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Healing a Heart

Kamran Keyvan, age 62, doesn't remember when the trouble with his heart started.

"My symptoms began many, many years ago. I've had a heart murmur ever since I could remember," he said.

For decades Keyvan had been living with aortic valve stenosis, a narrowing of the heart valve that leads from the heart's left ventricle to the largest artery in the body, the aorta, which sends oxygen-rich blood throughout the body.

In 2012, the shortness of breath and fatigue that the Marysville machinist had experienced since his youth was beginning to worry him. "It got worse and worse," he said. "My heart valve was getting smaller and smaller."

He knew it was time to see his cardiologist, Dr. Vinaya Chepuri, at Western Washington Cardiology in South Everett.

Though it's impossible today to pin down the exact cause of Keyvan's heart murmur, it's likely that it started with a bout of rheumatic fever contracted during his childhood. Often caused by untreated strep throat, rheumatic fever most commonly affects children. The disease can permanently damage the heart and its valves.

"It's a lot more common than people think. Some people have rheumatic fever as a child and never know it. They just have a sore throat and forget about it. That's why we're so aggressive about treating strep throat nowadays. We want to prevent it from developing into rheumatic fever," explained Dr. Chepuri.

In late 2012, Keyvan had his yearly echocardiogram, an ultrasound scan that shows the heart in action. It didn't look good.

"His stenosis had reached a critical stage," said Dr. Chepuri. "He didn't say that he was having increased symptoms. But the reason you monitor patients with this disorder is because their symptoms come on so insidiously they don't always notice. He said, 'I have had more shortness of breath, but I think it's because of my smoking.'"

Dr. Chepuri recommended surgery to replace Keyvan's failing heart valve. Keyvan had been Dr. Chepuri's patient for four years, with a check-up every six to twelve months. When Dr. Chepuri recommended surgery, Keyvan trusted his advice. Nonetheless, the prospect was frightening.

"We had been following his condition closely for years, but it was still a bit of a shock to him. No matter how long you prepare people for that eventuality, surgery can sometimes seem scary," said Dr. Chepuri.

Keyvan decided he needed some time to think about it. Though the surgery was necessary, it wasn't urgent — yet. Dr. Chepuri agreed that they could wait until after the holidays.

In January 2013, Keyvan returned to Dr. Chepuri's office and told him that his shortness of breath had grown even worse in the short time since he'd seen him last.

"He'd had time to pay attention to his symptoms and the kinds of activities he was and was not able to do. He has a fairly physical job, and he realized that he had been letting the younger workers take on some of the heavier tasks. He had thought he was just getting old, but he realized his shortness of breath and fatigue were actually caused by his heart condition," said Dr. Chepuri.

Keyvan had a transesophageal echocardiogram in order to prepare for surgery. Unlike his yearly echocardiograms, which were performed using an external probe that rests against the chest, a transesophageal echocardiogram uses a probe that is inserted into the esophagus. The internal probe receives much clearer images of the heart, since the ultrasound waves are not obstructed by the ribcage, lungs or other internal structures.

Dr. Jack Sun, a UW cardiothoracic surgeon, performed Keyvan's heart surgery at Northwest Hospital in March 2013. The procedure involved removing Keyvan's malfunctioning aortic valve and replacing it with an artificial one made of metal.

Unlike many heart surgeries, Keyvan's minimally invasive aortic valve procedure was accomplished via a small opening in his breastbone, or sternum, rather than by "sternotomy," or a complete opening of the sternum.

"He was fortunate in that he was able to have a smaller incision. This surgery is certainly less invasive than a sternotomy," said Dr. Chepuri.

When it was all over, Keyvan said he was glad he had the procedure.

"Of course, I was scared to have the surgery. It's natural. But it went great," said Keyvan. "There was some pain, and I had to take medication, but it's over now."

The surgery has permanently repaired Keyvan's heart condition, and allowed him to return to all of his usual activities without the symptoms he had suffered for so many years.

"I'm doing fine. Everything's great," said Keyvan. "I have much more energy now. I don't get short of breath like I used to. I would always get short of breath when I did more than I was supposed to. Also, I quit smoking."

No small accomplishment, since he had been a smoker for 48 years.

"It was very hard to quit. I was a heavy smoker. I hope I never go back. It is tempting sometimes, but after the surgery, I don't want to smoke anymore," he said.

Keyvan says he constantly lets his friends and family know how great he feels — and how happy he is with his cardiologist.

"Dr. Chepuri is number one. He's a great doctor in every way. He cares, he takes his time. If anyone asks me who's the best doctor, I say, 'Dr. Chepuri!'"

For more information about Dr. Chepuri and Western Washington Cardiology, visit westernwashingtoncardiology.org. For more information about cardiac care at Northwest Hospital, visit nwhospital.org.

 
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