Intuition and expertise lead to heart surgery at the right time

Carol Lafferty may have spent Christmas 2020 in a hospital bed, but she’s definitely “back in the game” and looking forward to a life of retirement and relaxation.

The 61-year-old underwent open-heart surgery to replace her bicuspid aortic valve and repair an aneurysm in her ascending aorta, conditions that might not have been discovered without a routine annual check-up in October 2018.

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“During the exam, the physician assistant asked me if I knew I had a heart murmur,” said Lafferty, a resident teacher and retiree from Linden, Michigan. “No one had ever mentioned this before.”

As a precaution, an echocardiogram was ordered for Lafferty, who had no heart problems or family history. Expecting to receive a positive report, she was surprised to learn that she would have to see a cardiologist. Her echocardiogram revealed a bicuspid aortic valve, responsible for the murmur.

Complications of a faulty valve

A bicuspid valve is a condition that affects 1-2% of the population. The genetic condition means that an individual’s aortic valve, through which the heart sends oxygen-rich blood to the body, has only two flaps (or “leaflets”) that open and close. A typical aortic valve has three.

Complications of bicuspid aortic valve disease include aortic stenosis (a narrowing or calcification of the valve, preventing it from opening fully), aortic insufficiency (leakage of the valve causing backflow of blood), aortic aneurysm (a balloon-like bulge) and aortic dissection (a separation of the inner layer of the aorta). All of these complications can be life-threatening.

“The cardiologist I saw near my home discussed my bicuspid valve with me but told me not to worry about it,” said Lafferty, who had symptoms including fatigue, chest tightness and shortness of breath. . However, as she also suffered from asthma, her symptoms were attributed to this. “He said I might need to have my bicuspid valve replaced in about 10 years, but so far I’ve been fine.”

Following his instinct

Lafferty’s intuition told him otherwise. Her husband, Matt, agreed: “If you have heart disease, I want you to go to the University of Michigan.”

Lafferty met with the Michigan Medicine Frankel Cardiovascular Center cardiologist Peter Farrehi, MD, in February 2019. During this visit, Farrehi also diagnosed an ascending aortic aneurysm measuring 4.7 cm.

The average aorta is about 2 centimeters, or just under 1 inch. An aneurysm means that the diameter is 1.5 times larger than normal, or 3 centimeters, in the abdominal aorta. Surgery is considered when an aneurysm grows to about 5.5 centimeters.

People with an aortic aneurysm typically experience a period of “watchful waiting” during which the aneurysm is closely watched until it reaches a size where surgery may become necessary.

“Since there was no way of knowing how fast my aneurysm was growing, Dr. Farrehi wanted to monitor it for a year. I had to let him know if my symptoms were getting worse,” Lafferty said.

“When I returned to UM in November 2019, they found that my bicuspid valve had become more calcified, but Dr. Farrehi still wanted to monitor me and monitor the valve and the aneurysm,” Lafferty said.

It’s time to act

In the summer of 2020, Lafferty was experiencing worsening symptoms, including chest pain, while working at her family hardware store. When the pain moved to her back and arms, she knew things were moving forward. Farrehi called thoracic surgeon Gorav Ailawadi, MD, to consult.

“I had a zoom appointment with Dr. Ailawadi on December 7, 2020,” Lafferty said. “He went through all my scans and said, ‘OK, I think it’s time for surgery.'”

On December 21, 2020, Lafferty is athe ortic valve and the ascending aorta were replaced.

“We replaced his tricuspid valve with a bovine valve, which can last up to 15 years,” Ailawadi said. “With these surgeries, we consider the patient’s lifespan and how we can help avoid future open-heart surgery.”

For Carol, that meant she would likely survive her bovine valve, but would be a potential candidate for transcatheter aortic valve replacement, also known as TAVR, instead of another open-heart procedure.

During the operation, Ailawadi also replaced the part of Lafferty’s aorta weakened by the aneurysm with a synthetic fabric tube, called a graft.

“The patient had a remarkable recovery and told us she could immediately feel the difference,” Ailawadi said.

“I really had almost no pain after the operation. My only problem was that I felt like I couldn’t expand my lungs or breathe deeply,” Lafferty said.

Back in the game

Today she feels good. “Looking back, it’s almost like a dream. I feel much stronger now.

Lafferty and her husband are wasting no time as they have both embraced retirement. The couple bought a truck and an RV and are busy touring the country.

“I’m absolutely happy,” she said as she looked forward to spending some quality time with her family. “I’m mentally and physically back in the game now that my surgery is over and the cloud hanging over my head has lifted.”

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