There are lots of blogs on the internet about undergoing and recovering from heart surgery, but strangely the huge audience of brass players wondering about what it might be like to get back to playing professionally after undergoing something like this is dreadfully underserviced. I hope this blog will not only be a good way for me to get my thoughts down, but will help other people, musicians or not, get ready for and get back in the game after heart surgery. Expect this to be frank and not overly copy-edited; perhaps I'll polish things up later. For now, I'm just going to try to get things down.
Where to start? I suppose I'll dive right in.
A couple of years ago, in February of 2016, I found myself in an urgent care centre with a gallbladder attack brought on by an overly ambitious encounter with a large assortment of fine cheeses. A gallbladder attack is no fun, and it was pretty scary to have sudden upper-right quadrant pain. I thought it might have been some sort of heart event, but luckily that was not the case.
While I was being looked after, a doctor listened to my heart and asked "you know you have a heart murmur, right?", which was the first indication I ever had of a problem I'd been living with for my whole life. The gallbladder event was an isolated event, and I've had no trouble since. But I was told to follow up about my heart murmur.
My GP sent me in for a transthoracic echocardiogram (echo for short), a non-invasive ultrasound of the heart. This revealed that I have a bicuspid aortic valve (BAV), a not-uncommon defect that substitutes a bicuspid valve of some sort for the correct tricuspid aortic valve. A tricuspid valve has three leaflets, and looks kind of like a skewed Mercedes logo; while a bicuspid valve has two leaflets and can be in several different configurations. Mine is pretty much 50/50, two equal leaflets, while for some people it's effectively a tricuspid valve with two fused leaflets, making a very different configuration. One of the four valves in a normal heart is indeed a bicuspid valve, so it's not a totally unfeasible configuration.
The problem is that a bicuspid aortic valve can get leaky. One big reason for this is that when you have a bicuspid valve your aorta (the main blood vessel taking oxygenated blood to the rest of your body) often ends up dilating over time. This causes the valve to be pulled apart and become increasingly leaky, and it also causes progressive weakening of the walls of the aorta, which can lead to pretty dramatically bad things.
The normal diameter of the aorta depends on your body type, but mine was pretty big. The normal recommendation for surgery is to go when it reaches 5cm. Mine has been steady in the 4.8 range since we spotted the problem. But due to my job, which certainly puts stress on my circulatory system, and the relatively low risk of surgery for me due to my age and general state of health, my cardiologist and cardiac surgeon have recommended that we go ahead and do it, and I'm following their advice.
My pre-op appointment is booked, and I'm waiting to hear about a surgery date. I assume this will all happen by the end of May, but the scheduling process is arcane and opaque, and I've decided not to stress about possible permutations of the schedule. I'll just take it as it comes, and be glad that the problem was diagnosed before my aorta went pop.