Managing Gallstones: Surgical Risks with Heart Valve Issues

Gallbladder surgery

Hello, Doctor.
Last month, I went to the emergency room due to discomfort in my upper abdomen and was diagnosed with gallstones.
I have scheduled surgery for gallbladder removal on January 19.
However, during the emergency visit, three electrocardiograms were performed, and one showed abnormal waves.
As a precaution, the gastroenterologist referred me to a cardiologist.
After undergoing an echocardiogram today, it was discovered that I have valve stenosis.
The cardiologist mentioned that since the gallbladder removal surgery requires general anesthesia, there are associated risks, and therefore, he advised against proceeding with the gallbladder surgery.
I am now unsure of what to do.
If I do not have the gallbladder surgery, my CT and ultrasound show that the gallstones have already occupied half of the gallbladder.
However, there is a risk to my heart if I proceed with the surgery.
Is it true that aging heart valves make surgery unsuitable? Thank you, Doctor.

Mr. Tang, 70~79 year old female. Ask Date: 2018/01/09

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
It is essential to have a cardiologist and a cardiac surgeon evaluate and manage your heart valve issue to prevent long-term cardiac dysfunction.
Once your heart is stable, you can proceed with gallbladder surgery; however, there is a risk of developing cholecystitis before your heart has fully recovered.
It is important to be prepared for a more complex situation at that time.
Changhua Hospital is concerned about your health.
Sincerely, Chen Shih-Dian.

Reply Date: 2018/01/09

More Info

Managing gallstones in patients with underlying heart valve issues presents a complex clinical scenario that requires careful consideration of both the risks associated with surgery and the potential consequences of delaying treatment for gallstones. In your case, the diagnosis of gallstones and the discovery of aortic stenosis (valve narrowing) necessitate a multidisciplinary approach involving both gastroenterology and cardiology.

Understanding the Risks
Gallbladder surgery, particularly laparoscopic cholecystectomy, is generally considered safe for most patients. However, in individuals with significant cardiac issues, such as aortic stenosis, the risks associated with general anesthesia and the physiological stress of surgery can be heightened. Aortic stenosis can lead to reduced cardiac output, which may be exacerbated during surgery, potentially resulting in complications such as heart failure, arrhythmias, or even myocardial infarction (heart attack).

The recommendation from your cardiologist to avoid surgery is likely based on the assessment of your cardiac function and the potential for perioperative complications. The heart's ability to tolerate the stress of surgery is a critical factor in determining whether it is safe to proceed.

Evaluating the Options
1. Cardiac Evaluation: It is essential to have a thorough cardiac evaluation, which may include echocardiography, stress testing, or even cardiac catheterization, to assess the severity of the valve issue and overall cardiac function. This will help determine if your heart can withstand the stress of surgery.

2. Medical Management: If surgery is deemed too risky, your healthcare team may consider medical management of gallstones. This could involve monitoring the condition, managing symptoms, and possibly using medications to dissolve gallstones, although this is less common and may take a long time to be effective.

3. Timing of Surgery: If your gallstones are causing significant symptoms, such as biliary colic or pancreatitis, the urgency for surgery increases. In such cases, your cardiologist may recommend optimizing your cardiac condition before proceeding with surgery. This could involve medications to manage heart function or even interventions to address the valve issue, such as valve replacement or repair, prior to gallbladder surgery.

4. Surgical Alternatives: In some cases, minimally invasive techniques or alternative surgical approaches may be considered, which could reduce the stress on the heart. Discussing these options with both your gastroenterologist and cardiologist is crucial.

Conclusion
In summary, the decision to proceed with gallbladder surgery in the context of heart valve issues requires a careful balance of risks and benefits. It is essential to engage in open communication with your healthcare providers, including both your gastroenterologist and cardiologist, to develop a comprehensive treatment plan tailored to your specific health needs.
Your heart's condition does not automatically disqualify you from surgery, but it does necessitate a thorough evaluation and possibly a staged approach to treatment. The goal is to ensure that any intervention you undergo is safe and effective, minimizing risks while addressing your gallbladder issues. Always feel empowered to ask questions and seek clarity on your treatment options, as informed patients often achieve better outcomes.

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