Teamwork for Complex Care

Lyal Lauth first had his mitral valve replaced in 1981, when his risk for serious complications was normal--about 2 to 3 percent. But last year, Lauth knew something was wrong when he started experiencing fatigue and shortness of breath, even with reduced activity. That's when Lauth, 62, found out the valve needed to be replaced again. He knew that this time around it would be more difficult.

Lauth was older and had additional health problems--a replaced aortic valve and weak liver--which made the surgery riskier. The Harbert, Michigan, resident's complex case needed the expertise of several specialists at the University of Chicago.

Lauth saw a cardiologist, who conducted several noninvasive tests that showed Lauth's mechanical mitral valve had become abnormally narrow.

Because it was the valve's second replacement, surgery was riskier and technically challenging, and Lauth's other health issues added to the complexity of care.

Valluvan Jeevanandam, MD, replaced Lauth's mechanical valve and after the surgery, a multidisciplinary team helped manage Lauth's medication and watched for fluid overload in the heart. When Lauth's heart went into atrial fibrillation and its beat became difficult to control, a pacemaker became necessary, said John Beshai, MD, an associate professor of medicine at the University of Chicago Pritzker School of Medicine.

In December 2010, Beshai performed an ablation on Lauth, a procedure that disconnects the electrical pathway between the upper and lower chambers of the heart, and inserted a pacemaker to control Lauth's heart rhythm.

"Since then, he has been doing fantastic," Beshai said. "After the initial follow-up, he felt like a new man--he was breathing better."

The cooperation among our specialists made the difficult procedure easier on Lauth, who said he appreciated the open dialogue.

"They talk about 'Why is this happening?' and 'What could happen?'" Lauth said. "It's the way it should be."