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Protecting Your Heart
One Surgery Fixed Two Heart ProblemsA combined surgery repairs the valve and corrects a heart rhythm disorder at the same time
Robert and Esther Flammer enjoy their garden together. Lessons From Robert Flammer’s Experience
While Flammer’s wife, Esther, was being checked by cardiologist Robert Malacoff, M.D., of Lehigh Valley Hospital and Health Network, Flammer read about the signs of heart failure—shortness of breath, swollen ankles, occasional racing of the heart, general fatigue. He had several of them. As a young man, Flammer had had a heart murmur de- tected. But he’d never been treated for anything except high blood pressure. “I thought I was just tired from taking Esther to her doctors’ appointments,” says the vibrant 80-year-old, who thinks nothing of chopping wood for his fireplace and working a 38 by 50-foot garden every summer. When Malacoff casually asked Flammer how he was doing, he pointed to the brochure and said, “I have many of these symptoms.” To his surprise, the cardiologist immediately checked his pulse and ordered an EKG. Further tests confirmed that Flammer was suffering from heart failure—a weakening of the heart muscle that prevents it from pumping enough blood—caused by a leaky mitral valve (see below). He also had atrial fibrillation, a disorganized quivering of the heart. Within days, Flammer was in Lehigh Valley Hospital—Muhlenberg. Cardiac surgeon Fernando Garzia, M.D., performed two procedures: repairing the leaky valve and correcting the heart rhythm with a procedure called Maze. (Maze involves creating scar tissue to rechannel the heart’s electrical impulses in an orderly and organized route.) “The goal was to give Mr. Flammer a valve that worked well and a regular rhythm, so he didn’t need to be on anticoagulant medication,” Garzia says. Such drugs—coumadin is a familiar example—carry the risk for bleeding. Flammer was out of the hospital and recovering from surgery in good time to plan this year’s garden. Given the increased energy he feels today, it’s bound to be a bumper crop. All About Your Heart ValvesThere are four of them: two on the left and two on the right. The left valves (mitral and aortic) are the ones that most often have problems. “A structural defect or infection allows blood to leak through the valve (called regurgitation),” says cardiac surgeon Gary Szydlowski, M.D., of Lehigh Valley Hospital and Health Network. “Or, valves can become narrowed (called stenosis), and it’s hard for the heart to pump blood across a narrowed passage.” Robert Flammer (see story on these pages) had a severely leaky mitral valve.What causes valves to malfunction?An infection can do it, but usually the problem is gradual deterioration. Valve problems can lead to heart failure, as in Flammer’s case.The most common symptom of a bad valve is heart murmur. “But just because you have a murmur, it doesn’t mean you have a valve problem,” says cardiac surgeon Fernando Garzia, M.D. And not all valve-related murmurs require surgery, Szydlowski says: “The need for surgery increases with age.” One-third to one-half of all open heart surgeries are for faulty valves, and in the past surgeons replaced the valve rather than repairing it. “Now, we’ve learned that a natural valve functions better than a prosthetic in the heart,” Garzia says. The surgeon cuts out the portion that is leaking, sews the remaining functioning valve back together and reinforces the repair with a ring to keep the valve from dilating. The supportive ring stays in place permanently. Is there any way to prevent valve problems?Those caused by infection can be headed off by promptly treating infections. “Rheumatic fever was the most common cause of valve disease before penicillin,” Garzia says.Otherwise, promote your overall heart health by exercising regularly, eating a low-fat diet and not smoking. This page last updated 3/30/08 03:18 PM
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