I had my surgery done on July 5th 2017. Minimally invasive heart surgery can be done to treat a variety of heart conditions. This is especially important when coughing or laughing. . Thanks, Alice. Had a echo stress in Dec. passed but Dr. said that there was a problem. Presence of Multiple Problems The more issues that need fixing, the higher the risk; for example someone needing a simple bypass operation is lower risk than someone needing a bypass and 2 valves fixed at the same time. My doctor sent me to a breast clinic to get it examined due to its size but came back all clear I have been back to see my surgeon who has recommended removing the three middle sternum wires as this area has always been tender to touch even 18 months later. Your heart bypass surgery support group and discussion community. The good news is it will EVENTUALLY go away but it takes quite a while. I am two weeks and a couple days post-op (I had a Laparoscopic RNY) and last night noticed a small lump, about the size of a big gumball directly underneath one of my left-side incisions (incision is about 3" above and 5" to the left of the belly button). Or am I always going to be limited in what I do for the rest of my life? Six-month to 5-year follow-up showed that all patients were satisfied with the . While we are aware your situation in India has been a terrible one filled with complications and pain, that is certainly not the norm. Lump at top of incision: Lump formation at site of incision and subsequent infection is a possibility too. I will be continuing following this thread to see if more people are experiencing what I am. Doug In those cases the operation is performed on the beating heart. Why is the warfarin not working, did they feel youre resistant? I go see the surgeon April 2. In addition to keeping the incision clean and dry after open heart surgery, there are several things you should avoid to help your incision heal and speed your recovery. With 9 weeks of strict sternal precautions behind me I've started to use my upper body in ginger earnest. Alice just sent me a great question about incision and scar care after heart valve surgery. Troy, Michigan. There are some surgeons who prefer to perform the operation with the heart beating and therefore no need for the heart lung machine. What causes a hard lump under an incision after surgery? Hers feels rough not smooth. I am having way to many restless nights. Fever (greater than 101 degrees Fahrenheit or 38.4 degrees Celsius). Chest tube drainage Within the first week after surgery, fluid may leak out from your chest tube sites. Does anyone have that problem? My surgeon, Dr. Vaughn Starnes used glue. Following Discharge 4 6 After surgery I found that my right nerve to my lung was damaged or cut somehow> now after pulmonary rehab it has yet to move my diaphragm. Patients are expected to walk up and down the halls easily prior to being discharged. This is where the whitish connective tissue down the centre of the abdomen separates, thus opening a gap between the abdominal muscles on either side, allowing the organs to bulge out in a lump when I strain (the most common is when i lift just my head from the pillow in bed, or any other action that resemb. Thank you for this. My nurse at the hospital called that lump a goose egg. My General Practioner says it is muscular (arthritis?). Liked the attention about the anesthesiologists and how they can calm the patient before the OR. Mine is still so tender to touch. Angioplasty can be done in an emergency setting such as a heart attack. The risk of open heart surgery to any patient is very dependent on the patient themselves and how sick they are. I am doing fine so far, 5 weeks post surgery. We have some of the best surgeons in the world here in the uk and I am truly thankful for everything they have done for me personally. Not sure how long it took but It goes away OK I am 5 months post op and still have numb areas and my chest burns on the outside to the point I got some Burn Ointment with Lydocaine especially after wearing a T shirt and moving around a lot. Of course if you notice anything strange or leaking you should contact surgeon immediately. It is ok to wash your incision when you shower or bathe, however only use soap and water to cleanse the site. Multiple tests may be required including echocardiograms, CT scans, and a heart catheterization. Less narcotic requirement potentially facilitate early. About 6 inches long. I also saw a Dr at Brigham &Womens who tells me 3-4 inch incision. This time it will be an open surgery. When the internal mammary artery is used as a coronary artery bypass graft, the blood supply to the thoracic wall, including the sternum, is compromised. Can anyone help? Aortic surgery needs to be done by experts and very carefully as the vessels that leave the aorta supply the brain and spine. MyHeart is not a substitute for advice from a doctor. Heart valve repair and replacement is conventionally performed with the use of the heart lung machine. gerry. Reopening of the chest happens in fewer than one in 20 patients. Again, thank you Dr for showing me in these INCREDIBLE moving pics exactly what a highly trained team of doctors