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"