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What is the cause of back pain in the back after aortic valve replacement?

Wednesday, 05 July 2006
Answered by: Dr. O.P. Yadava
Consultant Cardiac Surgeon, CEO
National Heart Institute and Research Centre
New Delhi
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Q. My husband underwent an open heart surgery 4 years ago, where his aortic valve was replaced with a mechanical one. He also had about 4 inches of aorta replaced due to enlargement. Since the surgery, he gets a pain in his back, lower part, on either side of the upper part and in the shoulder blade area. The pain is very intense and lasts from 5 to 10 minutes. Some are bad enough to make him feel like vomiting. He went back to the cardiologist, wore a heart monitor and got an MRI done. But there weren't any problems. No doctor is able to explain the cause of this pain. They say that it might be due to the surgery. The pain comes at various times like during sleep, sitting, standing etc. He is taking Lipitor 10mg daily, Diovan 160 daily and Warfarin 7.5 mg daily. Please advise.

A.  I am afraid, I won't be able to give any definitive answer because till one sees the patient and goes through the complete clinical records, it is impossible to give a firm opinion. In general however, pain the back following any open heart surgery is extremely common because when we open the middle of the breast bone and retract the bones to reach the heart, we also crack and displace certain ribs on the back side near the spinal bone and some of these fractures do not even unite. Therefore the pain between the shoulder blade and on the sides could be related to that also. However, some times the pain could be related to the original pathology also e.g. if the original operation was done for enlargement of the aorta, then the aorta which has been left behind, can also enlarge or even dissect and can give rise to pain in the back. However, these things should have been picked by an MRI scan, which you have written has come normal. I therefore would tend to believe, it is the former problem of pain coming from bones and joints and not from the heart or blood vessels. An important third cause for this kind of a pain could be totally unrelated problem with either the pancreas or the spinal column itself and therefore if the cardiologist has ruled out any heart related problem then you must consult a general surgeon/orthopaedic surgeon for their evaluation.

A.  I am afraid, I won't be able to give any definitive answer because till one sees the patient and goes through the complete clinical records, it is impossible to give a firm opinion. In general however, pain the back following any open heart surgery is extremely common because when we open the middle of the breast bone and retract the bones to reach the heart, we also crack and displace certain ribs on the back side near the spinal bone and some of these fractures do not even unite. Therefore the pain between the shoulder blade and on the sides could be related to that also. However, some times the pain could be related to the original pathology also e.g. if the original operation was done for enlargement of the aorta, then the aorta which has been left behind, can also enlarge or even dissect and can give rise to pain in the back. However, these things should have been picked by an MRI scan, which you have written has come normal. I therefore would tend to believe, it is the former problem of pain coming from bones and joints and not from the heart or blood vessels. An important third cause for this kind of a pain could be totally unrelated problem with either the pancreas or the spinal column itself and therefore if the cardiologist has ruled out any heart related problem then you must consult a general surgeon/orthopaedic surgeon for their evaluation.

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