Joseph L. Costello
Fri, 16 Jan 1998
HEART VALVE CRONOLOGY

My first recollection of any heart abnormality occurred around the age of 16 or 17 years during a physical examination required for high school baseball. I recall the doctor commenting about a heart murmur.

Although I didn't hear the word murmur again, I do remember doctors pausing and sometimes rechecking my heart with their stethoscopes during routine physical examinations.

In 1990 and during my annual physical examination, my internist told me that my heartbeat was irregular and that I should have an echocardiogram and consult with a cardiologist. I was 46 and he said I would probably need a valve replacement within 5 years.

The cardiologist reiterated my internist's concerns and decided to monitor my condition with annual echocardiograms. I had no overt symptoms of heart disease such as chest pain, dizziness or fainting and was physically active including regular exercise, senior league basketball, and jogging. In retrospect, I lacked endurance in sports even as far back as high school.

By 1995, annual echocardiograms had disclosed increasingly high-pressure gradients and my cardiologist recommended a cardiovascular catheterization. The hospital procedure measured my pressure gradient at 75-80. I still had no overt symptoms but my cardiologist said I should consider surgery before my heart was damaged.

My annual echocardiogram in January 1997 showed a pressure gradient of 90. Since anything over 50 is potentially reason for surgery, I decided it was time to consult with the surgeons. I saw a newspaper article about a newly approved procedure called keyhole or port, which was supposed to be less invasive than open-heart surgery. I called the manufacturer of the device and they referred me to the Falk Cardiovascular Clinic at Stanford University. I called and for the first time, a staff doctor told me about the Ross Procedure. He suggested I consult Bruce Reitz, M.D. one of their cardiovascular surgeons about my condition.

Dr. Reitz saw me and explained the various options relative to valve replacement. Based on my relative young age and good physical condition, he said I was an excellent candidate for a Ross Procedure and that I should get it done as soon as was convenient. Since I am a Kaiser Permanente member, he recommended that I consult with Keith Flacksbart, M.D., one of their cardiovascular surgeons in San Francisco with whom he had assisted on a Ross Procedure.

I met with Dr. Flacksbart and he agreed to do a Ross Procedure. He left it to me to decide when it would be convenient to have the surgery. My cardiologist had never heard of the Ross Procedure and I felt awkward having to explain it to him. I thought it over for a few months saw Dr. Flacksbart again and finally decided to have the surgery on December 17, 1997.

On December 10, I went to the hospital for a preoperative examination, which lasted about 2 or 3 hours and was told to return to the hospital for surgery on the morning of December 17.

I arrived at the hospital around 8:30 a.m. on December 17 and went to directly to the Surgical Unit. There I changed into a gown and my clothes and personal possessions were inventoried. I was shaved from the bottom of my neck to just below my abdomen. Around 11:00 a.m., I was given an injection in my buttocks.

My next recollection is awakening in the Intensive Care Unit. There were two nurses hovering around but I don't remember their names of faces. One of them usually worked at a computer outside the large glass window of my room. I vaguely remember a tube being removed from my throat but I definitely remember being very thirsty. The nurses gave me crushed ice which was very satisfying. I felt no pain.

Later, I overheard some conversation to the effect that I would have to be moved to another unit since my room was needed for another patient. I felt apprehensive about being moved and did not want to leave the intensive care unit. I have no idea how long I had been there.

Although I don't remember actually being moved, at some point I found myself in a room with another patient. This was called the Surgical Recovery Unit. A nurse or nurse assistant came every 4 hours to take my blood pressure, pulse, and temperature and to give me medication. It wasn't long until I was encouraged to eat and walk around the halls. I didn't feel much like eating at first and could only walk about 60 feet with the help of a doubled over pillow held to my chest. I can't say that I was in any pain but it was uncomfortable getting in and out of bed. Each day I was able to eat more and walk further and was visited by a dietary and rehabilitation person.

I have no complaint about my medical treatment and was much encouraged by the attention I received from the doctor in the surgical recovery unit and from daily visits by my surgeon. Also, a representative from Mended Hearts visited me in the hospital. My only complaint about the hospital was noise. It was very difficult to sleep because I was awakened at least every 4 hours for vital signs and medication and was aware of treatment being administered to my roommates. At one point my first roommate was discharged and a new roommate was being treated with a respiration machine. Also, this individual insisted on having his TV on at all time. I was surprised that the hospital permitted one patient to disturb another patient and complained aggressively until a nurse finally intervened and turned off the sound.

At this point, I wanted out of the hospital at all costs. I had a low-grade temperature and the surgical recovery room doctor was uncertain as to whether I should be discharged. I persuaded him that my lack of sleep was retarding my recovery and he agreed to release me on December 21, 1997. I showered for the first time with difficulty before leaving the hospital. Although the shower caused me to feel chilled, I didn't care because I wanted to leave the hospital as soon as possible.

After I got home, I continued to have a low-grade temperature and chills after showering. The first week, I walked three times daily for 5 minutes inside and sucked on a device to keep my lungs open. I was taking 2 aspirin, 25 mg of Metoprolol, and a stool softener. I took only 1 pain pill after returning home and needed no laxative. Aspirin is to thin the blood and Metoprolol is to regulate the heartbeat. An involuntary sneeze caused the most pain I can recall. The second week after discharge, I began walking outside twice daily for 10 to 15 minutes and as much as 25-30 minutes. By the end of the second week, I was walking a half-mile twice daily. My medication was reduced to 2 aspirins daily and 12.5 mg of Metoprolol. This is my third week after discharge. I feel quite strong and that I am recovering quickly. I am walking a mile daily, which takes 30 or more minutes. I'm glad I chose the Ross Procedure and would recommended it to anyone who wants to avoid blood thinners for the rest of their lives. I would advise any person who may need a valve replacement to educate themselves to the fullest by consultation with multiple cardiologists and surgeons and by medical research in libraries and on the Internet. Do not accept the opinion of only one cardiologist or surgeon.