From: km@speedy.cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: Congenital Heart defect - 2nd surgery?
Date: 23 Aug 92 02:56:18 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Organization: Computer Science Dept., University of Pittsburgh

In article <14968@ksr.com> dhb@ksr.com (Don Barstow) writes:

>2. Two remaining problems found via angiogram in 1989  - 50% SVC
>   drainage into left atrium, and one right pulmonary vein still
>   drains into right atrium.  These were apparently handled wrong
>   or not caught at all in my first surgery.

The SVC drainage into the left atrium is a "right to left shunt",
which results in unoxygenated blood (from the SVC) mixing with
oxygenated blood (from the pulmonary veins). The result is some
degree of hypoxia, and which will cause you the shortness of
breath and fatigue that you experience.

The pulmonary vein drainage into the right atrium effectively
causes a "left to right shunt". This does not contribute to
hypoxia, but makes the right side of the heard pump more blood
than the left, although the fact that you have the anomalous
SVC drainage may cancel this difference out.


>
>My main questions related to deciding if I should have the surgery are:
>1. Are there any known ways to quantify the risks of complications
>   due to the scarring in the RA I would have after a second surgery?

I don't know the answer to this.

>2. If I develop an arrythmia, and need a pacemaker, how normal a
>   lifestyle could I have?

That depends on the nature of the arrhythmia, not the pacemaker
per se. Pacemakers these days are very sophisticated, and most
patients have no problems at all dealing with them.

>3. What is a good textbook on cardac surgery I could read to understand
>   more about the procedures involved?

I don't know the answer to this, either. I am not a surgeon.

>4. Could I get this done just about any place that does cardiac surgery,
>   or should I only go to one of the top few places in the country?
>   (I go to Mass General, now).

NO! There are very few places that are adept at dealing with 
congenital heart surgery in adults. I would stay with Mass General.
Maybe someone else has more input on this - a long time ago I
had an adult patient with persistent truncus arteriosus, and this
was at an excellent University program. We sent the patient across
the country for the surgery, however, to a place with more expertise.


>5. What are the main problems I am likely to have if I don't have
>   the surgery?

This really cannot be answered without a good quantitative review
of your cardiac catheterization, by the people who performed it.
This all depends on the degree (percentage) of shunting, and the
degree of hypoxia. I would not try to answer this over the net.

>6. Should I or should I not exercise now?

Same answer as #5 - you need to review this with your cardiologists.
Your age, other health factors, etc. will enter into this, but if
you are already experiencing significant shortness of breath, I
suspect that exercise will make you much more symptommatic.

>7. Any other ideas or suggestions?

These cases are all very individualized - the anatomy is different
in each case, so that what to expect and what to plan for must be
different for each patient. The cardiac catheterization is the
gold standard for data in these cases, and this data should be
discussed with you by the cardiologists.

 -Ken Mitchum MD
 km@cs.pitt.edu
Newsgroups: sci.med