Still stable, but a wobble

Was it really 9 months ago that I said I'd "write more when I have time" and "my next checkup will be in another six months"?  Yes and yes.  But considering my heart checkup was just this week (due to scheduling) I don't feel terrible for not writing, just a little guilty.

First I'll say I've been feeling great, especially since I started exercising more since the summer.  The great Fall weather, like-minded friends (and daughters!), long work days, and convenience of gyms & working out at home all helped motivate me. Just this week I re-ran the stairs at the Johns Hopkins outpatient building (pictured here) as a measure of my condition -- I've been doing that for a few years.  I ran 5 1/2 flights (165 steps) before needing to walk and then rest.

My echocardiogram this week, along with my cardiologist's expertise in interpreting such things, confirmed my heart is doing as well as I feel.  Both the right and left ventricles are performing well.  The right is enlarged as expected, but it hasn't grown since last year.  A measure of blood flow across the stent in my pulmonary artery hasn't changed either, indicating that artery hasn't changed in size.  And my aortic valve, which was the original problem we addressed in 2008, is happy.  All of these are very good things.

So while I'm doing great, there is an indication the stent is not.  A test in the next weeks will confirm, but it appears the integrity of the stent itself is in question.  If the test confirms the stent is structurally unsound, we'll have to act soon.

First, a refresher.  The stent is a wire mesh tube, 19mm (3/4 of an inch) in diameter, and maybe 65mm (2.5 inches) long.  The stent holds open the pulmonary artery at the heart, which is where the valve rejection (and narrowing) took place.  By design, the stent extends into the right ventricle a few millimeters, rather than stopping right at the interior wall.  This placement, I gather, either keeps tissue from covering the stent opening or the muscle crushing the end of the stent -- I don't actually know and, I suppose, it's academic.

The problem is a wobble.  When viewed in the echocardiogram, a 2 dimensional video, the end of stent inside the ventricle is moving as the heart functions.  This suggests one or more fractures in the metal.  Enough wobbling and the stent becomes structurally unsound, and ultimately the end breaks off.  To me, if I absolutely must have metal floating around in the body, inside the heart and on the way to the lungs is one of my very last choices.  And while my cardiologist says this wouldn't necessarily be as bad as it sounds, I'd much prefer to avoid it.

Thanks to the wonders of modern medicine, and a bit of radiation, a quick, non-invasive flouroscopy will determine the condition of the stent.  This 3D view will tell us whether the stent needs attention immediately, or whether we can monitor it over time.  The test isn't scheduled yet, but I expect it sometime in the next week or so.

In the meantime I'll avoid activities that might impact the chest, like kickboxing as my doctor joked.  Instead, I'll be preparing for some longer bike rides and, with Eddie's help, establishing a time for the 100 meter dash and working to improve it.

Thanks for listening, and look for a followup soon :-)