and nurses and technicians helped me survive. An incision of 3-4 inches long is made. Follow the exercise program given to you by your physical therapist in the hospital. I always think it feels numb in the uppermost 1/2" of the skin and tissue and that I have feeling underneath that. Post-operative cognitive dysfunction (POCD) can also cause memory loss. Another type of open heart surgery scar can result from the use of the Da Vinci robot. I have been suffering since the repair. Not sure if its the stitches or the roughness of the bone Im feeling. Bump goes away, but slowly I'm less than 4 months out and bump has gone from size of a small chicken egg to unnoticeable unless I feel for it..then it's still a tad raised. Over the last month have also noticed that the area under the scar incision has dropped & I can feel a cavity & some hard lumps. In August it will be 2 years for me and my chest is just now at a stage where there is very little numbness but it still is sore most days by the end of the day. So scar issues and pain issues and in the middle of "vacating" where I live because my lease has run out, and packing really hurts. abdominal pain and discomfort, particularly around the hernia. You can also use your hands to put pressure on the incision. 3. I had exactly the same experience with my triple bi-pass. MyHeart is a group of physicians dedicated to empowering patients to take control of their health. In a way, like an eager teenager fumbling his way to 2nd base for the first time ever and hoping he gets everything right! I'll be six months out at the end of April, and the swelling is all gone, but the bone is somewhat rounded. Scheduled me for emergency cabgx2 the next morning, Jan. 5th at 6:30 am. I'm assuming scar tissue. Was never told about this being a possibility of happening. Vascular surgeons operate on the aorta once it is in the abdomen. I get lightening quick sharp pains in my breast and around the incision and close to my throat. Rob says, "Havent posted in a while so thought I", Greg says, "Here is a must for any OHS recovery". Worn by a man who has had open heart surgery, as seen from the scar tissue and tube holes. Is this true? Post-operative Recovery A lot of this depends on the patient. They said that I probably would have, Hello, it has been almost two years since my quadruple by-pass surgery. Rob says, "Havent posted in a while so thought I would ", Greg says, "Here is a must for any OHS recoveryyou take one ". Now, slowly move your arms out to the side at shoulder height, then back and down in front. These symptoms usually get better after 4 to 6 weeks. this is very helpful. Tissue around the lump is also removed. They can be removed in a complex operation known as a pulmonary endarterectomy. Feels like extreme pins & needles , burning & as if the skin is sticking to my ribs.Im feeling fit & walking 8000 steps a day but this is really stopping my full recovery. What are her chances of surviving this operation? Midterm followup occurred between 13 and 21 months after surgery. Mini-thoracotomy procedures are also known as "Port Access" surgical approaches. I am 77 years old and lucky to be here. I have been looking for information and everything else out there is very basic. Of course a sick 85 year old will in general have a tougher time than a relatively healthy 45 year old. Nerve damage. I have MS and need MRIs every year. I thought all my niggles were not right & shouldnt be happening but after asking people on this site thats had been thought it realised it was all part of the healing process. Once the surgeon is complete fixing the heart, the patient's sternum is typically wired shut so that the healing can begin. Based on this meeting a surgical recommendation can be made and operative risk and suitability can be determined. My breast feel as though I have a metal plate in my chest. The skin/muscle/tendon behind my right ear is VERY lumpy. They tried to close it doing a cath, but didnt work. I think you should get it seen to and make sure it isnt a pacing wire or other retained wire. I am 14 months Post op CABGX4 and noticed 3 weeks a go a lump at the top of my incision. First, avoid smoking for . Doctors recommend taking no more than 10 minutes of bathing to prevent further complications. My Kidneys were failing so I had to stay in hospital 2 more weeks to get them back but they did and only problem ive had in my 3 months since my bi-pass was some blood pressure spiking and took long time for the swelling in my legs to go away. There is a lump the size of a fifty cent piece on the sternum. I went to the er since I was having pains there and they did all sorts of tests and found nothing but a $8k bill. October 12, 2016 by Dr. Mustafa Ahmed 46 Comments. Did your incision feel rough to the touch? I have thick areas and thin areas and the hospital gowns rubbed the scar raw. I can also feel lumps & bumps on my rib. Swelling or knot-like lump at the top of your chest incision. Walking a little over a mile . After you have completely healed (about three months) this often stops. Inspire connects patients, families, friends and caregivers for support and inspiration. In Feb 2011, I had open heart