Ah, so that explains it

So as I said in my last post, I've been feeling a lower exercise threshold over the last year.  Sort of like a glass ceiling, I explained to someone, where I feel like I should be able to do more, but am held back.

Well a visit with Dr. Ringel confirmed it's not my imagination.  My pulmonary artery is indeed narrowed again.  Not as severely as the first time, mind you, but narrowed nonetheless.

It's academic to know exactly what happened, but it's one of three things: 1) the stent is fractured, 2) the stent is crimped, or, 3) my tissue grew into the stent.  In each of these cases, the artery is narrowed and, when I exercise vigorously, not enough blood is getting to my lungs.

While I otherwise feel fine, this is not a condition my heart can handle for the long haul.  The heart needs to work too hard to push blood through this smaller-than-normal opening, the effect being a right ventricle that grows in size.  When the ventricle size reaches some threshold, the way understand it, it won't pump as well.  And if it's like a left ventricle that's overtaxed, it could reach a point where when the root issue is resolved it would never return to normal.  That would be not good.

So there are two keys to knowing the next step.  One, if I decide I don't like how I feel, I could work with Dr. Ringel to fix the problem now.  I won't say, at least today, that I'm there yet, both physically and mentally.  That is, I generally feel fine and the exercise threshold is high enough that I can deal with it.  But because the stent procedure in 2009 eliminated my pulmonary valve, there's no such thing these days as a permanent solution.  Anything we do now is only temporary.  Once I get the first procedure, it generally follows that the second procedure will be sooner down the road.  There's a part of me that doesn't want to get on any road until I need to.  More on this later.

But it's not all about about how I feel.  The second key is the analysis of test results that look at my right ventricle.  If my right ventricle is getting too large, Dr. Ringel will recommend we fix the problem now.  Seems easy.  But the trick, however, is getting results that give enough information.  The best test for most people is an MRI, but alas this is not the case for me.  Because it is metal, and because of its placement, my stent would almost certainly create noise in an MRI exactly where the data is that we need.  So in the meantime, Dr. Ringel's staff is looking closely at the CT I had done in August, and combining that with a recent echocardiogram, in hopes of learning what's going on.  We shall see.

With that, I will close.  In my next post I'll talk about the solutions that we'll be looking at.