No matter where we are in our aortic journey, checking on aortic status (aorta, aortic valve, heart overall) inside the chest is part of life, as long as we live. It is so fundamental that it is the "A" in the Bicuspid Aortic Foundation's "Aortic ABC's".
Imaging tests such as echocardiogram, CT, and MRI, provide a great deal of information about aortic disease. Providing amazing detail, state-of-the-art CTA tests provide vital information, including aortic valve leaflet function in the beating heart.
Serious, life-threatening issues with the aorta in the chest may be silent, nothing wrong is "felt". Imaging studies to check the aorta (and heart) are important in order to prevent potential injury and loss of life.
Following is an account of the tragic loss of a young man whose aortic CT scan was not done in early June as planned, due to a COVID-19 lockdown at the hospital. He collapsed while jogging on August 13th and died August 15th. The CT scan intended to check the status of his aortic stent was never done. Reading about the damage inside his body that ultimately took his life is indescribably shocking, horrifying. He was only 19 years old.
Between a Rock and a Hard Place in 2020
COVID-19 complicated decisions around imaging in my own family this year. Initially all went so well, when someone traveled out of state to receive a TAVR valve along with a stent to protect blood flow to the heart. Yes, highly skilled hands saved a life, just before most medical facilities "locked down". But plans for follow up imaging, both echo and CT, were deferred. And then, when an echocardiogram was available locally, it showed an alarming increase in pressure across the new TAVR valve.
What could possibly be wrong?
One possibility was a complication called leaflet thrombosis that sometimes happens with biological valves. Blood clot formation, including the potential to block the stent which would be deadly, needed to be ruled in or out. It would take a specialized CTA scan to understand what was happening, only available by out-of-state travel.
Weighing the Risks - the Virus or the Heart?
Sometimes the decisions that must be made can be almost overwhelming. The specialized CT protocol was shared with local medical cardiac professionals, but they could not provide it there. The choice was: risk COVID exposure, including air travel, or risk the new valve and stent. Either one was potentially deadly. Ultimately, the decision to travel was made, taking all possible precautions.
What happened?
The specialty CTA scan revealed that the TAVR valve and stent were fine, no blood clots! It was explained that sometimes, in a case like this, the echocardiogram is not able to accurately calculate the pressure difference across the aortic valve. Yes, sometimes it is complicated.
It was good news, but risk was taken to get it. Thankfully, the travelers did not contract COVID-19. This is the reality of dealing with aortic disease in the chest - the aorta and the heart - in 2020. Aortic disease is challenging for many reasons, and the unknowns of COVID-19 have added to those challenges, as it has for other conditions. I have had conversations with others who struggle with going for follow up echocardiograms and cardiology visits. To date, they have done so safely, as hospitals and physicians develop sanitation protocols to protect everyone. There is a renewed emphasis on infection prevention, which is a good thing, for both viral and bacterial infection prevention.
As you and your doctors
follow your aorta and your heart,
in 2020 and the years to come,
you are
Creating a Climate of Hope,
~Arlys Velebir
Bicuspid Aortic Foundation
No comments:
Post a Comment