New valve brings renewed confidence

Two months after his heart operation, Sandy Smith is eyeing the steep road up to his Dunedin house. He would like to be able to walk up the hill to his home, and he can feel his confidence returning with his strength.

“You have got to have the confidence to do things and know that you are not going to damage yourself,” he explains. “I’ll try it this week or next week.”

The 66-year-old microbiologist at Otago University has had cardiothoracic surgery to replace an ailing heart valve with an artificial one supplied by Rem Systems. His aortic valve - the St Jude valve - is now made of a highly polished material that has proved to be virtually indestructible over more than 20 years that the valves have been in use.

The operation, carried out by cardiothoracic surgeon, Dick Bunton, corrected a heart defect that Dr Smith has had since birth. He was born with an aortic valve that had only two cusps instead of three - a defect he has been told affects one in 400 New Zealanders.

He found out about it during a medical examination in 1962.

“I had no problems until about two years ago. The valve gradually tightens as you get older. The ability of the blood to pass through the tightened valve gets less, so there is more pressure needed, and the ventricle that pumps the blood through the aortic valve has got to do a lot more work,” he says.

The ventricle itself may be damaged as it gets bigger and stronger to try to cope with the narrowed valve.

The first signs of problems were odd palpitations and heart flutters. “Then, a couple of months before the operation, I started to get short of breath. It’s an odd feeling, almost like a panic attack, or being slightly asthmatic. I felt tired and off-colour.”

What had started as a slow deterioration over time had become a relatively rapid deterioration. Leaving the condition untreated would lead to chronic heart failure.

Tests were carried out, including ultrasound testing to measure the blood flowing across the valve and its pressure as it passed through.

The operation to install the 23mm St Jude valve took three hours, and Dr Smith describes his recovery as “remarkably quick”. He was out of hospital in just six days.

He woke after the operation with tubes and monitoring devices attached to his body. As is normal, he spent the first 24 hours in the intensive care unit while his heart was monitored. At the end of the 24 hours, staff had him standing up and he was moved to a ward.

Most of the pain after the surgery came from the large wound down his sternum where his chest had been opened up. The ribs had been rejoined with wire and the skin stitched back over the top after the operation, but the wound certainly impressed one of his grandsons who insisted that Dr Smith show everybody whenever the child was visiting.

A physiotherapist had a major role at that stage, to get lung function back to normal so that the diaphragm worked properly and basic tasks such as nose blowing and being able to exert the pressure to go the toilet became possible again.

“You appreciate what your lungs do. The people who seemed to have more trouble recovering during the time in hospital were diabetics or people who had underlying lung disease. It brought home to me the dangers of smoking,” says Dr Smith, who has never smoked.

Pain control continued for four to five weeks. He also says he believes the anaesthetic reduced his ability to concentrate, but this returned five or six weeks after the operation. “For a time, I would pick up a book and read one page and then put it down. You just didn’t seem to have the mental ability to concentrate.”

Two months after the surgery, he was back doing part-time work and looking forward to returning full-time soon after. He says he had extremely good support from his wife and family, but he believes he should also have accepted the offer to attend cardiac rehabilitation classes so that he did not feel isolated.

The pain proved to be a minor factor for Dr Smith after the operation, but the major thing was anxiety. “That is the most difficult thing I have found - to get over the fear of the unknown. You can wake up in the night, almost panicking, not knowing where you are and what’s happening.”

Life is now returning to normal. Because he opted for an artificial valve instead of a mammalian replacement, he will have to take blood anti-coagulant drugs for the rest of his life. “There is no doubt that I certainly feel a lot better,” he says. He has had no more palpitations or heart murmurs. His new valve is operating quietly, but he has heard that in some cases, when a valve recipient is sitting in a quiet room it is possible to hear the valve clicking.

REM Systems is a New Zealand-owned distributor of medical products, with offices in both Australia and New Zealand. Its product ranges include products for the following hospital areas - orthopaedic surgery, cardiac surgery, cardiology, radiology, IV therapy, pain therapy, operating theatre, urology, anaesthetics, laparosopic surgery, electrosurgery, pharmacy, plus the veterinary market as well. Its aim is to help improve the quality of patients’ lives by providing high-quality products and also high service levels.