Which is better: heart valve replacement by surgery or catheter?
DEAR DRS. DONOHUE AND ROACH: My wife and I face a dilemma. Her aortic valve is narrowed and needs replacement. We have two options: transcatheter replacement of the valve, or cracking the breastbone open to reach the valve. Most of the articles we have read suggest the catheter approach. My wife's cardiologist said that method is too experimental and the possibility of infection is greater. I can see how it is more difficult to ascertain the correct size of the valve in the catheter method. My wife is 81, slender and has maintained her current weight of 100 pounds on a body of 5 feet 1 inch for 30 years. She is in good physical condition. -- A.G.
ANSWER: For readers, the catheter replacement of the aortic heart valve involves using a thin, pliable tube -- a catheter -- to transport the new valve into the heart by introducing the catheter into a surface vessel and inching it to the desired heart location. With surgery, the sternum (breastbone) has to be split for the surgeon to reach the heart and the site for the valve replacement. There is no argument that the catheter approach is easier on the patient. There also is no argument that the chest approach has been around for a longer time, and heart surgeons are more familiar with it.
The immediate outcome of surgery and transcatheter replacement are equally good, and remain equally good for two years. Later, leakage of the valve happens more often to the transcatheter-placed valves.
Currently the surgical replacement of the valve is the mainstay treatment for reasonably healthy people. For those unable to withstand the rigors of surgery, catheter replacement is the better choice.
Why not discuss this matter with the surgeon who has been chosen to perform the operation? You'll hear both sides of the story.
As for your fear of an error in judging the size of the valve in the catheter procedure, exact dimensions are obtained by ultrasound pictures of the aortic valve area before either procedure is done.
DEAR DRS. DONOHUE AND ROACH: Please explain degenerative changes of the spine noted on an X-ray. I have known that my back is very bad for quite a while. What exactly are these changes? What are remedies for it? -- J.O.
ANSWER: "Degenerative" changes of the spine is the same thing as saying you have osteoarthritis of the spine. Osteoarthritis is the most prevalent kind of arthritis, the kind of arthritis that comes with aging. Bone spurs form on the backbones, back disks shrink and the situation is painful.
Tylenol is one way to relieve the pain. If it doesn't, you can try nonsteroidal anti-inflammatory drugs like Aleve or Advil. You should use them intermittently and carefully. They can irritate the stomach and cause bleeding.
Physical therapy is another option. The therapist can limber your back and show you how to safely increase the back's range of motion. Exercising back muscles is another way to lessen the pain. Every hospital has a department of physical therapy.
DEAR DRS. DONOHUE AND ROACH: Please provide me information about alopecia areata. -- D.S.
ANSWER: Alopecia areata is a scalp condition in which round patches of baldness appear on the scalp. They may also appear in other places, like the eyebrows. It's due to an immune attack by the body on its own hair follicles. No one is sure what prompts the attack.
A few people have a spontaneous regrowth of hair in a matter of months. Others have regrowth in one to two years, or longer.
Injecting the bald spots with a cortisone drug often prompts a return of hair. Other treatments are available if the cortisone treatment fails.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.
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