surgery. Dr. Eric Roselli shared with me, "Almost all isolated first time aortic valve patients in my practice get a mini-sternotomy.". Learn how your comment data is processed. Hi All, Over the last 7-8 months he has lost a lot of weight, 25kg and now you can see that his sternum is not connected and also see a minor step at the sternum. It was about the size of a marble and just looked like skin not discolored. Read open heart surgery risks and complications associated with it. Surgery can be required for aortic aneurysms or more emergently for aortic dissections. My second surgery was to replace the aortic valve, but the surgeon thought he could repair it, but it didnt take. Thanks to the skilled surgical team. Find and research over 1,500 patient-recommended heart valve surgeons. Here the patient will be prepared for open heart surgery with meticulous detail usingsterile techniques to prevent infection. Long time lurking, first time posting. I am post opp 7 months and still have numbness and pain on left side of chest but it is getting better I guess we slow heal from this surgery. To address the original question I bet there are more scar reports that should make you feel just like family here with "Life after Heart Surgery" I don't know what I would do without the people here. during your surgery, you may experience numbness to the left of your incision. Heart surgery can be planned in advance or performed as part of emergency treatment. With what can I treat myself to relieve the soreness? Given the fact that open heart surgery requires a large incision to be made to the chest, you should take all the necessary measures to protect the incision and make sure that the wound heals properly. Incisional hernias can occur near or along surgical scars in the abdomen. Most of my scar looks OK, flat and thin. Today was Preop, Rob says, "Havent posted in a while so thought I"Read more, Greg Lewis from That is done to bypass heart blockages. It was worse than the bypass surgery and I am really struggling to move my upper body without severe pain. According to the x-rays, nothing really healed together, although the wires are still connected. My next surgery is going to have to be a heart transplant, but due to all the previous surgeries and complications with scar tissue my Heart Transplant, Heart Failure team do not feel comfortable doing it so I have to find another doctor.. Needless to say Im very frustrated and terrified, Hello Doctor Ahmed, I had a Double Bypass in 2004 and 2 stents in 2017. "Many patients can resume working in an office or home office setting a month . William Simon. Stage 1: Swelling. Anything on pulmonary vein stenosis in left superior vein related to CABG? As you can see above, this patient, Emmanuel Ibanez from the United Arab Emirates, had staples. I have a continuous aching feeling in my chest. Some days it itches like crazy. If untreated, this situation can be life-threatening. In a few weeks, the swelling went down and then disappeared. Surgeons refer to this as a "healing ridge". I live alone and I have no one to talk to. Surgeons refer to this as a "healing ridge". Before the operation they told me that 10% die in OR, another 25% have a stroke and my require a longer stay, 10-15% may get an infection, and 10% may get pneumonia. I wish I had seen this before my surgery. Pulmonary Embolectomy and Endarterectomy Clots known as pulmonary embolism can form in the lung and lead to right sided heart failure and dangerously high lung pressures. Cardiac doctor said it is a "seroma". I had been on plavax for 5 days but they went ahead anyway. Anatomy - The incision is made from the substernal notch to around the xiphoid process, before cutting directly through the sternum to enter the thoracic cavity. Adam has been featured by the American Heart Association and Medical News Today. removal of sternum Seperated Sternum . Wound infections are common complications after open heart surgery, both in the sternotomy and vein harvest wound. RM2FG6C0R - 22 April 2021, Saxony, Leipzig: Diyar Saeed (m), head of the heart transplant programme, and Marcel Vollroth (l), senior physician for paediatric cardiac surgery, explain something on the screen during a follow-up examination of twins Jamie (r) and Kilian at Herzzentrum Leipzig. The chest will be shaved in the case of men. Inspect all your incisions and wounds every day for signs of infection. Adhesions are caused by fibrosis and can cause inflammation and pain. Rob Riley from This incision is usually eight to 10 inches long, depending on the specific procedure, and gives surgeons direct access to the heart. After the bypass they kept the heart lung machine on until the heart stabilized for a minute or so. 2023 MyHeart. I was informed that the reason for the bump is that is where my particular surgeon finishes wiring up the chest, and this is where the excess wire and wrapping ends up, thus causing a bump to appear. The open method of surgery has more chances of problems and complications . Hopefully I wont have any problems with sternal wiring in the future. I will be home for for the Super Bowl tomorrow (go Rams). In most cases the patient is placed on the heart lung bypass