Dr. David Ohmstede understands what many of his young patients go through. Like them, he’s been the one on the gurney, being wheeled into the operating room. Like them, he’s had his chest cracked open for open-heart surgery and faced the arduous recovery.
Ohmstede, a Novant Health pediatric cardiologist, recently had a heart valve replaced.
“I am aware of some of the thoughts that may go through the minds of my patients, and may be better prepared to answer,” he said. One of his young patients had a valve replacement using animal tissue (bioprosthetic) and “asked if I ‘was going to be part cow, too?,’” Ohmstede asked. “I'm positive my interactions with some of my patients will be far more colorful now.”
About 15 years ago, Ohmstede discovered he had a heart valve defect during an echocardiogram he needed to apply for life insurance. The defect – a bicuspid aortic valve – wasn’t disrupting Ohmstede’s daily routine. But he knew that eventually he’d likely face surgery to repair his valve.
He had to monitor his condition through regular examinations as he aged. Ohmstede didn't have symptoms that limited him, but he reached an age (he’s 51) when repair is common because the valve can gradually harden, which affects blood flow.
He had to go through the stressful part of being a patient, even though he knows the intricacies of how a heart works and the surgery involved.
Novant Health’s Dr. Tom Theruvath performed the open-chest surgery to repair Ohmstede’s valve in mid-September. A couple of weeks later, Ohmstede was walking a few miles each day as part of his recovery process.
"If I had been having something completely unrelated to my area of expertise, I may have been more anxious,” Ohmstede said. “Some people have asked me ‘Was it scary since you know so much about it?’ but the opposite was true for me. We know that there are occasionally bad outcomes, even in lower risk situations, but the majority of these procedures go well. Every time my mind started to go down the rabbit hole of the potential for such a rare complication, I chose to remain optimistic, knowing that the odds were on my side to have a good outcome. Having confidence in the team taking care of you makes that process a whole lot easier. I always felt I was in good hands.”
Ohmstede’s bicuspid aortic valve condition can be inherited in families. Because of that, doctors often recommend that all first-degree relatives – parents, children and siblings – of someone with a bicuspid aortic valve be screened through an echocardiogram.
“It's really just serial screening, making sure you're paying attention if you have symptoms and checking family members,” said Ohmstede, whose children were screened.
A bicuspid aortic valve is the most common congenital heart condition. Your heart’s aortic valve usually has three cusps, which open and close to help blood flow from the heart. But, someone with a bicuspid aortic valve only has two cusps (also called flaps or leaflets). That makes the heart work harder than it should, which could lead to heart failure.
Some people with bicuspid aortic valve have symptoms in early childhood, including fatigue, shortness of breath, fainting or lightheadedness. Others won't have symptoms until adulthood, if ever.
“We see kids in the pediatric cardiology clinic who need surgical intervention, even in childhood,” Ohmstede said. Other times, as patients age, they learn to live with the symptoms and may not realize they have a heart valve issue, he said.
“You’ve learned to accommodate, and this is your normal,” he said. “It’s not something sudden like appendicitis, where you have crushing pain in your abdomen.”
Ohmstede pointed out Minnesota Vikings linebacker Cameron Smith, 23, who during the summer had a heart exam because he’d contracted COVID-19. A bicuspid aortic valve was discovered, and Smith’s heart was enlarged. Surgery quickly followed to repair his valve.
“Obviously, you can be very functional and not be aware of it,” Ohmstede said. “He’s an NFL player.”
Bicuspid aortic valve happens in about 1% to 2% of the population and is more common among men, according to the Centers for Disease Control and Prevention. Studies have shown that 4% to 11% of first-degree relatives of someone with bicuspid aortic valve had the same disease.
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Ohmstede has returned to caring for young heart patients, and will continue monitoring his condition with ultrasound examinations. Ohmstede takes a daily aspirin, and antibiotics during any dental work to prevent infection.
“There are a lot of really excellent treatments out there,” Ohmstede said. “There's not a one-size-fits-all concerning valves. Even kids and adults who have valves that are abnormal, but they're functioning well, they need to get imaging on a regular basis.”
And, if any patient or their parent has a question or concern about heart surgery, Ohmstede can offer them “I’ve-been-there” answers.
“Returning to my place in the exam room with patients was certainly a big motivating factor for me,” Ohmstede said. “It is truly a privilege to be able to do what I do every day in the office. A big part of the joy of being a physician is taking the journey with your patients during difficult times. Coming out of my own personal medical journey has made that even richer.”
MAIN PHOTO: Novant Health pediatric cardoligist Dr. David Ohmstede (left) and wife Catherine.