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A Collaborative Approach to Complicated Cardiac Surgery

 

Donerick solo
Donerik Black is back at work after a series of health setbacks, which culminated in heart valve replacement surgery.

It often takes a team approach to ensure patients get the best and most complete care possible. Donerik Black of Clayton, who underwent heart valve replacement surgery at Miami Valley Hospital, knows that for a fact. His was a complicated case requiring a team of specialists to ensure a good outcome.

After donating a kidney to his father in June 2006, Donerik continued to see Augustus K. Eduafo, MD, medical director of the kidney transplant program at MVH and clinical associate professor of medicine at Wright State University Boonshoft School of Medicine. Dr. Eduafo says kidney donors must continue to see renal specialists for life.

Dr. Eduafo adds that, even though it’s not typical for kidney donors, Donerik developed kidney dysfunction in March 2008. Specifically, his creatinine levels were higher than normal. (Creatinine is a waste product processed by the liver and excreted by the kidneys.)

Addressing Multiple Medical Conditions

Previous to his kidney dysfunction and about a year after donating his kidney, Donerik discovered he had a mitral (heart) valve leak. Initially it didn’t require treatment, but Donerik’s wife, Angela – a physician relations manager at MVH – asked Donerik to get it rechecked. Before he had a chance to do so, Donerik was admitted to MVH for unrelated minor surgeries.

He wasn’t out of the hospital for long before he started having other symptoms, including shortness of breath. An avid softball player and mountain biker, Donerik admits he had been feeling tired, but he attributed it to being a bit out of shape and vowed to hit the gym harder.

As it turned out, it’s likely the unrelated surgeries exacerbated his heart valve leakage. By the time Donerik re-entered the hospital, the valve was in full-blown regurgitation, which means blood was backing up in his heart instead of traveling properly through the four chambers. The situation seriously jeopardized his heart muscle.

A Top-notch Team

The next series of events required a team of four physician specialists to get Donerik back on his feet.

It began with Brad Evans, DO, a hospitalist and assistant director of Miami Valley Hospitalist Group, which works exclusively at MVH. Hospitalists treat inpatients, often admitting them from the ER, conducting initial evaluations, coordinating care and placing referrals to specialists. He was the first to see Donerik upon his second admission, and he was immediately concerned.

 

Evans HS
Brad Evans, DO
Eduafo HS
Augustus K. Eduafo, MD
Jain HS
Steven Jain, MD
Zaman HS
Ali Zaman, MD

“It was evident he had a significant issue with his heart,” says Dr. Evans.“He had a murmur and fluid in his lungs. Dr. Evans says the fact Donerik was 39 years old and athletic was even  more troublesome as it’s not typical for symptoms like these to be present in someone his age. “We got a cardiology consult on him right away,” says Dr. Evans.

As part of that consult, Donerik underwent a transesophageal echocardiogram, in which a probe is inserted into the esophagus to study the heart from behind. This is the only way to study the mitral valve properly as it sits at the back of the heart.

Next, Steven Jain, MD, an interventional cardiologist and clinical assistant professor at WSU Boonshoft School of Medicine, examined Donerik and recommended a heart catheterization.

A catheterization is done prior to heart surgery to determine if there are any blockages in the coronary arteries and to measure certain pressures in the heart, explains Ali Zaman, MD, medical director for cardiothoracic trauma at MVH and clinical assistant professor at WSU Boonshoft School of Medicine.

Protecting Donerik’s Kidney

During a heart catheterization procedure, dye is injected into the arteries to indicate contrast and illuminate blockages. However, this dye is dangerous to someone with an elevated creatinine level. “The dye may poison the renal tubular cells and worsen the already high creatinine levels,” explains Dr. Eduafo.

“He was really protective of my kidney,” recalls Donerik.

After Dr. Eduafo had a conference call with Dr. Jain, both specialists decided the test should be done. The situation was stressful and quite scary for Donerik and Angela, but they put their confidence in his team of doctors.

“I have a strong faith in God. Sometimes you have to put your trust in the hands of other people. I’m the type of person who says, ‘If it needs to be done, let’s do it,’” explains Donerik.

Special actions were taken to ensure Donerik’s heart catheterization was as safe as possible. Dr. Eduafo prescribed certain medications as well as extra fluids 48 hours before the procedure. Fortunately, the catheterization went smoothly, although it indicated Donerik’s mitral valve had suffered significant deterioration.

Consultation and Communication Guide Treatment

At this point, Drs. Jain and Eduafo consulted with Dr. Zaman regarding surgery to replace the valve. Even though each physician is highly trained, consults are necessary in cases like Donerik’s and in many other situations. Dr. Zaman says many of his heart surgery patients have existing medical conditions such as diabetes, high blood pressure and renal failure.

Many cardiac patient consultations between specialists like Drs. Jain and Zaman take place on an informal basis, especially since they work in the same building and see each other daily.

However, doctors also hold a formal conference each Thursday to review cases like Donerik’s. “It gives us more opportunities to determine the right course of action,” says Dr. Zaman. “This ongoing communication makes a big difference.”

“It’s critical to discuss both routine and complicated cases to review all the data and assess the risks and benefits of various treatment options,” adds Dr. Jain.

Dr. Zaman talked extensively with Donerik about his options for mitral valve replacement surgery. Both pig and cow tissue replacements are available, as well as mechanical valves. While mechanical valves last up to 40 years, patients must take the blood thinner Coumadin for the rest of their lives. Tissue valves last a shorter time, but don’t require blood thinner prescriptions post-surgery.

 

Donerik and Don
Because Donerik had donated a kidney to his father Don (right) a few years ago, his heart doctors consulted with a renal specialist to ensure that his remaining kidney was unharmed during various cardiac procedures.

“Most young people want to be active,” explains Dr. Zaman. Since Donerik hoped to return to his favorite athletic activities, he and Dr. Zaman opted for a tissue valve replacement.

Dr. Zaman also had to decide if Donerik was a candidate for minimally invasive surgery – which does not require a large chest incision and the breaking of the chest bone – or if a traditional open-chest surgery was best.

 

Although it sounds contrary, the open-chest surgery – called a sternotomy – requires a patient to be put on a heart/lung machine for a somewhat shorter time than a minimally invasive procedure. Since being on this machine could also endanger Donerik’s one remaining kidney, the traditional sternotomy route was chosen, and performed by Dr. Zaman on Dec. 17 of last year.

Throughout his illness, Donerik educated himself about his condition and says that reduced some of his stress.

Although he is not yet fully recovered, Donerik is back at work as a public relations and marketing specialist with The Dayton Weekly News, a newspaper that he and his dad own and operate. He hopes to return soon to all his activities and says he can see continual progress toward getting back to normal.

As his surgery was deemed successful, Donerik has been released from Dr. Zaman’s care, and is currently in cardiac rehabilitation. Drs. Jain and Eduafo will continue to monitor Donerik’s care.

Even though Donerik jokes that it’s sometimes hard to keep all his doctors straight, having a team of specialists he and Angela could rely on made the whole ordeal much easier, “It was an amazing collaboration. I felt I was the only patient they had.”

Learn more about cardiology services at Miami Valley Hospital.