In a nutshell: Chris has a diseased heart valve which needs repair. He is scheduled to have heart surgery on September 17th in Boise, ID. For more details, read on.
If you asked me to identify a mitral valve four weeks ago, I am sure I would have guessed wrong. I knew the aorta had something to do with the heart, and I probably would have remembered something about four chambers and pumping blood, but other than that, I usually think of the heart in a much more metaphorical sense. I like to think of the heart in terms like this: "Hear my soul speak. Of the very instant that I saw you, did my heart fly at your service" (Shakespeare, The Tempest), rather than as an organ that keeps your blood flowing.
Four weeks ago, Chris and Tom were getting ready to go to scout camp, and they met up with the two PAs in our neighborhood for the routine physicals needed to go. During Chris' physical, our PA friend listened to Chris' chest and heard a murmur, then had the other PA, also a friend, come in to confirm. We weren't terribly concerned at that point—a lot of people have heart murmurs, and most people live perfectly normal lives without the murmur affecting anything. Still, both doctors told Chris that he should have it checked out just to make sure everything was fine.
A couple of days later, Chris visited the doctor's office and had an echocardiogram. The ECG is basically like an outside ultrasound on the chest, and Chris' revealed that his murmur was caused by a condition called mitral valve prolapse and mitral valve regurgitation. I like to think of it as the blood going into the heart through these little doors that are supposed to open and shut like a gate, making sure the blood is only going one way. Chris' little gate isn't working right, so some of the blood is going back out the wrong way. Here's a cool YouTube video that gives a good visual:
It was at this point that I did a bunch of online research to learn exactly what the mitral valve is and what we need to do about its regurgitation problem. One thing I learned is that mitral valve prolapse is actually quite common (it's one of the things that causes a heart murmur), and that most people with the prolapse have very little regurgitation, so it doesn't affect their lifestyle at all. The doctors we talked to at this point were hopeful that Chris would fit in this category, especially since he doesn't really have any shortness of breath or any of the other common symptoms of this condition.
Our doctor referred us to a cardiologist, so we visited with him and learned that Chris' regurgitation is classified as "severe" (terrible word, isn't it?!), and that the amount of blood being pushed back the wrong way is enough to cause eventual heart failure. The mitral valve works in the left atrium of the heart which is in charge of getting blood to the lungs. Because of the leak, Chris' heart has to work extra hard to supply his lungs properly and in doing so, is actually growing and further stretching the damaged valve, making the problem worse. While Chris doesn't feel any symptoms now*, the cardiologist assured us that, if left untreated, Chris would soon be feeling very short of breath and low on energy, and that the heart disease would eventually lead to full failure. Scary. This isn't a problem that can be fixed with a lifestyle change or medication; both our doctor and cardiologist told us the same thing: Valve repair surgery is the only thing that can cure a diseased valve.
* I should add that even though Chris and I don't think he has a lot of symptoms, I am starting to wonder if this is something he has just lived with so long that he is just used to the way he feels. He does get tired very easily, and he often feels light-headed after doing things that shouldn't be that much effort, like mowing the lawn. When I do a race or something strenuous, my face gets red and flushed, and even though I get tired, I usually just need some water. Chris, on the other hand, gets extremely pale and nauseated and has to sit down for a while to recover. I don't know if these are really symptoms, but it seems like they might be. Chris said, "I thought I was just lazy."
Anyway, the cardiologist knew that the valve was diseased and that Chris needs surgery, but needed a closer look, so he ordered a transEsophageal echocardiogram, or TEE. Basically, this test required Chris to swallow a probe so that the doctors could get a closer look at his heart from this inside. This link is my favorite on explaining that lovely procedure. This test required a hospital check-in and some anesthetics, neither of which was very appealing to Chris.
Here he is getting ready and looking pathetic before the TEE.
The TEE showed a closer look at the prolapse, and it revealed that the some of the chords have ruptured that are attached to the muscles that function to open and close the valve. I looked at the ECG while the doctor explained what he was seeing, and even though I have absolutely no medical background, I could see that things did not look right. The door that was supposed to be straight open and shut was kind of flailing in the wind.
Before the TEE, we knew that there were two options for surgery: valve repair and valve replacement. Replacement means taking out the valve completely and putting in a new artificial valve while repair means fixing the valve that is already in place. With repair, there is a newer procedure called a thoracotomy that allows the surgeon to go in through the side instead of the traditional open-chest option, offering a much shorter recovery time and less overall pain. Here's a picture of the different surgical options; we were definitely hoping to be the guy in the front.
The TEE confirmed that Chris is a good candidate for the thoracotomy which is great news. The only downside (aside from the fact that he has to have heart surgery in the first place) is that there aren't any surgeons in Idaho Falls who are experienced in this type of surgery, so we'll have to travel to get it done.
Our cardiologist referred us to two cardiac surgeons in Salt Lake City and Boise, respectively. The Boise doctor is in our insurance's physician network, so we were leaning that way, then the Boise surgeon got a hold of Chris right away and scheduled a face time consultation for Sunday afternoon. Yesterday, Chris and I sat on our bed with Chris' iPhone and had an hour-plus long conversation with the surgeon in Boise. We talked about football and food, our families and our time commitments, and of course, Chris' heart, and in the end, Chris and I both felt really good about literally putting Chris' life in this man's hands.
We decided to schedule the surgery for September 17th-- far enough away for us to get our ducks in a row, but close enough that the doctor and Chris feel comfortable. The surgeon referred us to this site for a great explanation on what will happen during the surgery. The only part that really freaks me out is that Chris' heart will be stopped and his lung will be collapsed while the surgery is being performed. If I don't think about that too much, I feel confident that this operation is going to be a really good thing for Chris. The surgeon is really excited to work on someone so young-- he said that he feels like he will make Chris into a new man.
Through this whole thing, I can't help but feel extremely grateful. The fact that Chris' condition has probably been around for a long time, but it wasn't heard until what our surgeon called "the keen ear" of our friend is kind of amazing. The thoracotomy procedure wasn't even really around ten years ago, and it has only been perfected and practiced regularly in the last few years. Being able to have a face-to-face conversation with a surgeon more than five hours away is incredible, and being able to meet and see him in that setting was so reassuring.
Additionally, we are in a position with our family life and finances that taking a few weeks off for this procedure is going to work out better than it would have a year ago or a year from now. Chris' mom has agreed to come and stay with the kids while Chris and I are in Boise, and we're so grateful that she is willing and able to help us. My family is here in Idaho Falls and will be available to help us during the recovery period as well. And of course, the fact that we "caught it now," before Chris suffers any major symptoms or his condition worsens is a huge blessing.
So, now I know what a mitral valve is. Heart disease on a 36-year-old sounds scary, but the more we understand and learn about it, and how to fix it, the more confident we are that we're doing the right thing. All in all, we're going to be okay-- maybe even better than okay-- and I can get back to my metaphorical hearts.