(February is National Heart Health Awareness month.)
Sitting off to the left of center in your chest is the heart. It is a remarkable organic pumping device, a muscle controlled by electrical impulses. When working correctly, this little fist-sized organ will beat at an average of 72 beats per minute (bpm), or over 100,000 times each day, and by the time you reach 70 years old it will have kept that rhythm up 2.5 billion times. It stays busy recirculating your blood at the rate of 1,900 gallons every day – at 70 years old it will have pumped 48 million gallons of blood.
No wonder it gets a whole month dedicated to it!
I was mowing the yard, way back in 2003, when my push mower ran out of gas. I hoofed it over to the garage for the gas can but had to sit down on the steps as a curtain of blackness washed over me and I felt dizzy. If you’ve been there, you know this is syncope (sing-ko-pay) and it is a pretty good indicator of your brain not getting the blood supply it needs. Like any good American man, I ignored it.
Fortunately, though, my primary care doctor was paying attention.
At my next routine visit Dr. Kelly listened to my heart, like he always did, and said: “I’ve not heard that before.” Exactly the kind of thing that you do not want to hear. Off to the cardiologist I went, and things escalated from EKG to echocardiogram to cardiac catheterization. I remember laying on the table as the Cath doctor tried to push the probe past my valve – he was obviously having trouble, and finally said “I’ve never not been able to get past the valve.” I asked him how to fix the problem, and I will never forget those fateful words:
“You don’t fix it. You replace it.”
Easy for him to say.
Every year in America about 80,000 people have the aortic valve replaced. This is NOT the same as the more-common heart blockages, but it is instead caused by aortic stenosis. In my case, I was born with a bicuspid (two leaf) valve, while a tricuspid (three leaf) is normal. My problem was not caused by diet or obesity or smoking – it was going to happen no matter what I did.
So off to the surgeon I went. And a fine surgeon he was, the locally famous Dr. Richard Morrison. He explained the procedure and drew a diagram on the sheet with a marker (the laundry must love him!) and assured me it was straightforward surgery – “Routine” he said.
Easy for him to say.
Surgery went well, and he decided to use a Red Cross tissue valve (homograft) because it would be a good lifestyle choice, with no Coumadin needed. After five days in the hospital, I was home, with a huge stitched scar down my chest, but able to feel the difference in my heart function. Two months later I was driving and back at work. Recovery was not as “routine” as the good doctor suggested, and it was years before I got past the trauma of that surgery. But life went on and I felt fine.
Until the summer of 2017.
I was feeling increasingly breathless and ultimately went to the ER almost unable to walk in. My O2 was at 89% (this morning it was 97%), they immediately strapped oxygen on me and I was admitted. After a weekend of tests and consultations, my worst fears were realized: the 14-year-old valve was failing. My ejection fraction (EF) was about 36%, when it should have been over 50%. It would have to be replaced. I was terrified, because now I was much older, I remembered how hard it had been to recover last time, and I just did not feel good about it. Because who does feel good about having their chest sliced open? Apparently, the cardiac surgeon, Dr. Zellner, was not any more excited than I was – my homograft valve had severe stenosis, and the surgery would be a challenge. He said it would take all day and, until he got in there, he was not sure exactly what it would take to fix me.
And here’s where it gets good.
The trans-catheter aortic valve replacement (TAVR) has been around a while and the Chattanooga Heart Institute was an early adopter of the concept. By making a small puncture in the femoral artery in the inner thigh, they are able to thread a catheter up to the heart, insert a valve made of bovine pericardial tissue and titanium, inflate it, and the job is done. Most patients leave the hospital the next day and life is almost immediately returned to normal. No heart bypass, no intubation, simple anesthesia, few surgical complications. Too good to be true?
Unfortunately, the procedure was for elderly, high-risk patients.
There were some hurdles to jump through to get approval. Ultimately a board of surgeons convened and agreed that it was my best choice forward. At the worst, they would have to open me up and repair it the tried-and-true “routine” way, but at best I would go home the next day, sans the 10” wound, and with what could be a permanent solution.
I scheduled the surgery and off I went to the spaceship-like TAVR suite, surrounded by the area’s most competent medical team, and an hour later my valve was working just fine. I remember Dr. Clements coming to the SICU and I asked how it went. He answered: “Just beautiful. It was just beautiful.”
Recovery from TAVR is a couple days rest and then life is normal. At my last follow-up, after a cardiac CT scan, Dr. Oellerich told me it was working just fine, my EF was 50% (not far from normal for a man my age) and the new valve sounded great.
I said all that to say this.
If you have symptoms, such as shortness of breath, syncope, dizziness. If you cannot walk up a hill without pause. If you feel tired all the time. Get help. Chattanooga is home to one of the top 100 Heart Hospitals in America. The very latest technology is available, and it is getting better every day. The era of robotic surgery is here, and they may be able to solve your problem without open heart surgery. TAVR has since been approved for the general population, and the expensive ($23,000!) valves keep getting better. The team at CHI Memorial has the ability to diagnose and treat your heart problem.
To anybody who has a heart, take care of it. I was first diagnosed nearly twenty years ago. Since then, I have watched my kids graduate from high school and college. I got to see three of them married. I have been blessed with knowing four grandchildren. This year I will have been married to my wonderful wife for 37 years. Let this heart month be a sign to seek help.
And then you can get back to living.