Expert: Ronald Levy, M.D. - 12/17/2011

Question
I am a 49 year old female considered borderline obese. I had a disc removed last September 2010, L1 S5. I felt better for a few months but got progressively worse and was treated by a pain management specialist with no results. My neurosurgeon told me I was a candidate for a lumbar fusion but during a routine EKG it was discovered that I have an enlarged left side of my heart. I also have also always had mitral valve prolapse. I have been extensively monitored for hypertension which none was found. My surgeon will not operate until the cause of my enlarged heart has been found and treated. We are suspecting sleep apnea and I have an appointment with a sleep doctor. My question is my doctor tells me that I cannot be operated on until the heart situation is fixed due to anestesia concerns. What exactly are the ramifications of having surgery with this condition and is this with any type of surgery or just the lumbar fusion? Could you please explain this to me?  Thank you, Terry Termine

Answer
It is probably wise to find out the cause of the enlargement but it may not be treatable, per se. That being said, you can still have the operation but at least the anesthesiologist knows what your heart problem is and can be prepared to manage it. This would be true for any major operation (minor ones are things like cataracts, hernias, etc). The major ramifications have to do with how well you can handle fast heart rates and low blood pressure. This is not to say that these things will happen during surgery but we like to know how well you handle the stress in advance.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston