News From Terre Haute, Indiana

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February 26, 2012

VIDEO: Mending Broken Hearts

Incidence of heart disease keeps surgical units busy

TERRE HAUTE — Regina Nieft calmly entered Union Hospital early Thursday, confident and hopeful that the complicated cardiac surgery scheduled for most of the day would improve and extend her life.

She placed her future in the hands of cardiac surgeon Tamim Antaki, anesthesiologist Scott Samson, perfusionist Steve Peterson, and a team of highly trained nurses who took Regina through five procedures: a coronary bypass; repair of two leaky heart valves; the biopsy of some lymph nodes, and a biopsy of her left lung.

Regina agreed to share her story with the Tribune-Star to help raise awareness during February, designated as American Heart Month, an initiative undertaken by the American Heart Association to battle cardiovascular disease and to educate Americans on how to live hearth-healthy lives.

Heart disease is the leading cause of death for both men and women in the United States, killing an estimated 630,000 Americans each year, according to the American Heart Association. Most Americans probably know someone who has had heart disease or a stroke.

A longtime smoker, Regina, 48, gave up cigarettes about a month ago in preparation for her surgery. She relied on a portable oxygen tank to assist her breathing because of poor lung function due in part to heavy smoking. And she relied on the care of her husband, Ron, a Terre Haute native. The couple, who have been married 28 years, moved to Rosedale from Milledgeville, Ga., in part to go through the surgery, and also to be closer to a granddaughter who lives in the Wabash Valley.

“We moved here because of the doctors, and my granddaughter’s here,” Regina said during a visit to Dr. Antaki’s office a few days before the surgery. “That’s one reason why I’m having this surgery, is to be around a little longer.”

Regina said she had a childhood case of rheumatic fever, and she has been told that the illness weakened her heart valves later in life. Being a smoker contributed to her declining health.

Dr. Antaki explained that rheumatic fever most likely contributed to the deterioration of Regina’s heart valves, which developed scaring. An echocardiogram of her heart function showed that the mitral valve and aortic valve were not completely closing, allowing blood to leak between the chambers in her heart.

In Regina’s case, her mitral valve on the left side has a combination of problems; it is too tight, and it is leaking severely, causing a blood-flow problem. The aortic valve between the left ventricle and aorta also is leaking, causing blood to back up into the left ventricle.

“So, you can see how much mechanical problem this heart has,” Antaki said Thursday as he reviewed Regina’s examinations. “It’s pure plumbing and heart mechanics.”

Dr. Antaki said he prefers to repair a heart valve if possible, fixing the defect that is causing the problem. But in Regina’s case, the valves needed to be replaced with biologic valves made from pericardial tissue.

“We will correct the mechanical problem with the heart,” Antaki said of the procedures for the interior of Regina’s heart. “When it comes to heart valves, it’s a mechanic problem.”

On the exterior of her heart, the bypass surgery was needed because the heart’s muscle is fed with a network of small arteries that supply nutrition. If those arteries become blocked, the heart has inadequate blood flow and it becomes weak. That can turn into congestive heart failure because the heart is not working effectively.

And, a cumulative loss of heart function leads to heart attacks, which can slowly kill the function of the heart.

A long morning

Regina’s preparation for the surgery took a few hours. She was transferred into one of the two new surgery rooms around 8 a.m. The cardiac surgery nursing team of Kelly Hill, Nicole Johnson, Lori Dowers and Kay Smith took care in her preparations, and Dr. Samson administered the anesthesia that put Regina into a deep sleep while a breathing tube was inserted so that her breathing could be controlled during surgery and recovery.

Samson remained in the room monitoring her sedation throughout the surgery.

Shortly after 10 a.m., an incision was made in Regina’s left leg to remove a portion of a superficial vein to be repurposed in the artery bypass. Scott Kunz, a registered nurse first assistant, inserted an endoscopic device into Regina’s leg that allowed him to see the interior of her leg on video as he located the vein and sealed off the smaller branches while not damaging the vein.

Kunz carefully dissected a segment of the vein about 14 inches long. He then inspected it for leaks and set it aside for use by Dr. Antaki in the bypass phase of the surgery.

Antaki said the procedure to harvest the vein used to be the most painful part of the bypass for the patient. That was mainly due to the lengthy incision that was made along the leg. The new procedure is done through a one-inch incision, with carbon dioxide gas pumped in to inflate the area around the vein, making more room for the procedure. The small incision that becomes the only outward sign of the vein harvesting also has a much lower incidence of post-operative infection.

Another critical stage of the surgery occurred after Dr. Antaki opened Regina’s chest cavity to reveal her beating heart. Antaki inserted tubular instruments called cannulas into the proper blood vessels to bypass the heart and lungs by use of the heart-lung machine that keeps the patient alive during open heart surgery.

When Antaki gave the order, the perfusionist, Peterson, cooled Regina’s blood and administered drugs to stop her heart. Peterson monitored the heart-lung machine as it drew blood from Regina, added oxygen and removed carbon dioxide, and then pumped the blood back into her body. He monitored and adjusted the machine to ensure proper blood pressure and flow during the surgery, and to maintain blood gases.

Peterson has worked in surgery for 45 years and as a perfusionist for 40 years. He has participated in more than 5,000 heart and lung surgeries. He also has developed computer software that electronically charts the perfusion record in real time.

It was around 11:14 a.m. when the heart-lung machine took over the life flow of Regina’s body. Dr. Antaki packed some ice slush onto her heart to preserve the heart, which no longer had electrical or mechanical function. In addition, the perfusionist on command would administer a cold solution with chemicals to stop the heart from any activity, and to protect the heart muscle. A few minutes later, he removed the somewhat melted ice, and was then able to perform the cardiac surgery, which lasted into the afternoon.

A team effort

During the surgery, nursing team leader Pam Dreher oversaw the actions of the surgery team and explained the process to onlookers. With its expansion two years ago, Union Hospital now has two surgery rooms for the cardiac team, and the latest technology to perform the surgeries.

“As technology grows, we grow with it,” Dreher said. “This is a big step for us with all of the new equipment.”

The cardiac surgery team has 10 members, she said, and that is enough staff to allow two cardiac surgeries at the same time. In fact, two heart surgeries were scheduled simultaneously on Friday, plus additional standby.

Dreher said she, herself, has experienced a heart procedure, and she said that she is confident in the skill of the surgical teams at the hospital.

“With us being a small group, I feel the patients get more personal care,” Dreher said. “It’s not like some of the bigger Indianapolis hospitals.”

She said she foresees growth for cardiac surgery in Terre Haute, and technology keeps up with advancements in treatment.

Amazingly, after the five hours that Regina was on the heart-lung machine and a total of eight hours in surgery on Thursday, she was ready to have the tube that assisted her ventilation to be removed Friday afternoon. She will remain in the intensive care unit for two or three days, where her recovery will be monitored continuously, but her progress surprised even Dr. Antaki.

Two days later

By Saturday afternoon, Regina was talking to visitors in the intensive care unit. She said that she had some soreness in her chest from the surgery, but she was able to breath deeply.

Nurse Candy Herron called Regina’s progress “remarkable.”

Herron is assigned to the hospital’s critical care unit where she and up to seven other open heart nurses are responsible for the patients. In the first 12 to 18 hours after a patient’s surgery, one nurse is assigned solely to that patient’s care, she said.

“We wake her up, get her to breathe, see that she has good blood circulation and activity,” Herron said. “We get them awake and off the ventilator as soon as we can.”

Dr. Nabil Mnayari, a partner of Dr. Antaki, was with Regina on Saturday, working on her post-operative progression.

“She’s going good,” Mnayari said.

Antaki also gave credit to Dr. John Yacoub, a local cardiologist who diagnosed Regina’s problems and referred her to Antaki.

“He’s the guy who figured out she was in deep trouble,” Antaki said.

Terre Haute is fortunate to be a city with a number of heart surgeons who not only work here, but reside here, he said.

“There are three heart surgeons who live and practice in town,” Antaki said, adding that he is amazed when people think he resides in Indianapolis, and travels here to practice medicine.

“It does mean a lot to the patients here, to know that we are committed to living here and serving in the community,” Antaki said.

Lisa Trigg can be reached at (812) 231-4254 or lisa.trigg@tribstar.com

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