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Forum Name: Miscellaneous Cardiology Topics

Question: Stent Placement Now Bypass & Valve replacement


 cfusse - Sun Nov 09, 2008 10:37 am

Hello,

I apologize if my post seems quite long. My mother, age 61, with diabetes type 1, and CAD had chest pain and visited the cardiologist. After her visit, it was determined that she needed a stent placed.
She then proceeded to go into the hospital for a stent placement two days later. I was told that the physician that placed the stent said that the blockage was so severe that the artery rerouted itself? That when he went to place the stent the artery "blew out". She then was to have emergent bypass surgery done. During her preparation for the bypass surgery she suffered a myocardial infarction. The bypass was successful as far as I know.
She then was transferred up to the CCU for recovery. What followed was horrible. Of course she was placed on many forms of life support, ie. ventilator, dialysis, heart pump, and her prognosis was unknown. My family was then notified by the surgeon that my mothers mitral valve was not functioning correctly. It was leaking but they thought it may be from the fluid overload because her kidneys were not functioning.
The doctors decided to let a few days go by and see if the valve would recover. It did recover but the problem just came back. We were then told she would have to have the second surgery to replace her mitral valve and have a ring placed around her tricuspid valve. They did not know if she would make it through the surgery due to her poor health.
Well, the surgery was a success and as of now she had the ventilator removed yesterday but she still has kidney failure.
My question is, could this have been prevented? When you do a stent placement can you tell if it just won't work and decide to go ahead with bypass? Will her kidney's come back?

Thanks so much for any help!
 John Kenyon, CNA - Wed Nov 12, 2008 1:10 am

User avatar Hello -

First, I'm very sorry to hear your mother has had to endure such a complex and problematic course and hope things are improving even as I write this.

What I believe the doctor meant by the artery having "rerouted" itself is that the blockage was severe enough that the heart built its own bypass, called a collateral blood supply. While this is usually a positive thing, if the collateral is too small (or there is only one and it's not large enough to perform the function of the original artery), then the original artery still needs to be stented or bypassed. In attempting to place another stent it would seem the artery dissected, which is a rare but far from unheard-of complication of angioplasty and stent placement. It often can cause a long enough interruption of blood supply to cause an MI, which is another recognized potential complication of percutaneous angioplasty and/or stent placement. Both dissection and subsequent MI are relatively rare, but happen often enough to be noted ahead of time as a possible complication of the procedure. They do happen occasionally.

It seems as though almost everything that could go wrong did this time, as some myocardial infarctions (MI) can affect the way the ventricular wall moves, that it disturbs one of the valves, and the mitral valve is complex enough to be affected more often than not when this is the case.

To answer your bottom line question, it is very difficult, as a rule, to forsee the kind of catastrophic complications that your mother suffered. When these are predictable, the procedure isn't performed, at least not without discussing the additonal risks in advance. Usually it is a surprise to everyone. The cascading effect of injuries is not surprising in itself, just unusual enough to be a surprise when most such procedures go without a hitch. Not all, however, and your mother happens to be one of the exceptions that proves the rule.

I am very grateful she's doing so much better now. As for her kidneys, much depends upon the reason for the failure, and again, this is not unusual in the cascade effect, where one organ failure leads to that of another. Since her heart seems to be functioning far better now, there is a very good statistical likelihood her kidneys will recover their function, assuming there was no pre-existing kidney disease before the procedure and surgery.

Your mother sounds like someone with a substantial constitution to have survived the other mishaps, so I would bet on her recovering her kidney function as well. It's impossible to know any of these things with any certainty, and especially at a distance, but given the facts as you've presented them here, I think she may do well over time. I certainly hope she does.

I hope this helps answer your question. Please stay in touch with us here.
 cfusse - Wed Nov 12, 2008 10:51 pm

Hello,

Well my mother is still in CCU and still having problems. She now is going to have a pacemaker placed. She is dillusional and saying things that don't make sense. Is this related to the kidney failure as she is not producing enough red blood cells to get the oxygen to her brain? I am having a difficult time not being able to be by her side as I live out of state and had to return home. I will keep you posted as I hear. Thanks so much for your reply. Thanks to the good that people like you volunteer their time for people hurting like us!
 John Kenyon, CNA - Thu Nov 13, 2008 11:39 am

User avatar Hi -

The disorientation could, in part at least, be due to kidney failure, mainly because it permits toxins to build up in the bloodstream. However, it's fairly common for this to happen with extended ICU stays anyway, for a variety of reasons, some not clearly understood. Usually once the patient is well enough to be returned to a regular room the disorientation resolves. Hopefully this is the case with your mother. Please continue to update us.
 cfusse - Mon Dec 08, 2008 12:12 am

Hello,

I am giving an update on my mother. She has returned home. She finally made it over the hump and was able to convince the doctors to let her go home instead of a rehab center. She was taken off of dialysis and her kidneys are now functioning. She is now following the posts as much as she can. She tells me that she cannot use the computer as her hands are having horrible tremors. She also complains of not being able to concentrate or focus for very long. Can you give us an explanation as to why this may be happening. I imagine this is very emotional and devastating not to be able to handle daily tasks as before all this happened and I worry about her emotional needs. Thanks for helping!
 John Kenyon, CNA - Mon Dec 08, 2008 3:44 pm

User avatar Hi there -

Well, great news and some not-so-good news. While I'd like to emphasize the good news (your mom's home, she's off dialysis, she's over the hump and doing much better) I also understand the concern over the tremors and difficulty concentrating, and this probably would have been better addressed in a rehab facility (and is one of the main reasons that would have been offered). Of course this can be addressed on an outpatient basis as well, or should be. In fact, I would think the insurance company would be happier to have it worked on via outpatient basis.

But what is going on? Simply this: during the traumatic (to her body) events that resulted from what might otherwise have been a routine surgery, your mom's central nervous system has taken a hit. This is pretty common, and there are a lot of ways of mitigating the problems, most of which would involve some sort of physical therapy as well as, possibly, medication to help with mental clarity as well as controlling the tremors. This would depend upon how "deep" the CNS trauma is found to be. Often these things will resolve on their own over time, but because of the demoralizing effect, many times the things (routine activities) don't take place and so the problems linger. Physical therapy, outpatient rehab, is probably the best route toward resolving these lingering problems. Also, balancing the good news against the bad (she's out, she's home, she's on the mend, etc., vs. her hands shake and she's limited in what she can do right now) is important, because keeping the balance on the positive side in remarkably effective in the overall outlook. It's not just a mental "trick", either. It really makes a difference in the future improvement of the patient. People who feel positive about their situation, on balance, tend to do better overall. Now the bad thing already happened. It's been survived and that's a huge positive. There are often CNS aftereffects, but the prognosis for those (the tremors, etc.) should be pretty good.

I'm awfully happy to know your mom made it over the big bump, is home (a much better place than the hospital in general), and has recovered her kidney function. The remaining problems should be relatively easy to manage, and if they are kept in the proper perspective it can be a very literal help. But I would look into rehab/PT on an outpatient basis for sure, as this would speed the improvement of the remaining CNS issues.

Thanks so much for the update and again, I'm extremely happy to hear about the positive outcome. The rest can be managed. Best of luck to both of you, and please do stay in touch with us here.

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