Starting around the end of 2018 and for the next four or five months, Gary Kisamore would come home from work and find himself exhausted, falling asleep as soon as he sat down.
“I thought my lack of energy was just due to age,” says the 58-year-old Churchville resident, who performs the strenuous work of a logger.
During that time, Kisamore also experienced persistent coughing. Initially he paid little attention to the cough, but one evening it became so persistent that he was taken to the Sentara RMH Emergency Department. The physician there quickly determined that Kisamore was suffering from fluid around his heart and in his lungs, a sign of heart failure.
After an echocardiogram and a heart catheterization confirmed the heart failure diagnosis, Kisamore was referred to Yuriy Zhukov, MD, a fellowship-trained cardiothoracic surgeon at Sentara RMH.
Mitral Valve Insufficiency
“Mr. Kisamore had a classic presentation of mitral valve leakage, or insufficiency,” says Dr. Zhukov. “I could practically diagnose his disease with just a stethoscope—his heart murmur was that bad.”
A heart murmur, Dr. Zhukov explains, is associated with mitral regurgitation, a condition that results when the mitral valve in the heart fails to close sufficiently, allowing blood to flow backward in the heart.
Kisamore already knew he had a heart murmur, which was discovered by his family doctor when Kisamore was a child. However, the murmur had never presented any problems.
According to Dr. Zhukov, mitral leakage can result from damage to the valve due to a high-force blow to the chest, or it can come about as the result of a heart attack—but those types of scenarios are uncommon. “Most often, mitral insufficiency is the result of wear on one of the valve parts,” he notes. “Or just bad luck.”
Cardiologists grade mitral valve insufficiency as trivial, mild, moderate or severe. “You can have quite a bit of mitral valve leakage for your entire life without experiencing any serious problems,” says Dr. Zhukov. “But when the leakage is severe and prolonged, things can start to go bad, and the result is usually heart failure.”
The classic symptoms of problematic mitral valve insufficiency include shortness of breath and fatigue—typical indicators of the type of heart failure Kisamore was experiencing. The condition also can cause lightheadedness and arrhythmia, which often manifests as a rapid, fluttering heartbeat.
In many cases, patients with symptomatic mitral insufficiency live “miserable” lives, according to Dr. Zhukov. When the condition starts to interfere with daily activities and a patient’s quality of life, it’s time to consider open-heart surgery.
“In fact, we advise corrective valve surgery prior to the onset of severe symptoms,” says Dr. Zhukov.
Kisamore’s operation was performed on May 28, 2019.
Repairing the Mitral Valve
“The operation is performed through an incision in the chest,” Dr. Zhukov says. “If we’re just repairing a leaky valve, we can often make the incision between the ribs. If it’s a more complicated case, however, or if we also have to correct a heart arrhythmia during the surgery, we typically operate by making an incision though the sternum, or breastbone.”
During the operation, the patient is placed on a heart-lung machine to circulate the blood, and the heart is stopped.
Kisamore’s surgery went well, with no complications, and he stayed in the hospital four days.
“Immediately after waking up from the surgery, I noticed I had no more shortness of breath,” Kisamore recalls. “And as I recovered enough to get up and walk, I was no longer fatigued and exhausted like I had been before.”
Four weeks after his surgery, Kisamore began cardiac rehabilitation at Sentara RMH to strengthen his heart, and he returned to his logging work after just six weeks. He has been symptom-free since his procedure.
An Elusive Diagnosis
Not all mitral valve patients have the straightforward, classic presentation that Kisamore experienced. Dale Bowman, 60, of Rockingham County, had been experiencing vague chest pains and shortness of breath on and off for eight years, “with no clear answer as to why,” he says. Some days brought no problems at all, while others could be quite challenging—but in general the condition seemed to be growing worse. Finally, after a thorough workup, his cardiologist, Tanya Tajouri, MD, and pulmonologist, Earl King, MD, referred him to Dr. Zhukov for mitral valve repair.
Dr. Zhukov points out that the difficulty in finding Bowman’s mitral valve problem did not result from lack of knowledge or failure to test appropriately. Mitral valve disease can be quite elusive in some cases.
“Even with echocardiograms, computed tomography (CT) exams and the other powerful tools we have today to diagnose patients, mitral valve disease can still be difficult to find,” he says.
Bowman had his mitral valve repair on March 20, 2019. The procedure went well, and in four days he was discharged to home. Like Kisamore, Bowman also was referred to cardiac rehabilitation at Sentara RMH in the weeks after his surgery. But before he began therapy, he had already begun walking to strengthen his heart.
“Each day I walked a little bit longer,” says Bowman, who works in excavating for A & J Development. He also helps his daughter and son-in-law with their small-business venture. “By the time I went for cardiac rehab, I was walking about two and a half miles a day and feeling better.”
Today, just months after his heart surgery, he is doing well and continues to stay active.
A Great Team
Dr. Zhukov says he realizes most people find the idea of open-heart surgery a frightening prospect. Despite the invasive nature of the operation, he says, he wants people to know that the risk of mortality is extremely low—about 1 percent.
“Heart surgery in 2019 is very safe,” he says. “I’ve been doing these procedures regularly since I completed my training in 2015, and I have never seen a patient who had his or her mitral valve surgically repaired who did not feel and do better afterwards.”
Kisamore and Bowman were both in fairly good health and living active, productive lives before their mitral valve insufficiency became a problem. They both have the highest praise for Dr. Zhukov and the cardiothoracic surgery and rehabilitation teams who provided the care that has enabled them to return to their daily activities.
“Everything was perfect, and I couldn’t have asked for better care,” says Kisamore. “While I was in the hospital, Dr. Zhukov stopped by my room often to see if I was in any pain.”
“I’d recommend Dr. Zhukov and his team to anybody who needs heart surgery,” says Bowman. “They’re an asset to Sentara RMH, and I can’t thank them enough for giving me back my life.”
Heart Surgery at Sentara RMH
The Sentara RMH Cardiothoracic Surgery Program offers a wide spectrum of cardiac procedures, including coronary artery bypass grafting, heart valve repair/replacement, and aortic surgery. A patient’s cardiologist, in consultation with a Sentara RMH cardiothoracic surgeon, will determine if the patient is a candidate for cardiac surgery based on:
• The patient’s overall health
• The patient’s specific anatomy
• The location and severity of any blockages in coronary arteries
• The need for valve repair or replacement, based on the degree of malfunction
• The need for aneurysm or heart-rhythm surgery
The Sentara RMH cardiothoracic team also performs all noncardiac surgeries within the thoracic (chest) cavity, including surgery performed on the lungs, diaphragm and chest wall.
Contact Sentara RMH Cardiothoracic Surgery Specialists at 540-689-5555.