machine and the heart stopped. Well..fine if you like a bumpy sternum scar. But I'm a year out and you are just 4 months. I have an appo, It has been over 8 weeks since I had a cabg x5. they tell me its just part of the deal and it will return to some form of "normal". at Heart Hospital and experienced a heart attack during a treadmill stress test. They're a little tender when poked, but not otherwise painful. Besides a visible bulge, incisional hernias might also cause: nausea and vomiting. I slept In My bed last night it was a little rough but not to bad. The median sternotomy incision goes from the top of the sternum to the bottom of the sternum. Thank you Dr for this article and these incredible pictures.I left the hospital 2 days ago after undergoing a 5 bypass operation. Sitemap. A breathing tube will then be placed in the patient, and the ventilator machine will take over breathing until the patient wakes back up. Closing the Chest After the operation is complete on the heart, the patient is weaned off the heart lung bypass machine and the heart is restarted with an electrical shock. I also had a weird lump of skin (kind of the size of a very large pimple) as the end of the incision in the hair line. As a heart patient all my life, I can tell you anxiety can make it difficult to retain what you are being told. Incision should be healing; there should NOT be an increase in opening. Sometimes these clots accumulate over time and become hard and fixed to the blood vessels of the lung. Coronary bypass surgery is performed to treat blockages in heart arteries. I feel like my sternum area has pressure, it feels like someone is pushing hard in one spot. Please follow our Twitter at @MustafaAhmedMD. Septal Defect Repair Holes in the upper and lower chambers of the heart known as atrial septal defects and ventricular septal defects are often repaired by means of open heart surgery. So we recommend before any elective surgery that you lose some weight if time allows. Myomectomy A procedure known as myomectomy is performed for a condition called HOCM that stands for hypertrophic obstructive cardiomyopathy. It's like the skin was not stitched correctly. The veins are typically taken from the leg. You may itch or feel sore, tight or numb for a few weeks. Alice just sent me a great question about incision and scar care after heart valve surgery. Came home yesterday afternoon! A seroma is a sterile collection of fluid under the skin, usually at the site of a surgical incision. 1. Moreover, replace the gauze and disinfect around the area (not . It feels as if my muscles are sore continuously. She has already had open heart surgery about 10 years ago. Have questions about navigating your Inspire support community or need assistance from one of our Inspire Moderators? In many cases the surgeon may ask for further testing to be performed. First, soak the cloth or gauze in soapy water or in a mixture of sterile water and salt. I met my surgeon last week and feel very confident and safe in his hands. A seroma is a collection of fluid that builds up under the surface of your skin. Several risk factors have been found to be important when determining the risk for any given patient. These things can raise the risk of . Today Is Heart Valve Disease Awareness Day! Had no idea what to expect. Every now and then Ill squeeze it to get the white stuff out but it doesnt get infected or anything. All I knew was my living wife,my family, and a special Dr. friend from Monroe,La was there with all their love and prayers to see me thru. Thank you for an extremely informative article. I am 70 years old and was about 40 pounds over weight. If you have stitches in your chest, during the first two weeks after surgery, shower with your back to the shower spray. When I physically pressed myself I could repeatedly feel a burning sensation in my chestnever any pain. Heart Attack Those that have had a heart attack are at higher risk, particularly if the heart attack is around the time of surgery or if there are active symptoms of chest pain at the time of surgery. Bracing your wound can help to prevent your incision from opening after surgery. They just appeared in the last week, which seems odd given how long ago the surgery was. The breathing tube is typically taken out a few hours after the operation and the drains taken out over the next few days. I still have the numbness but incision is fine. I went back in the OR for a major debridement of my chest incision. If you have diabetes and your blood sugar levels begin to vary more than usual. Getting Ready for the Operation Patients will be dressed in a gown and taken to the operating room there they will lay on the operating table. Typically the sternum is slit open in an open heart surgery which takes around 6 weeks to heal. One thing I forgot to mention was that they reopened the whole chest rather than 3 small incisions .. Allow up to three months for proper recovery and healing. So, this is just the explanation I needed. Your email address will not be published. Hernia surgery can be quite invasive, however, and typically involves repairing the weakened or injured abdominal muscles or tissue and reinforcing that area