Restaurant owner Tony Foreman was born with discriminating taste buds, an appreciation of fine wines and unfortunately, two congenital heart defects. His condition did not slow him down, but upon hitting the age of 37, Foreman's cardiologist warned him that down the road he would need to have his aortic valve repaired. Both Foreman and his doctor suspected that would be at least a decade away, but just four months following that conversation, Foreman found himself out of breath quite easily.
"I was huffing and puffing after doing something as simple as moving a case of wine," explains Foreman, co-owner of two Baltimore restaurants: Charleston and Petit Louis. "I was a college athlete and I am still very active, so I did not think this was associated with approaching middle age."
The reason he became winded so easily was because of his aortic valve. After being referred to the University of Maryland Heart Center, which specializes in state-of-the-art valve treatment, it was quickly discovered that Foreman would need to have his aortic valve replaced.
Learn more about the Maryland Heart Center's innovative aortic valve surgery program.
The aortic valve separates the left ventricle, which is the main pumping chamber of the heart, from the rest of the body. Its purpose is to allow blood out of the heart and at the same time prevent it from traveling backwards into the heart. "There are many reasons why the aortic valve may need to be repaired or replaced. It can be a result of stenosis when the valve is blocked. It can be from an insufficiency where it leaks. It can be abnormal, such as a bicuspid valve, or it can be damaged by an infection or an occurrence such as an aortic aneurysm," explains a cardiac surgeon at the University of Maryland School of Medicine.
In cases where the aortic valve leaflets are normal but the valve leaks, surgeons typically use techniques to save the patient's valve. Following an aortic aneurysm, the valve can also be repaired.
If the valve is severely degenerated or hardened, it will often need to be replaced with either a tissue or mechanical valve. While the mechanical valve is very sturdy, patients who have this type of replacement will need to take blood thinners for the rest of their lives. There is also the Ross Procedure where the aortic valve is removed and replaced with the pulmonary valve. The pulmonary valve is then replaced with a cadaver valve.
For some patients, both the repair and the replacement can be done minimally invasively, which results in less blood loss, a faster recovery and a better cosmetic outcome. With time and technology, minimally invasive techniques have evolved and are considered very safe. In time, valve repair will evolve even more.
The hope is that sometime soon, University of Maryland Heart Center surgeons will be able to do these surgeries without having to use a heart-lung machine, which is now used to circulate blood and oxygen in the body after a patient's heart is stopped in order to complete the procedure.
There are many options surrounding an aortic valve repair or replacement. Patients need to talk with their surgeons about which is the best option for them.
Foreman and his surgeon had discussed what would work best for Foreman. It was decided he would have his valve replaced with a tissue valve—a decision he is quite content with.
"I feel great and I am back at the gym," Foreman says. "Just today I was able to leg press 1,300 pounds."