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[h=1]Bicuspid Aortic Valve Repair: Bryan’s Story[/h] http://www.dailylocal.com/article/DL/20180205/NEWS/180209896
By Barbara Curtis
A collegiate athlete turned physical education teacher, Bryan Tingle has been physically active his entire life. He was an accomplished lacrosse player and even tried out for professional leagues, like the New York Titans. At 34-years-old, he continued his fit lifestyle, completing triathlons while keeping up with three young children at home – until one day he experienced an uncomfortable sensation.
“I was running over the summer and could feel my heart beating differently. It was a strange feeling – it didn’t hurt but I knew something wasn’t right,” said Tingle.
He was a young, healthy guy with no known medical issues, other than a heart murmur he was diagnosed with at the age of 11. “The murmur never had an impact on my life, so I figured the palpitation was from everyday stress,” added Tingle.
Five days later, he continued to feel palpitations along with chest pressure. His wife insisted he go to an urgent care facility for peace of mind. The clinicians detected unusually high blood pressure and his electrocardiogram (EKG) was abnormal – they immediately called an ambulance in fear he was having a heart attack.
Tingle was rushed to Chester County Hospital’s Emergency Department, where a team of doctors and nurse practitioners evaluated his condition. Multiple tests were performed and Tingle was relieved to learn he had not experienced a heart attack. His lab work was good, a second EKG was normal, and the test results determined he had not suffered any damage to his heart. He was released and told to schedule an appointment with a cardiologist.
With this good news, he went on a family vacation to the Outer Banks, North Carolina with his three children and wife, who was expecting their fourth child. But once he was there, he began feeling chest pain and immediately went to the local emergency room. Their diagnosis – a panic attack.
Having two emergency room visits within weeks of each other was concerning for Tingle, especially with a fourth baby on the way. As soon as he returned home, he made an appointment with his cardiologist, Dr. Mian Jan at West Chester Cardiology. Dr. Jan ordered a Transesophageal Echocardiogram (TEE).
A TEE is a special type of echocardiogram that produces detailed images of the heart’s structure by using a thin tube that goes down the esophagus. Since the esophagus is close to the upper chambers of the heart, physicians have a clearer, more detailed view of these chambers than from a traditional echocardiogram.
The results confirmed Tingle was not experiencing symptoms of a panic attack, but in fact, had a congenital heart condition (from birth). Tingle had a bicuspid aortic valve, meaning his aortic valve only had two leaflets instead of three and was leaking severely.
A healthy aortic valve has three cusps or leaflets – known as a tricuspid valve – which open and close to regulate blood flow. Oftentimes a bicuspid valve will work well for many years, only beginning to show symptoms later in adulthood.
In Tingle’s case, the TEE showed that the symptoms he was experiencing were a result of the leaky aortic valve, which caused blood to flow back into the heart instead of flowing forward. When this occurs, the heart muscle weakens since it must work harder to pump blood throughout the body. If left untreated, it can lead to dilation of the aortic valve and left ventricle causing irreversible damage and heart failure.
Dr. Jan referred him to the Heart Valve Center at Chester County Hospital. For Tingle’s consultation, Steven Weiss, MD, chief of Cardiac Surgery, invited Nimesh Desai, MD, PhD, director of the Thoracic Aortic Surgery Research Program at the Hospital of the University of Pennsylvania (HUP), to join him in evaluating this complex case.
“It was a scary experience knowing I had a heart condition that was causing my symptoms. But when I met with Dr. Weiss and Dr. Desai, I knew I was in good hands. They were very reassuring and made me comfortable,” says Tingle.
Depending on each patient’s unique situation, there are a few surgical procedures available to correct a valve condition. The first is a mechanical aortic valve replacement, which provides a durable, long-lasting solution but requires patients to take Coumadin, a blood thinner, for the remainder of their life. The second option is a tissue aortic valve replacement, which does not require long-term use of medication but at Tingle’s age could only be expected to last between 10 and 15 years.
The third and best option is an aortic valve repair. Patients who have a valve repair do not require lifelong medication or future surgeries. Fortunately for Tingle, his surgeons were confident they could successfully repair his aortic valve.
“We performed an advanced repair that only a few places in the country are doing. It’s called a bicuspid aortic valve repair with Lansac ring. The ring sits outside of the aorta, underneath the coronary arteries, and prevents the repaired aortic valve from ever dilating. It’s a new refinement of the leaflet repair procedure intended to provide lifetime durability, which was a perfect fit for a young individual like Mr. Tingle,” said Dr. Weiss.
As the surgery was being finished, Tingle was taken off of the heart and lung machine, often called “the pump,” and was in excellent condition. But shortly after, his aorta developed a tear resulting in blood loss.
The issue was detected immediately and his care team worked together to cool his body, get him back on the pump and fix the tear. After living with a heart condition for over thirty years, his aorta had become very thin and prone to a complication.
“What makes a program great is not the absence of complication, but eliminating failure to rescue. Detecting and correcting a problem early, so that no harm occurs to the patient, is what makes a hospital have great outcomes,” added Dr. Weiss.
Typically only available at HUP, along with a few other facilities in the U.S., the procedure was successfully performed by Dr. Weiss and Dr. Desai at Chester County Hospital.
Today, Tingle is in better physical condition than ever before and is able to live a life without restrictions just 12 weeks after his surgery.
“I can’t say enough positive things about my experience. The surgeons, nurses and the team at cardiac rehabilitation all took great care of me. My priorities have changed since the surgery because I’ve been given another chance to live without fear of my heart condition. I’m looking forward to spending more time with my family, my students… and living an active life with them again. God has a lot in store for me,” added Tingle.
