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Thanks a ton, urbanscout50. Even if there's a healthy dose of "maybe" and "probably" in your answer, it’s enough to help me keep moving forward.
"Probably" nobody paid much attention to my carotid arteries before the surgery. I mean, the coronary angiogram showed totally clear vessels, and the carotid color Doppler didn't show any plaque either—so there just wasn't any reason to track their path all the way up to the brain. It was only after the procedure that everything actually surfaced. Between the kinking and the coiling happening right at the base of the brain, surgery would be pretty damn complicated. We're talking about a maxillofacial surgeon having to remove jawbone—I think that's how it sounds in Latin—and dealing with a massive amount of nerve fibers while they're at it... Anyway, opinions are split down the middle; some say it's a hard "no" on surgery, others say it's absolutely mandatory, and I'm just over here trying not to lose my mind. Personally, what matters to me is that before the surgery, I didn't have any heart issues, aside from the heart itself suddenly giving out. Everything started spiraling after that, so I'm pretty convinced it's all a consequence of the operation. Those vision gaps aren't happening every single day anymore—whether that's because the EKC emboli are clearing out or because I'm trying to keep my anticoagulant at 2.5 or higher, I honestly have no clue. My neurologist appointment isn't until late May, and I'll get a follow-up color Doppler at the end of this month. If the pressure in that pseudoaneurysm between the two bends starts climbing, I guess I won't have much choice but to go under the knife. In the meantime... keep your fingers crossed for me.
In any case, I'll check back in as soon as there's news—maybe we can all learn something from it.👍
I’m hanging out here because the cardiology section is a bit of a mess, and I was thinking maybe urbanscout50 or Scott Allen10 might have some insight to offer.
Back in July, I had heart surgery—they fixed my valves and put in a ring (St. Jude No 30)—and right after that, these vision issues started hitting me. Sometimes it's total blindness, other times the whole world just feels like it's spinning in a centrifuge... usually lasts about 20 minutes. A color Doppler pointed toward issues with my carotids, and an MSCT confirmed it. I was all set for surgery, but then—of course—I run a fever and everything gets pushed back. To be safe, since the neurologists suspect microemboli, they want me to get an MR. So, I went back under the knife to have them remove the wires used to close my sternum (we use wires here too), pull out the pacemaker wire that was accidentally left behind, and clear out some tissue buildup near the incision. Now, look—I’ve never really had issues with anesthesia before, and this was my third heart surgery in less than two years, but once they pulled the tube out this time, I could barely breathe. And God, the waking up part... the shouting and the frantic calling... it’s a pretty horrific memory, honestly.
The MR results came back saying: A solitary punctate lesion with high signal intensity on T2W and FLAIR sequences is visible at the left parietal corticomedullary junction. The subarachnoid space at the base and convexity of the brain appears widened. There is coiling of the distal segment of the left extracranial ICA and kinking of the distal segment of the right extracranial ICA, with lumen dilation (pseudoaneurysm) present immediately following the first kink. The vertebral arteries are elongated and tortuous without stenosis or aneurysmal dilation.
CONCLUSION: The MR scan of the endocranium shows a solitary microangiopathic change in the left parietal region, cortical reductive changes in the brain, and the aforementioned coiling and kinking.
So, here are my questions: Would things have played out differently if we’d had a solid carotid scan before the heart surgery? I’m not trying to point fingers or blame anyone, I just need some peace of mind. Would the extracorporeal circulation or the surgery itself have been handled differently if they knew what the carotids looked like? It would help me process everything if I have to accept that the surgery went sideways, because it feels insane that all these eye issues showed up only after the operation—before that, I was perfectly fine.
Second question: Should I go through with carotid surgery given these brain findings and where the carotid issues are located? I’m terrified the surgery might do more harm than good. The vascular surgeon saw the kinking and said it’s positioned too high to easily reach, basically saying, "We can try, but if we can't get to it, we stop." But what about the brain stuff on the MR? What does that actually mean? Am I allowed to risk leaving my brain without normal circulation just to take a shot at fixing the carotids?
What am I looking at regarding the surgery and anesthesia? And what happens if I just... don't do anything?
Thanks in advance, everyone! 😘
Hey everyone. I’ve been lurking here for a long time, basically hoping I could learn something from other people who’ve had surgery, or maybe just waiting for Trebor to chime in about the specific mess I’m dealing with. But at this point, I don't really have a choice—I have to ask.
I had surgery about seven months ago at the Mayo Clinic in New York City. It was a mitral valve repair with a ring replacement. Everything went smoothly at first—I was already up on my feet by the second day and was discharged by the sixth. But ever since the operation, my eyes have been giving me constant trouble. Sometimes I lose vision entirely, but usually, it’s more like the picture is just jumping or flickering. These episodes can last anywhere from a few seconds to forty minutes, and honestly, it’s terrifying... I never get any warning signs beforehand. It’s pretty creepy because I’m starting to feel like I’m becoming disabled. I can’t even cross the street without guessing what color the traffic light is, I definitely won't get behind a wheel because I don't want to kill anyone, and I can't even make it through a workday...
I’ve been bouncing from doctor to doctor for months now, and if anything, I seem to know less than when I started. Not that I actually understand 😕
The Carotid arteries were re-evaluated after the surgery, and apparently there's coiling in the left ICA and some double kinking in the right one, which has dilated to 8.5mm (something they didn't see before the procedure)
Could non-pulsatile blood flow be causing this????
Is it microemboli traveling to the occipital region? Or is it because I have to stay on anticoagulants for life and my INR levels fluctuate? (They decided this after they called off a carotid procedure when they switched me back to oral anticoagulants—my INR hit 2.75, and for the first time in four days after surgery, my vision was actually fine)
When I finally asked, "Surely I'm not the first patient you've seen with these issues?" the response was just—"Of course not." And that was it. Nothing else. Just a shrug. 😁
Help—what is happening to me?