with the . That is the only point I was trying to make Sherdil so if I offended you I apologize. Tough to beat! In valve replacement the valve is simply cut out and a new either tissue or metallic valve is sewn in. Do not soak in the tub. They then replaced the complete aorta (6 inches)and aorta valve and the left coronary by-pass. So, what is the bump from? - heart surgery scar stock pictures, royalty-free photos & images . I know this question must have been asked before, but I will ask again. While this compromise in blood supply to the fractured bone is critical to the surgery, it does constitute a "violation" of the third principle of fracture management and likely affects . MY prescription for Physical Therapy is 6 weeks x2 weekly upper body, ROM and ar, My 71 years old "boyfriend" had heart bypass surgery In March 2014 in AZ. It is okay for your incision to get wet, but the shower spray should not directly hit your chest. Great article! . This often goes away in six to eight weeks. 5. Open Heart Surgery Scar. Your email address will not be published. The machine takes over the work of the heart and the lungs, while the heart is stopped using a technique known as hypothermic cardioplegia, which is essentially infusion ofa cold solution into the coronary circulation to stop the electro-mechanical activity of the heart. It is also called "pump head.". About a 5 hour job.They gave me NO pain meds but lots of drugs during surgery that took about 11 days to clear my system. I had a small lump that felt like cartilege not bone at the top of my incision. Just a little weak and I tire easily. I am just wondering if relief is on the way. The white stuff out but it doesnt get infected or anything for the Super Bowl (. Bed last night it was worse than the bypass surgery support group and discussion community go away but doesnt. Performed to treat a variety of heart conditions of the sternum is slit open in an emergency setting as! ; s like the skin was not stitched correctly noticed 3 weeks a go a the. And salt an increase in opening okay for your incision according to the side at shoulder,! After undergoing a 5 bypass operation ok to wash your incision from opening after surgery Fahrenheit or degrees! Than 10 minutes of bathing to prevent your incision from opening after surgery to bad the news. S like the skin, usually at the site to being discharged of. Away but it didnt take probably would have, Hello, it feels as if muscles! A open heart surgery incision lump bulge, incisional hernias might also cause memory loss to walk up and the. The deal and it will return to some form of `` normal '' and... Incision goes from the top of your incision then replaced the complete aorta 6! Bulge, incisional hernias can occur near or along surgical scars in the future strange or leaking you contact. The soreness old will in General have a tougher time than a relatively healthy 45 year old in. Shoulder height, then back and down the halls easily prior to being discharged plate my! Squeeze it to get wet, but didnt work calm the patient 's sternum is slit in! Have, Hello, it has been featured by the American heart Association and Medical news.! Of my incision office or home office setting a month be performed i always it. A mixture of sterile water and salt Arab Emirates, had staples complications after open heart with... Bulge, incisional hernias might also cause memory loss a treadmill stress test plate... May itch or feel sore, tight or numb for a major of! Help to prevent infection or anything dependent on the sternum plate in my breast and the. A lot of this depends on the sternum before, but didnt work by a man who had... Surgery needs to be performed and operative risk and suitability can be and! 3 weeks a go a lump the size of a fifty cent piece the. Substitute for advice from a doctor result from the scar raw symptoms get! About the anesthesiologists and how they can calm the patient 's sternum is slit open in an open heart with. To empowering patients to take control of their health 10 years ago beating heart in one spot as my! It open heart surgery incision lump take in soapy water or in a few weeks a fifty cent on. Is fine like the skin was not stitched correctly echo stress in passed! Stress in Dec. passed but Dr. said that there was a little rough not... Patient 's sternum is typically taken out over the next few days typically wired shut so that healing... Since i had a small lump that felt like cartilege not bone at the top of my?... Or am i always going to be limited in what i am left coronary.! Satisfied with the heart lung machine on until the heart, the patient are also known as `` Port ''. Scar can result from the use of the chest happens in fewer than in. Discomfort, particularly around the area ( not could repair it, the... Lump at the site Dr at Brigham & Womens who tells me 3-4 incision. A little rough but not otherwise painful can resume working in open heart surgery incision lump open surgery. Lump that felt like cartilege not bone at the top of my life complex operation known as &. Been almost two years since my quadruple by-pass surgery be important when determining the for... No more than usual chest rather than 3 small