Dr. David G. Kastl

It is assumed that the blood is not in the form of a liquid that can be removed with simple chest tube placement or a much smaller tube drainage called a thoracentesis. Therefore, the blood is in the solid form and requires removal called a decortication. Thoracentesis, decortication and chest tube placement are not technically "lung surgery" but procedures perform in the space between the lung tissue and the chest wall.

A decortication may require opening the chest via the space between two ribs to remove the thickened blood. This procedure could leave one with acute and maybe chronic chest pain due to injury to an intercostal nerve that is positioned the underside of each rib. A VATS procedure uses a scope and small incisions to visualize the pleural space and contents for removal. There is minimal chance for much discomfort with this minimal invasive surgery technique. If there is adhesions to the lung, the "blood" removal could cause small air leaks from the lung that will require placing a chest tube in the pleural space via a rib space for several day until the air leak stops.

Any growth anywhere in the esophagus should be of concern and needs a diagnosis. If not cancerous, what? The first consult should be with a reliable gastroenterologist who can order appropriate CT scans and perform a biopsy with a flexible endoscope, if indicated. A thoracic surgeon will be consulted for excision, if indicated.

This is a difficult question to answer because a lack of information. There are several possibilities for "a hole in the heart" and closures are different. Possible holes are ventricular septal defect (VSD), atrial septal defect (ASD) of which are two: premum and secundum ASDs. There is also another atrial septal defect call failed foramen ovale closure. The best answer comes after knowledge of the type of heart hole.

Major increasing body changes occur with pregnancy that are mild during the first trimester and become more demonstrable by the third trimester. One major change is an increased heart rate that is a normal response to increasing demands for increased blood volume to mother and baby.

Blood volume is increased by the faster heart rate that can increase by 25% (normal 70 to 80-90 beats per minute). During pregnancy, the increased heart rate will increase cardiac output by 50-90% by the third trimester.

If the heart rate increases to greater than 100 beats per minute and especially associated with chest pain, shortness of breath, fainting or coughing up blood; a physician should be consulted to rule out serious health issues.

This question lacks sufficient information to answer appropriately. It is assumed that its the skin sutures that "opened up." If this event is a simple non-infected superficial dehisence, it should be only enough time for the re-closed incision to heal. If infected, superficial vs. deep is important to know. Deep usually means involvement of the sternal bone. If infected bone is involved, it depends on the procedure(s) needed to correct the problem. Deep infections take weeks and sometimes months to treat. A superficial infection not involving bone may take several weeks to heal and this also depends on the operation needed. If more information is available, a better answer is available.

Chest pain as described can be related to heart, esophageal spasm from gastric reflux or stomach ulcers. There is no way to determine the reason for the chest pain without testing. Chest pain should be investigated ASAP to rule out an active heart attack or the precursor to a heart attack. This is serious and could result in life long congestive heart failure and more importantly, death.

The symptoms described are classic for atrial fibrillation or atrial flutter. Both are situations that only progress in magnitude if not treated. You need an EKG and or a heart monitor to record and evaluate the heart rhythm.

Diastolic dysfunction means that the ventricular heart chamber does not open well to receive enough blood volume from the atrial chamber. If it opens poorly, the blood volume collected within the ventricle is insufficient for an adequate stroke volume when the ventricle contracts to propel blood to the body. This is a form of heart failure.

A common reason for diastolic dysfunction is the result of a non-compliant ventricular muscle wall that is stiff. A good example is muscle thickening (hypertrophy) resulting from aortic valve stenosis. In this case, the valve is scarred and does not open well causing the ventricular muscle to hypertrophy. The thickened muscle enables the ventricle to over come the resistance through the small valve opening but over time makes the ventricular stiff and noncompliant causing the ventricle to fill and empty inadequately. This resistance to blood flow across the valve can be auscultated with a stethoscope as a heart murmur.

Always be in favor of repair over replacement. You get to keep your own valve rather than having an artificial prosthetic valve that can initiate its own problems. The key to a successful repair is having a surgeon who performs many repairs. Do your homework on surgeon and institution where s/he works. Both need good credentials. The Society of Thoracic Surgeons (sts.org) is a good starting point. Valve repair is an art/skill that takes practice. A bad result is no repair.

Abdominal aortic aneurysm (AAA) is a silent killer. Usually, the only symptom is rupture that is associated with 80% mortality. Siblings or children of patients with an AAA have a genetic increased rate of 7% over the normal population of developing an AAA. People at normal risk usually have history of hypertension and smoking. If one has a family history or at risk because of hypertension and/or smoking, after age 50-55 years one should have an abdominal aortic ultrasound (painless) to scan the abdominal aorta for aneurysmal formation. If one is present, there is no significant alarm unless the aneursym is 5.0 cm or greater in size. Depending on its characteristics, there is a good chance it can be repaired as a minimally invasive endovascular procedure not requiring an abdominal incision. If less than 5.0 cm in diameter, the AAA can be followed annually with ultrasound scans. Don't smoke and keep hypertension under control (best antihypertensive medicine for AAA is valsartan).

Coffee is not recommended right before or immediately after any form of cardiac surgery, including heart valve surgery. I suggest to start reducing to one cup daily and none within days of operation. Within two weeks following operation you can resume coffee intake assuming the operation was successful without complication.

Dental plaque is plaque regardless of its origin. It contributes and/or causes gengivitis (gum inflammation) that leads to shedding mouth bacteria into the blood stream (bacteremia). This bacteria can settle and grow on the heart valves (endocarditis) subsequently destroying a functional valve making it dysfunctional. A dysfunctional valve leads to heart failure.