Keeping the Pace
The first time Rick Kuntz learned he had a defective heart valve, he was in an emergency room with congestive heart failure.
Although he always thought of himself as a healthy individual, in fall 2004, a tiny part of Rick Kuntz’s heart – the mitral valve – began causing a life-threatening condition. Following surgery to repair the valve, Rick is again enjoying his daily routine of walking and biking. Most of all, he’s happy to be alive.
It Began With a MurmurAbout 14 years ago, Rick learned he had a heart murmur during a medical exam. A murmur is often caused by a defective heart valve. But Rick felt fine until the summer of 2004. “I always exercised, but suddenly, I had no energy,” he said. In addition, he was retaining water and gaining weight. He felt a gurgling in his chest and had trouble sleeping.
Over the next few weeks, Rick’s symptoms worsened. “While lying down at night, I had trouble breathing, but I didn’t realize anything was wrong with my heart.” By the fall, his health declined dramatically. On Sept. 26, he awoke unable to breath. He was taken by ambulance to a local hospital, where he learned he had congestive heart failure.
“I found out my heart was three times its normal size, it was too badly damaged for surgery, and I might need a heart transplant.” The next day, Rick was transferred to Froedtert & the Medical College of Wisconsin, where he and his wife, Cindy, welcomed a second opinion. He was admitted to the Cardiac Intensive Care Unit under the care of David Rutlen, MD, Medical College of Wisconsin cardiologist and associate chairman for ambulatory programs.
An echocardiogram revealed mitral valve regurgitation (MVR), caused by degeneration of the mitral valve and excess tissue in the valve. He also had atrial fibrillation, an abnormal heart rhythm. “Dr. Rutlen discussed options with me and said surgery could help,” Rick said.
“The echocardiogram showed Rick’s valve problem was repairable,” said Alfred Nicolosi, MD, Medical College of Wisconsin cardiothoracic surgeon. On Oct. 1, Dr. Nicolosi performed surgery to repair Rick’s mitral valve and treat the abnormal heart rhythm. A week later, Rick received a pacemaker to regulate his heart beat. After a two week hospital stay, Rick returned to Froedtert & the Medical College for several weeks of outpatient cardiac rehabilitation.
Valve Disease Common“Next to coronary artery disease and arrhythmias, valve disorders are the third most common type of heart problem among adults,” said Timothy Woods, MD, FACC, FCCP, Medical College of Wisconsin cardiologist. Dr. Woods is also director of the Valvular Disease Clinic and the Adult Echocardiography Laboratory at Froedtert & the Medical College.
“There are many types of valve disease, but the two most common disorders we perform surgery for are mitral valve regurgitation and aortic stenosis,” Dr. Nicolosi said.
Mitra Valve RegurgitationMitral valve regurgitation is an incomplete closure of the mitral valve, located between the left atrium and the left ventricle. This leads to regurgitation: blood leaking backward through the valve. The heart works harder to pump the extra blood. Mild cases of MVR cause few problems, but more severe cases eventually weaken the heart and lead to heart failure.
“Most MVR is caused by mitral valve prolapse – an abnormality people are born with,” Dr. Woods said. Other causes include infections and other forms of cardiovascular disease. A person with MVR may or may not have symptoms, such as fatigue, swelling in the legs or shortness of breath. A physician can often detect a leaking valve by hearing a murmur during an exam.
“No medications have proven useful for treating MVR or aortic stenosis,” Dr. Woods said, “but certain valve problems can be fixed. Particularly with the mitral valve, it’s preferable to repair the valve when possible to help the person retain their natural valve tissue.”
Certain mitral valve problems can be repaired, or the valve can be replaced. “Many disorders that lead to MVR are repairable,” Dr. Nicolosi said, “and we prefer to repair vs. replace the mitral valve when possible. If repair isn’t possible, an artificial valve can replace the mitral valve.”
Aortic StenosisIn aortic stenosis, the aortic valve, located between the left ventricle and the aorta, becomes calcified, causing the valve to narrow or become obstructed. The most common cause is degeneration of the valve. The smaller valve opening limits the flow of blood to the aorta, making the heart pump harder and reducing blood flow to the body. Aortic stenosis can be detected before symptoms begin through a regular exam that reveals a prominent murmur.
Symptoms include angina (chest pain due to an inadequate supply of oxygen to the heart), spells of passing out, shortness of breath, fatigue and swelling in the legs.
“In aortic stenosis, the valve becomes calcified, and there’s no way to repair it,” Dr. Nicolosi said. “We almost always need to replace the aortic valve with an artificial valve.”
Three are three types of prosthetic valves:
- Mechanical valve (man-made materials)
- Bioprosthetic tissue valve made of animal tissue
- Bioprosthetic tissue valve made of donor human tissue
“A mechanical valve can last forever,” said R. Eric Lilly, MD, Medical College of Wisconsin cardiothoracic surgeon. “However, blood clots can form with a mechanical valve. Therefore, patients with this type of valve must be monitored closely and take a drug to prevent blood clots.”
With a bioprosthetic tissue valve replacement, a blood thinner may be needed temporarily, or not at all. However, this type of valve typically lasts 10 to 15 years and will eventually need to be replaced. Dr. Lilly specializes in performing less invasive surgery to repair and replace heart valves, including mitral and aortic valves.
“Almost everyone who has isolated valve problems is a candidate for the less invasive approach,” Dr. Lilly said. “Patients can usually return to normal physical activities 15 to 20 days sooner than with the open chest procedure, and they tend to tolerate post-surgery pain better.”
In addition to surgery for MVR and aortic stenosis, Froedtert & the Medical College offer surgery for other valve disorders, including valve-sparing aortic root replacement and tricuspid valve regurgitation. (The aortic root is the part of the aorta attached to the heart. It contains the aortic valve.)
“Once a valve has been repaired, it’s durable,” Dr. Lilly said. “There’s a 93 percent chance of a successful, long-term outcome.”
Taking it EasyTwo years after surgery to repair his mitral valve and irregular heart rhythm, Rick once again enjoys walking and riding a bicycle. And he takes life a little easier.“My doctors and nurses were great,” Rick said. “The way they took care of me was wonderful.”
Source: Froedtert Today
Date: March 2007