Winter 2007
The Minimally Invasive Way to Susan’s Heart
The Minimally Invasive Way to Susan’s Heart

Susan Brown and Murphy.
Trumbull resident Susan Brown is a savvy woman. When she was told that she needed to have her heart’s mitral valve replaced—for the second time!—she did her homework. After comparing hospitals throughout New England, she chose Bridgeport Hospital for its expertise in minimally invasive heart surgery. Here’s her story.

Susan was 45 years old and living in Maryland in 2002 when she began feeling nauseated and tired all the time. She had known since her 20s that she had mitral valve prolapse, so when she also started having heart palpitations, she realized that she needed to talk to her cardiologist.

"I expected to be told, 'You're overstressed, take these pills and try to relax.'" Susan says. "I did not expect to be told that I needed open-heart surgery to replace the mitral valve!"

Susan’s Maryland physicians gave her a biological valve (made of living tissue—in Susan’s case, a valve taken from a pig). Their goal was to avoid the need for life-long use of anticlotting agents, which are necessary with mechanical valves (crafted of man-made materials).

A biological valve is supposed to last 12–15 years. Susan’s lasted only four.

In 2006, Susan’s father died and she began the sorrowful task of helping her mother clean out the family home on Long Island. As she worked, she again began experiencing the familiar fatigue, nausea and palpitations. Her mother took her straight to the nearest hospital. "They told me they thought the replacement valve had become blocked somehow," Susan says. By then Susan was living in Trumbull, and she was referred to Bridgeport Hospital–affiliated cardiologist Zosimo Adefuin, MD. Dr. Adefuin ordered more tests, verified the blockage, and told Susan that she needed a second valve replacement.

"I really wasn’t looking forward to that! The first time I had a valve replaced, I had a major chest incision, and I vividly recall how difficult my recovery was," Susan says. "For weeks after that surgery, my chest hurt whenever I moved either arm. It took a long time to get back full arm strength. Driving was the most difficult—you don’t fully realize how much your chest is involved in driving a car," she points out ruefully.

"So this time, I researched other options, including minimally invasive valve replacement, because I had read about the smaller incisions involved," Susan adds. "My search led me to Bridgeport Hospital. I read about the Heart Institute and how it had recently been named one of America’s top 100 cardiovascular hospitals, and the best hospital in Connecticut for cardiac services. I thought, 'This place is really good!"

She was also impressed with what she learned about the cardiovascular surgery staff and their level of expertise.

Juan Sanchez, MD, Chief of Cardiothoracic Surgery at Bridgeport Hospital, became Susan’s surgeon. "He took lots of time to discuss procedures and options with me. We decided that the mechanical valve would be best this time," Susan says. "I was impressed to learn that Dr. Sanchez had co-authored a paper in the Journal of Heart Valve Diseases on the minimally invasive procedure. He made me feel very confident."

On July 12, 2006, Dr. Sanchez used minimally invasive techniques to replace Susan’s faulty valve.

The left side of the heart, showing the valve in place. Art by Juan Sanchez, MD.
The left side of the heart, showing the valve in place. Art by Juan Sanchez, MD.

In the Operating Room, a small incision was made in a groin artery so the cardiac perfusionist could connect Susan’s circulatory system to the heart-lung machine. This device took over the heart’s job: pumping blood to her brain, body and heart muscle during the procedure. That left the chambers of her heart empty of blood. (It’s important to remember that the heart muscle is nourished by its own system of arteries and veins, not by the blood that passes through the chambers on the way to the body.)

Dr. Sanchez made a four-inch incision between the ribs under Susan’s right breast to insert the valve. He made two smaller incisions nearby. Through one of the small incisions he placed special long-handled surgical instruments. Through the other small incision he positioned a miniature video camera that sent images to a monitor right over the operating table.

In order for Dr. Sanchez to view the heart on the monitor, Susan’s right lung had to be collapsed. This made anesthesia more complex than usual. Anesthesia provided with only one working lung involves a sophisticated procedure called single-lung ventilation. "This requires a special double-lumen (two-tubed) breathing device, a fiberoptic bronchoscope (broncho = lung; scope = view), and very close monitoring of breathing and circulation," explains Bridgeport Hospital Chairman of Anesthesiology Charles Watson, MD, who has published several papers on the single-lung procedure.

When he had an unobstructed view of Susan’s beating heart, Dr. Sanchez used a mild electric shock to set it fibrillating, or quivering, making it easier for him to carefully make an incision and expose the valve. Using his long-handled instruments, Dr. Sanchez removed the failed valve and the scar tissue that was causing the blockage.

An Operating Room nurse unwrapped a mechanical valve—a metal ring about the diameter of a silver dollar, and about 1/4 inch thick—and placed it in Dr. Sanchez’s gloved hand. Two centered flaps opened and shut like doors, allowing blood to pass through. A fibrous outer circle made it possible to stitch the valve to Susan’s heart. No battery was required—the pressure of moving blood would make the flaps swing open and shut, keeping blood flowing in the right direction.

Once the valve was securely in place, Dr. Sanchez stopped the fibrillation of Susan’s heart, which immediately went back to its normal rhythm. The heart-lung machine was disconnected: The operation was a success.

Susan will need to take blood thinners for the rest of her life to prevent clotting—a small price to pay for a healthy heart.

"For me, the biggest advantage of the minimally invasive procedure was how quickly I regained my ability to use my arms," Susan says. "After this surgery, I could more easily use at least my left arm, so I could drive sooner, which made me i

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