wife and friends. The surgery went fine, I was on the pump only 25 minutes. My perfusionist friend scrubbed in and watched, she said my artery was big, but looked healthy. Dr. Gaudiani used a procedure he's developed for such cases, where he opened the artery, sewed in a 12 cm length of 2.8 cm diameter graft, then closed the artery up around it, instead of removing the aneuryesed artery altogether. As he said to me, a "natural bandage" that helps the collegen integration of the graft and promotes better healing. My coronaries did not need reimplantation.
When you wake up, after they've extubated you (I have a vague memory of that, it was no big deal), here's what you have in you: An IV going into your arm at your wrist, for administration of drugs. A neck line, where they have a probe that goes down into your heart so they can monitor your blood pressure and cardiac output directly. Two chest tubes, one in the center and one on my right side, for fluid drainage. Two wires, wrapped, on your left side that head to your heart, which are for connection to a pacemaker if you have an arrhythmia that needs to be managed. And a big incision down your sternum where they did the operation, covered with a bandage. You're also hooked up to an EKG through the standard 12-lead connection and the adhesive pads on your body.
My post-op had a few complications. While in the ICU, I had some internal bleeding, which wasn't discovered until my cardiac output started dropping due to the fluid buildup. They turned me (which they should have done earlier), and I dumped a lot of blood out through my chest tubes. My hematocrit (red blood cell percentage of your blood volume) dropped to 24 from a pre-op level of 43, so, they decided to give me four units of blood. Too bad I'd listened to them and had NOT gotten my friends and family to donate blood pre-op, as I had to take blood from the blood bank (O-negative). While HIV testing is pretty good, hepatitis C is not so good, so I hope I lucked out in the long run. Once I was in my room, I had some issues with PAC's keeping me up, and I was very constipated (most likely from the Percoset they were using for pain management). I also had some post-op water weight gain, for which they used Lasix (a diuretic). I peed about 5 liters in 3 hours - wow, that can make you feel like crap. After 4 days I was discharged, my crit was back up to about 32, and I received a shot of Procrit (artificial erythropoietin, the hormone that regulates your red blood cell generation). My post-op meds were 50 mg of Metoprolol (beta-blocker) daily, folic acid daily, and Vicodin for pain management. I never took the Vicodin, depending instead on Tylenol and Advil for pain management. I had trouble sleeping the first few days, so I got a prescription for Ambien for sleeping. We flew back home 3 days after my discharge.
I was able to walk around the ward when in the hospital within a day of surgery, and got better as time went on. I could walk a couple of miles outside within 2 days of my discharge, and within a week to two weeks, could walk up to 5 miles at a time in fairly hilly terrain. My sternum hurt quite a bit at first, but healed well and I went off pain meds for it within about 3 weeks of discharge. I continued to have problems sleeping, which I attributed to the Metoprolol, pain, and some PAC's. I started eating two bananas a day for added potassium, eliminated caffeine from my diet (except for a Coke now and then), reduced my sodium intake (by watching labels and making better choices when dining out) , and limited my alcohol intake to one drink a day (generally, 6 oz of red wine). As a result, my PAC's went away for the most part. I started driving again at about 3 weeks after my discharge, and riding my bike (road bike) again at 5 weeks. I was able within a week or so to ride about 15 miles in mildly hilly terrain at about 17 mph average speed. I expect that in time I should be able to approach or exceed my previous fitness levels. I was able to start mountain biking at about 7 weeks, which went very well. I was concerned about spiking my heart rate when doing anaerobic sections (e.g. ledges and sharp pitches) but had no problem when I tried them, limiting my heart rate to about 160 bpm. I caught a couple of colds from my kids during my recovery, which slowed things down but were resolved quickly.
It's now been 9 weeks since my surgery. I had some problems with the Metoprolol, I found my bp going up and down all day, between 110/80 and 150/100. I got my new cardiologist (Dr. Robertson) to let me reduce my Metoprolol to 25 mg daily, and supplement it with 150 mg daily of Avapro (irbesartan), an angiotensin II receptor blocker (ARB). It took about 2 weeks to kick in, but now my bp is about 110/70 most of the time and I'm working on kicking the last of the Metoprolol, which I dislike as it limits your cardiac output for aerobic activity. I couldn't get my heart rate above 140 bpm when I was on 50 mg of it daily, now I have seen 160 bpm and feel much better. I've continued to have some sleep problems, mostly with my heart pounding hard when dozing off, and I've used Ambien when needed.
As far as I can tell, everything went fine and in time I should be back to my previous fitness levels or better. I'm extremely grateful to my wife, kids, and friends for their support and assistance with this ordeal. I couldn't be more pleased with the staff and nurses at Sequoia for my care while there, and my biggest thanks is to Dr. Gaudiani and his team, who provided me with the best possible outcome for my surgery. I'm grateful this problem was discovered and successfully repaired before I had secondary complications or a dissection, and I am looking forward to a full recovery.