By Billie Stewart
In 1993, Sam Stewart began experiencing changes with his energy level and heart arrhythmia.
He had been diligent in his annual cardiology appointments, always keeping in mind the day would come that a valve replacement would be necessary. Early detection of changes was important.
The doctors began some significant testing and began therapy protocol. His heart muscle had enlarged significantly, and the aortic valve was leaking moderately to severe. The doctors at Nasser, Smith and Pinkerton in Indianapolis were in agreement to monitor him more closely until his valve began leaking at a severe level.
He began a regiment of blood thinners to prevent blood clotting during tachycardia. He would be scheduled for random cardioconversions and begin a series of medications to control the arrhythmia.
During a summer vacation in 1994, Sam began experiencing extreme tachycardia, which required a hospital stay at Grand Strand Hospital. They coordinated treatment plans with St. Vincent’s Cardiac Care via teleconference.
Prior to his admittance, the emergency room staff ran routine checks — one of which included a chest X-ray. A great discovery was found: A surgical needle. Shining brightly in the film appearing in the shape of a fish hook was a surgical needle. It was buried deep in tissue mass. Unlike today, there was little accountability for surgical aides or instruments during the time period of the first two surgeries. Today, everything used during surgery is counted and collected prior to closure.
By January 1996, Sam’s health situation changed drastically enough to warrant the valve replacement. Dr. Matheny at St. Vincent Cardiac Care Group recommended a Ross procedure. He would be the third patient in Indiana to undergo the procedure in the past few months. Because of his age and long-term medicinal therapy, he would be a perfect candidate.
The Ross would mean extracting his own pulmonary valve and placing it in the aortic position and replace the pulmonic valve with one from a cadaver donor. The valves would be homograft to his heart tissue to begin acceptance.
On Feb. 2, 1996, the surgical procedure began with a risk factor of 20% and was completed within eight hours. The sternotomy would be a cautious procedure due to his history of scar adhesions between the bone and pericardium. Prior to the closing of the chest cavity, he experienced a bleed on the back side of the heart that required further attention. Thus the surgery was extended by about two hours.
He continued to be monitored every three to six months. During one of his routine cardiology exams, valve deficiencies were gradually being noticed. Leakage became more severe over the months. Within 18 months of the Ross, it was determined the procedure had failed.
It became apparent it would be necessary to reverse the procedure or the worst-case scenario place him on a heart pump until a donor heart could be found. This was the first failed Ross in Indiana and the first attempt at reversing the procedure. The heart transplant team of Dr. Keith Allen and Dr. David Heimansohn with St. Vincent’s Cardiac Care Group would be given the task.
On Sep. 22, 1988, he underwent a fourth major surgery in an attempt to replace the aortic and pulmonary valves. They were successful in removing the homograft valves and inserting two St. Jude mechanical valves in their respective positions.
Placing a mechanical valve in the pulmonic position was a risky decision since the success rate is much lower than a tissue valve. Due to the extensive surgery on the heart, it was necessary for the doctors to mesh in the valves to keep them tight within the heart tissue.
The mechanical valves now required a change in medicinal therapy. He would be required to remain on blood thinners for the rest of his life to prevent blood clots from forming. Due to the invasive surgeries on his heart in the past years, his arrhythmia medication would have to be routinely adjusted along with beta blockers to keep his heart from being taxed.
After several weeks, Sam was able to resume work and a normal lifestyle. His only restrictions were on excessive weightlifting and sodium intake.
Unless you knew Sam very well, you would never know he had such severe health issues. His appearance did not depict that of a person with severe medical issues. His stamina appeared normal as any healthy person. He, too, was very hopeful the severity of his medical condition had been corrected.
In 2012, the arrhythmia medicine was no longer effective in controlling his tachycardia. After wearing a daily monitor, in January 2013, it quickly became known he was no longer suffering from tachycardia, but also bradycardia (an extreme drop in beats per minute) during rest. He was scheduled for a pacemaker implant at the Indiana Heart Institute on Jan. 24, 2013.
Most of these are done on an outpatient basis, but for Sam, he would have to be admitted due to the complications of his blood thinner. For any extensive testing or surgery, he has to stop the blood thinners that are therapeutic in reducing the risk of blood clots and bridge with lovenox injections twice daily in the abdomen before and after procedure until the blood is thinned to a therapeutic level.
In 2014, Sam’s health began to decline. Routine cardiac testing did not reveal any issues. He was referred to a pulmonologist to determine if there was an underlying cause for his shortness of breath and decrease in oxygen levels.
Dr. Voohra at St. Vincent suspected right-sided heart failure. In May 2014, his family insisted he needed to be seen because his decline was drastic, but his regular cardiologist, Dr. Nancy Branyas, a St. Vincent Cardiac Care physician, was on medical leave. The Care Group scheduled an appointment for him with Dr. Philip Kirlin at 4:30 p.m. on a Friday afternoon.
After an initial evaluation that could not have lasted more than 10 minutes, Dr. Kirlin informed Sam he was a very sick man and he was admitting him immediately to the hospital. He was in congestive heart failure and the cause to be determined.
Dr. Douglas Pitt, a transplant physician, was placed on his case. After extracting more than 30 pounds of fluid, comprehensive testing showed Sam was in right-sided heart failure and the severity was compromising other major organs (i.e. lungs and liver).
All of the doctors involved, including Dr. Branyas from her home, conferred on the best way to proceed. It was determined that Dr. David Heimansohn should perform the tricuspid valve replacement through a less invasive procedure since Sam had already had four sternotomies.
Billie Stewart is a Seymour resident. Her husband, Sam Stewart, is a 66-year-old man who has undergone multiple heart surgeries. In honor of National Heart Month, she is sharing his story. This is the second of a three-part series. Send comments to [email protected].