For the majority of his life, Brian Gilbert was told he had a heart murmur. But five years ago, he learned it was something more serious – Gilbert was diagnosed with a bicuspid aortic valve.
What is a bicuspid aortic valve?
The aortic valve regulates blood flow from the heart into the aorta. One of its essential roles is to prevent blood from flowing back into the heart from the aorta. A normal aortic valve has three leaflets through which blood can flow, while a bicuspid aortic valve only has two, according to the National Institutes of Health. Unlike a normal aortic valve, the bicuspid aortic valve may not be completely effective at stopping blood from leaking back into the heart. This can cause a series of complications like congestive heart failure and narrowing of the valve’s opening.
A bicuspid aortic valve is the most common congenital heart disease and often runs in families. The condition is hard to diagnose in infants and children because it causes no symptoms.
From routine visit to surgery
Because of Gilbert’s diagnosis, he had routine visits with Dr. John Alexander, a cardiologist with the Novant Health Heart & Vascular Institute in Charlotte, North Carolina, to monitor his condition and ensure there were no changes that needed to be addressed. Earlier in 2016, during a routine visit with Alexander, Gilbert learned that his left ventricle had started to increase in size, which can lead to heart failure. Gilbert was referred to Dr. Tom Theruvath, a cardiothoracic surgeon with the Novant Health Heart & Vascular Institute.
Theruvath told Gilbert he would need to have surgery within the next year to replace his aortic valve. He said if the valve wasn’t replaced, Gilbert’s heart would continue to grow weaker and he could experience heart failure.
“I asked if we could do the surgery the same week,” Gilbert said. “I wanted to get the surgery over with.”
Traditionally, surgery to repair or replace a valve requires a full sternotomy, where the chest is fully opened in order for a surgeon to operate.
However, Theruvath provided Gilbert with a newer surgical option – a minimally invasive thoracotomy, which only requires about a four-inch incision. Theruvath has only done a handful of these surgeries and said this approach is relatively new.
The recovery time is also significantly shorter. Instead of a minimum six week recovery time with a five-to-seven day stay in the hospital, patients are only admitted for four to five days.
“Patients can go back to lifting things and driving a car as soon as two weeks after surgery,” Theruvath said.
“My wife and I looked at each other and said we’d read about it,” Gilbert said. “We were honestly wondering if that type of surgery was possible. It seemed too good to be true.”
But Theruvath was confident that Gilbert met all the qualifications to be a great candidate for the minimally invasive thoracotomy. This surgery is performed when a patient only needs a valve replacement.
Theruvath said often when patients need a valve replaced; they may also need a bypass, or some other procedure to be done at the same time. Those patients who need multiple procedures are not candidates for the minimally invasive thoracotomy.
Gilbert had his surgery in September and is recovering well.
“I have the smallest incision – maybe four inches,” Gilbert said. “I had a friend who had the full sternotomy and he told me I was going to hate this surgery because I wouldn’t be able to get out of bed. But I could do sit-ups from day one. My recovery has been really easy.”
Gilbert said he can already feel the difference when it comes to his stamina.
“When I was a kid, I would get really short winded and it was always attributed to asthma,” Gilbert said. “Now I realize that I’ve actually had symptoms of bicuspid aortic valve disease my whole life, but never realized this wasn’t how other people felt.”