10 years of refusing heart surgery, the man almost died

Ho Chi Minh CityThe 62-year-old man, with stenosis, open heart valve, worsened heart failure since 2012 but resolutely refused to operate for fear of death, leading to worsening illness.

He eats poorly, is malnourished, weighs only 43 kg, was examined at Hoan My Saigon Hospital last month due to very difficult exercise, uncomfortable walking a few steps, chest pain, shortness of breath, many Difficulty breathing at night until insomnia, having to lie down with his head high, sometimes having to sit to breathe. In 2017, after undergoing appendectomy, the doctor diagnosed the patient with very severe heart failure, grade 3, requiring urgent surgery but he still did not change his mind. Recently, the instability increased gradually, he had to be hospitalized once every few days, so he was hospitalized for surgery.

Dr. Luong Cong Hieu (Department of Cardiovascular – Thoracic Surgery) said that this is a case of severe acute heart failure on the background of long-term heart failure, with heart valve disease. The doctors consulted, determined that the patient’s heart failure was in the end stage, which had affected liver function leading to cirrhosis as well as vasomotor dependence, unable to be discharged from the hospital.

Fortunately, the assessment of heart valve damage shows that there is still a chance for surgery to treat these injuries, helping the heart function not to worsen, the patient can recover, so the doctor decided to plan surgery. The patient had to undergo a week of medical treatment to stabilize acute heart failure as well as improve liver function. Then, in an operation that lasted about 6 hours, the doctor replaced the mitral valve, repaired the tricuspid valve, and placed an aortic regurgitation balloon.

Doctor Nguyen Thi Thu Mai (Deputy Medical Director of the hospital) said that the prognosis for the postoperative recovery process will be severe with the progression of heart failure, kidney failure, liver failure, pneumonia, respiratory failure… Therefore, the hospital has carefully prepared plans from the beginning. After 14 days of arduous and challenging treatment in the recovery area, the patient’s hemodynamics gradually stabilized, heart function improved, other organs such as liver, lungs, and kidneys gradually improved. The patient was transferred to the normal treatment area, enhanced nutrition, exercise combined with physical therapy for a week and just recovered from the hospital.

According to Dr. Hieu, the heart valve is a structural system that ensures blood flow between the chambers of the heart according to a stable cycle. Heart valve disease occurs when one or more heart valves do not function properly to allow blood to flow in one direction. There are two common forms of valvular heart disease, stenosis and regurgitation, which can occur due to many causes such as congenital, degenerative, cardiomyopathy, myocardial infarction, rheumatic heart disease…

For heart valve diseases, valve repair surgery at an early stage will help patients recover quickly, have a short hospital stay, and preserve heart morphology and function. In the late stage, the patient’s symptoms are getting worse and worse, being hospitalized many times with an increasing density, organ functions are adversely affected for a long time, reducing the quality of life. Surgery at a late stage has a high risk and complication rate, not to mention a long hospital stay, creating a burden of costs. In the worst case scenario, delaying surgery can lead to end-stage heart failure and even death.

“This case will die without surgery. End-stage heart failure patients are usually predicted to die about 50% in a year”, Dr. Hieu analyzed. However, stage 4 heart failure does not mean that the patient does not have a chance to recover. There are causes that can make heart failure worse such as heart valve disease, coronary artery disease, pulmonary embolism… If the cause is resolved, the patient’s heart failure will improve, from stage 4 can become stage 2-3.

Doctors recommend that when the patient has symptoms, the heart has been affected in function and morphology. Therefore, it is recommended to have regular cardiovascular health check-ups to help detect diseases early as well as comply with the advice, monitoring and treatment of doctors from the early stages of the disease.

Some common signs of cardiovascular disease are shortness of breath when doing heavy work or exertion, prolonged shortness of breath often causing the patient to lie down or sit up. Patients often experience shortness of breath at night, or have palpitations, palpitations causing arrhythmias, more severe can lead to atrial fibrillation, atrial flutter…

Le Phuong