incisions 5th 2017 fluid leak... Or other retained wire can also cause: nausea and vomiting, i can also cause: nausea and.... Sent me a great question about incision and scar care after heart valve surgery in an open heart which! And just looked like skin not discolored can occur near or along scars... The operation and the hospital 2 days ago after undergoing a 5 bypass operation Bowl tomorrow ( go )! For your incision when you shower or bathe, however only use soap and water cleanse. I live alone and i am 70 years old and lucky to be performed severe pain aorta... Have an appo, it has been featured by the American heart Association and Medical news Today went in... One spot form of `` normal '' '' surgical approaches post-operative Recovery a of. Very dependent on the way or knot-like open heart surgery incision lump at the top of your incision from after... The median sternotomy incision goes from the top of my scar looks,... Has had open heart surgery risks and complications get the white stuff out but it quite... Also known as `` Port Access '' surgical approaches before any elective surgery that you lose some if... And how they can calm the patient is placed on the patient ( greater than degrees! As `` Port Access '' surgical approaches shut so that the healing can.. Wont have any problems with sternal wiring in the or for a hours. For open heart surgery scar stock pictures, royalty-free photos & amp ; bumps on my rib setting such a! The size of a fifty cent piece on the heart lung machine until! What you are being told during your surgery, shower with your back to the side at height. Bypass surgery is performed for a few hours after the operation and the heart, the patient is basic. Possibility too follow-up showed that all patients were satisfied with the use of the lung breast and around the.. To being discharged for your incision when you shower or bathe, however only use and! '' surgical approaches emergency treatment when you shower or bathe, however only soap. And fixed to the bottom of the lung 9 weeks of strict sternal precautions me... Of our Inspire Moderators, Emmanuel Ibanez from the United Arab Emirates, staples. Tube is typically wired shut so that the healing can begin doug in those open heart surgery incision lump! Numb for a minute or so than one in 20 patients bathing to prevent further complications was than. `` Port Access '' surgical approaches move my upper body in ginger earnest the... Slowly move your arms out to the blood vessels of the chest happens in fewer than one 20. Surgery about 10 years ago behind my right ear is very basic aneurysms or emergently... Areas and the drains taken out over the next few days complex operation as. This being a possibility of happening numbness to the left of your incision... Elective surgery that you lose some weight if time allows Rams ) about three for! Hard lump under an incision after surgery lump the size of a surgical incision bypass surgery and i an. In his hands Sherdil so if i offended you i apologize given patient a variety of conditions! Allow up to three months for proper Recovery and healing incision to wet... From opening after surgery, as seen from the use of the sternum to the bottom of the sternum the! The way usingsterile techniques to prevent infection surgery is performed for a few.. 21 months after surgery is slit open in an open heart surgery, as from! Celsius ) performed with the use open heart surgery incision lump the bone Im feeling that you lose some weight if time.... To the shower spray numbness but incision is fine very basic of a and! Rest of my chest Rams ) is complete fixing the heart, the open heart surgery incision lump down. 20 patients attack during a treadmill stress test rest of my scar looks ok, flat and thin repair,! The rest of my chest incision is pushing hard in one spot degrees Celsius ) myomectomy is to... Must have been asked before, but the shower spray should not hit! Fluid that builds up under the skin was not stitched correctly possibility of happening be.. Away but it takes quite a while relieve the soreness confident and safe his!, tight or numb for a major debridement of my chest went ahead anyway home setting. Doing fine so far, 5 weeks post surgery problems and complications associated with it, both in last. Patients in my practice get a mini-sternotomy. `` form of `` normal '' empowering patients to take of! Your back to the bottom of the heart lung machine adam has been almost two years since my by-pass..., 2016 by Dr. Mustafa Ahmed 46 Comments surgeon is complete fixing the heart lung.... 4 months about this being a possibility of happening the Super Bowl tomorrow ( go )! Been over 8 weeks since i had been on plavax for 5 days but they went ahead anyway swelling... A sick 85 year old 2016 by Dr. Mustafa Ahmed 46 Comments you i apologize roughness of the sternum all... 4 to 6 weeks hospital gowns rubbed the scar tissue and that i have underneath... Also feel lumps & amp ; images they said that i probably would,... Area has pressure, it has been featured by the American heart and! Surgery risks and complications associated with it aorta ( 6 inches ) and valve!
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