Mian Jan, MD, FACC is also chairman of Chester County Hospital’s department of medicine.
By Barbara Curtis
A collegiate athlete turned physical education teacher, Bryan Tingle has been physically active his entire life. He was an accomplished lacrosse player and even tried out for professional leagues, like the New York Titans. At 34-years-old, he continued his fit lifestyle, completing triathlons while keeping up with three young children at home – until one day he experienced an uncomfortable sensation.
“I was running over the summer and could feel my heart beating differently. It was a strange feeling – it didn’t hurt but I knew something wasn’t right,” said Tingle.
He was a young, healthy guy with no known medical issues, other than a heart murmur he was diagnosed with at the age of 11. “The murmur never had an impact on my life, so I figured the palpitation was from everyday stress,” added Tingle.
Five days later, he continued to feel palpitations along with chest pressure. His wife insisted he go to an urgent care facility for peace of mind. The clinicians detected unusually high blood pressure and his electrocardiogram (EKG) was abnormal – they immediately called an ambulance in fear he was having a heart attack.
Tingle was rushed to Chester County Hospital’s Emergency Department, where a team of doctors and nurse practitioners evaluated his condition. Multiple tests were performed and Tingle was relieved to learn he had not experienced a heart attack. His lab work was good, a second EKG was normal, and the test results determined he had not suffered any damage to his heart. He was released and told to schedule an appointment with a cardiologist.
With this good news, he went on a family vacation to the Outer Banks, North Carolina with his three children and wife, who was expecting their fourth child. But once he was there, he began feeling chest pain and immediately went to the local emergency room. Their diagnosis – a panic attack.
Having two emergency room visits within weeks of each other was concerning for Tingle, especially with a fourth baby on the way. As soon as he returned home, he made an appointment with his cardiologist, Dr. Mian Jan at West Chester Cardiology. Dr. Jan ordered a Transesophageal Echocardiogram (TEE).
A TEE is a special type of echocardiogram that produces detailed images of the heart’s structure by using a thin tube that goes down the esophagus. Since the esophagus is close to the upper chambers of the heart, physicians have a clearer, more detailed view of these chambers than from a traditional echocardiogram.
The results confirmed Tingle was not experiencing symptoms of a panic attack, but in fact, had a congenital heart condition (from birth). Tingle had a bicuspid aortic valve, meaning his aortic valve only had two leaflets instead of three and was leaking severely.
A healthy aortic valve has three cusps or leaflets – known as a tricuspid valve – which open and close to regulate blood flow. Oftentimes a bicuspid valve will work well for many years, only beginning to show symptoms later in adulthood.
In Tingle’s case, the TEE showed that the symptoms he was experiencing were a result of the leaky aortic valve, which caused blood to flow back into the heart instead of flowing forward. When this occurs, the heart muscle weakens since it must work harder to pump blood throughout the body. If left untreated, it can lead to dilation of the aortic valve and left ventricle causing irreversible damage and heart failure.
Dr. Jan referred him to the Heart Valve Center at Chester County Hospital. For Tingle’s consultation, Steven Weiss, MD, chief of Cardiac Surgery, invited Nimesh Desai, MD, PhD, director of the Thoracic Aortic Surgery Research Program at the Hospital of the University of Pennsylvania (HUP), to join him in evaluating this complex case.
“It was a scary experience knowing I had a heart condition that was causing my symptoms. But when I met with Dr. Weiss and Dr. Desai, I knew I was in good hands. They were very reassuring and made me comfortable,” says Tingle.
Depending on each patient’s unique situation, there are a few surgical procedures available to correct a valve condition. The first is a mechanical aortic valve replacement, which provides a durable, long-lasting solution but requires patients to take Coumadin, a blood thinner, for the remainder of their life. The second option is a tissue aortic valve replacement, which does not require long-term use of medication but at Tingle’s age could only be expected to last between 10 and 15 years.
The third and best option is an aortic valve repair. Patients who have a valve repair do not require lifelong medication or future surgeries. Fortunately for Tingle, his surgeons were confident they could successfully repair his aortic valve.
“We performed an advanced repair that only a few places in the country are doing. It’s called a bicuspid aortic valve repair with Lansac ring. The ring sits outside of the aorta, underneath the coronary arteries, and prevents the repaired aortic valve from ever dilating. It’s a new refinement of the leaflet repair procedure intended to provide lifetime durability, which was a perfect fit for a young individual like Mr. Tingle,” said Dr. Weiss.
As the surgery was being finished, Tingle was taken off of the heart and lung machine, often called “the pump,” and was in excellent condition. But shortly after, his aorta developed a tear resulting in blood loss.
The issue was detected immediately and his care team worked together to cool his body, get him back on the pump and fix the tear. After living with a heart condition for over thirty years, his aorta had become very thin and prone to a complication.
“What makes a program great is not the absence of complication, but eliminating failure to rescue. Detecting and correcting a problem early, so that no harm occurs to the patient, is what makes a hospital have great outcomes,” added Dr. Weiss.
Typically only available at HUP, along with a few other facilities in the U.S., the procedure was successfully performed by Dr. Weiss and Dr. Desai at Chester County Hospital.
Today, Tingle is in better physical condition than ever before and is able to live a life without restrictions just 12 weeks after his surgery.
“I can’t say enough positive things about my experience. The surgeons, nurses and the team at cardiac rehabilitation all took great care of me. My priorities have changed since the surgery because I’ve been given another chance to live without fear of my heart condition. I’m looking forward to spending more time with my family, my students… and living an active life with them again. God has a lot in store for me,” added Tingle.
Mian Jan, MD, FACC is also chairman of Chester County Hospital’s department of medicine.
