The
When Anesthesia
Poses A Coronary Risk
MARSHALL FRANKLIN SPECIAL TO THE JEWISH NEWS
ark Kruze needed circulatory disturbance that
eye surgery that would might occur during the opera-
require general anes- tion.
For example, it is common
thesia, but his sur-
geon wanted cardiac clearance for the blood pressure to drop
because he heard a heart mur- several points due to anesthet-
mur. The surgeon was con- ic effect or surgical manipula-
cerned that the murmur might tions.
Normally, the heart prompt-
indicate a high cardiac risk for
administering general anesthe- ly responds by increasing its
pumping force to return the
sia.
Mark had played tennis until blood pressure to a safe level.
a year before, but had to stop The tight aortic valve blocks this
because his eyesight would compensatory mechanism. If the
sometimes fail, causing him to lowered blood pressure persist-
lose his visual orientation and ed, his circulation could fail.
I reviewed Mark's alterna-
fall. Further evaluation indi-
cated a neuromuscular eye prob-
lem requiring complex surgery
with general anesthesia to cor-
rect.
I evaluated Mark in my office.
He was a healthy-looking 71-
year-old with no symptoms to
suggest a serious heart condi-
tion. On physical examination I
heard a very loud murmur that tives with him:
• He could have the eye
suggested a major narrowing of
the main outlet valve of the surgery done using special mon-
heart, something called aortic itoring of his heart and circula-
tion during the procedure to
stenosis.
An echocardiogram confirmed improve safety. This would in-
that suspicion, while EKG test- clude the insertion of a Swan-
ing suggested he also might Ganz heart catheter to monitor
have a coronary artery problem his circulation during the pro-
cedure.
as well.
• He could undergo heart
I informed the surgeon and
surgery
(aortic valve replace-
Mark of my findings. I suggest-
ed a heart catheterization test ment) first. This would alleviate
to define the extent of the heart the blockage caused by his tight
condition more clearly and help aortic valve. After recuperation
determine the risk general anes- from heart surgery, he could
have the eye surgery done at a
thesia might pose.
Using measurements ob- much lower risk.
• Because he was having no
tained by cardiac catheteriza-
symptoms
from his heart and
tion, the degree to which the
aortic valve opens can be calcu- was not incapacitated by his eye
lated. The normal aortic valve condition, he could do nothing
opens wider than 1.5 square cen- and be followed carefully for
both as an outpatient.
timeters.
If Mark chose the first option
We begin to be concerned
noted
above, his operation would
when the valve does not open
more than 1.0 square centime- probably go well, but the aortic
ters, while an opening of less valve problem would contradict
than 0.75 square centimeters in- his playing tennis again. The
dicates severe - and potentially absolute need for aortic valve
replacement surgery would
dangerous - aortic stenosis.
The catheterization study be signaled by the appearance
confirmed severe aortic stenosis of symptoms: shortness of
with a calculated aortic valve breath, angina pectoris or faint-
opening of 0.61 square centime- ness.
Mark's initial decision was to
ters. Fortunately, there was
no serious coronary artery prob- do nothing and just leave things
as they were. In time, if his eyes
lem.
These findings put Mark at got worse or he developed car-
a significant risk for the admin- diac symptoms, he would re-
istration of general anesthesia. consider his options. At the time
With such a tight valve, the of this writing it is one and a half
heart would not be able to com- years later, and he is still hold-
pensate for any temporary ing his own without any dete-
rioration. E
(c) Copley News Service 1996
Dr. Marshall Franklin is a San
Measuring
the aortic valve
opening.
Diego-based cardiologist.
24111 Civic Center Drive • Southfield, MI 48034
Welcomes...
Alyssa Tobias
Masters of Social Work
to our staff.
(810) 352-0208
ormel Gifts &Toy
*Unique Personalized Gifts*
Mcirmel Gifts & Toys
28857 Orchard Lake Road
Farmington Hills, MI 48334
(810) 553-3250
Off
ANY PURCHASE OF
$25.00 OR MORE
$5.00
Store Coupon • Expires December 24, 1996 • Limit 1 Coupon Per Family
"","."
1 7,7 7,722',W.747.4"",
""
••• ' 7, 7t7 e717-1.7<77,7"