Heart Surgery Repairs Potential ‘Time Bomb’
DECEMBER 04, 2024
Joe’s surgery was scheduled for 2/22/22—a date that felt lucky. It capped off a string of coincidences that led him to the Aortic Center at Beth Israel Deaconess Medical Center. Joe felt remarkably calm, though heading into the OR wasn’t exactly where the 38-year-old expected to be just a few months earlier.
In late 2021, Joe hadn’t been to the doctor in a while but was feeling fine, working a physically demanding job. A family member's reminder of the importance of regular check-ups nudged him to call his primary care provider. His physical with John Chisholm, MD, seemed routine—until Dr. Chisholm picked up on a faint murmur while listening to his heart and referred Joe for a cardiac ultrasound (echocardiogram).
The scan revealed that one of Joe’s heart valves didn’t close properly. Instead of the usual three leaflets that help seal the valve, his had only two—a condition called a bicuspid valve, present in about 1% of the population. Though Joe’s aortic valve was mildly leaking, more concerning was the enlargement of his aorta, a condition commonly associated with a bicuspid valve. He referred Joe to a cardiologist for next steps.
The aorta is the largest artery in the body, starting at the heart and ending in the lower abdomen with branches that feed the entire body. Under certain conditions, the aorta can become weakened and start to form a balloon-like bulge (aneurysm). Aneurysms often cause no symptoms, but if left untreated, large aneurysms can rupture or tear, which can be fatal.
Initially, a cardiologist recommended monitoring the aneurysm instead of opting for surgery. The suggestion was a relief, but the more he thought about it, Joe wasn’t sure it was the best choice. He knew a high school friend whose husband had the same kind of aortic aneurysm - only his proved to be fatal.
“Why am I waiting?” Joe asked himself. Repairing the aneurysm could provide him—and his family—peace of mind. He wanted to see his seven-year-old daughter and four-year-old son grow up. At his friend’s recommendation, Joe consulted Brett Carroll, MD, the Director of Vascular Medicine and Medical Director of the BIDMC Aortic Center, for a second opinion.
“There are multiple factors that are considered when determining the appropriate timing for repair of an aortic aneurysm. For most patients the threshold for surgery is between 5.0 and 5.5 cm,” according to Dr. Carroll. “Joe’s aneurysm was 6.1 cm when he came to BIDMC, so at that size it was clear an intervention was indicated.” Together with Aortic Center Co-Director and Chief of Cardiac Surgery, Kamal Khabbaz, MD, they discussed surgery to repair the aneurysm and replace the bicuspid valve. Careful consideration was given to what type of valve might last longest given Joe’s age.
In February 2022, Dr. Khabbaz, an expert in repairing complex aortic aneurysms, performed Joe’s surgery. In what Joe describes as “a minor miracle,” Dr. Khabbaz not only repaired the aneurysm but was able to repair, rather than replace, his valve.
“He bought me more time. I didn’t need a new valve at age 38. Dr. Khabbaz was a miracle-maker.” The valve-sparing surgery also came with another advantage: Joe had anticipated receiving a mechanical valve, which would have required daily anticoagulant medication to prevent clots. Fortunately, his repaired valve didn’t need that therapy.
After three days in the hospital, Joe returned home to recover. Progress was slow but steady, and in time, he regained his strength. Looking back, Joe recommends keeping up with regular check-ups. “It wasn’t a high priority for me a few years ago, but I’m lucky that changed. I felt fine, but I had a time bomb in my chest.”