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Complex Cardiac Care through a Team Approach Restores Quality of Life

Daniel Kusek

Daniel Kusek, 69, was coming off the 17th green of his local golf course one day in 1996 when he began to sweat profusely and feel not quite well. A trip to his local emergency room confirmed he had had a heart attack. Kusek underwent an angioplasty, which mechanically widened an artery that had narrowed due to atherosclerosis, the build-up of fatty materials such as cholesterol.

For the next three years, Kusek returned to his normal activities and undertook the daunting task of changing some of the lifestyle factors that may have contributed to his condition. He continued to exercise, reduced his salt and saturated fat intake and went back to work as the owner of a printing business.

But on Labor Day weekend 1999, after his last sales call of the day, Kusek felt the familiar symptoms of another heart attack. At the same community hospital that had treated him three years earlier, Kusek was told that six additional arteries had become blocked, and he underwent a procedure during which a stent was placed in the artery to allow blood to flow more freely.

Kusek recovered from the procedure and returned to working, exercising and watching his diet. Over the next few years, he noticed he was short of breath and fatigued.

Valluvan Jeevanandam, MD Valluvan Jeevanandam, MD

"I felt like I was a car operating on seven cylinders instead of eight," he said. This time, when he went back to his community hospital, he was told that he had a highly complex case of heart failure. He was referred to Valluvan Jeevanandam, MD, chief of the Section of Cardiac and Thoracic Surgery at the University of Chicago.

"When I met Dr. Jeevanandam, I was in awe," Kusek said. "At that point, I had been given the impression that my heart problems were so complex and severe that a transplant might have been my only chance at staying alive. Dr. Jeevanandam listed off all of the problems and, one by one, explained how he was going to fix them."

"I am a living example of the amazing technology and care that physicians at the University of Chicago provide," Kusek said.

Kusek’s second heart attack left him with a large aneurysm in his heart that developed as a result of muscle death. Death of the heart muscle, or myocardial infarction, causes portions of the heart to become replaced by scar tissue.  Because the scar tissue cannot expand and contract, the remaining heart enlarges and becomes less efficient, causing symptoms such as shortness of breath and fatigue.

The enlargement of Kusek’s left ventricle in turn caused a distortion of his mitral valve, which regulates the flow of blood in a one-way direction from the left atrium to the left ventricle, causing blood to leak into his lungs. Additionally, Jeevanandam found that Kusek had a hole in his heart that had most likely been present since birth.

"Mr. Kusek’s case was extremely complex, and at another medical center, he might have required a transplant," said Jeevanandam. "Transplants are wonderful and lifesaving, but it is preferable for a patient to keep his or her own heart and avoid the complications and lifelong medication required after a transplant."

As complex as his case was, Kusek is typical of the type of patients Jeevanandam sees. "While each of these problems might be fixed in a separate surgery at many hospitals, we are able to surgically correct each problem in concert with the others during the same procedure, effectively reconstructing the heart," he said.

"My quality of life has been wonderful since the surgery," Kusek said.

During a lengthy surgery that took place in January 2003, Jeevanandam reshaped Kusek’s entire heart. He stitched shut the hole and resected the aneurysm and reshaped the normal contour of his left ventricle. To repair Kusek’s mitral valve, Jeevanandam placed a prosthetic ring, known as an annuloplasty ring, to reestablish the normal shape and contour of the valve.

Five days after the surgery, Kusek was up and walking and was discharged a few days later. "I was so thrilled with the results and the care I received from the University of Chicago Medicine that I asked Dr. Jeevanandam to refer me to a cardiologist there for my follow-up care," Kusek said.

Kusek began to see a cardiologist in the University of Chicago’s Advanced Heart Failure Program every four months. He takes several medications each day, including a blood thinner and a diuretic to minimize water retention as well as ACE inhibitors and a beta blocker, both of which are proven to prolong survival and improve quality of life in heart failure patients.

"My quality of life has been wonderful since the surgery," Kusek said. "I am not fatigued anymore and I am going to restaurants with my wife and babysitting our grandchildren."

Ongoing medical management is critical for patients like Kusek to preserve the success of complex heart reconstruction. While medication or surgery alone would not have treated his advanced heart failure, the multidisciplinary approach prevented the need for a transplant. The collaboration at the University of Chicago Medicine among heart care experts also includes electrophysiologists, cardiologists who specialize in treating heart rhythm disorders.

Martin Burke, DO Martin Burke, DO

In March, after Kusek received an electrocardiogram to monitor his heart function, his cardiologist spotted an irregularity that indicated an atrial flutter, an abnormal heart rhythm in the upper chambers of the heart, and referred him to the coordinated care of Martin Burke, DO, professor of medicine, and his advanced practice nurse Deborah Moyer, both members of the University of Chicago’s electrophysiology team.

"The electrical pathways in Mr. Kusek’s heart were affected by his heart disease, putting him at risk for worsening heart failure," Burke said.

Atrial flutter occurs when the electrical impulses that normally occur within the heart take an abnormal path through the atria, causing the atria to beat very rapidly. When untreated, atrial flutter decreases the efficiency of the heart, making everyday activities very difficult. Additionally, in a minority of patients, it can lead to sudden death or stroke.

Because Kusek already was taking medications to improve his heart function and he was healthy enough to withstand the procedure, Burke performed a catheter ablation to correct the arrhythmia.

During the catheter ablation, Burke inserted three catheters (thin, flexible wires) into Kusek’s heart through veins in his leg. Through the catheters, he diagnosed the path of the flutter and delivered radiofrequency energy to the abnormal electrical pathways, restoring a normal heart rhythm.

After the ablation procedure, Burke noted a delay in electrical activation from the atria to the ventricles, placing Kusek at further risk of heart failure due to an electrical conduction delay that prevents normal contraction of the heart. To address this problem, four weeks later, in a separate procedure, Burke upgraded his internal cardioverter defibrillator (ICD) to a biventricular pacemaker/ICD. The device fires small electrical impulses to Kusek’s heart muscle whenever his heart rate drops below a safe, programmed rate, effectively resynchronizing his heart rhythm in order to improve his cardiac function and stamina.

In addition to effectively controlling Kusek’s disease, the device transmits electrocardiogram data through a phone line to his physicians at the University of Chicago Medicine, allowing them to manage his care remotely and adjust his medications when necessary.

Although he hasn’t yet returned to the golf course, Kusek says he feels enormously fortunate for his referral to the University of Chicago. "I am a living example of the amazing technology and care that physicians at the University of Chicago provide," he said. "The biggest problem I have now is trying to figure out a way to express my gratitude for these physicians who have kept me alive and made the process so easy."

October 2009