A8
Blue Mountain Eagle
Wednesday, February 1, 2017
Community HEALTH BEAT
Quality Healthcare Close To Home
170 Ford Road, John Day • 541-575-1311 • www.bluemountainhospital.org
Bruce McLellan, MD
Blue Mountain Hospital Visiting Specialist
/ St. Charles Heart & Lung Center
Heart valves perform the same function as the
valves in your home plumbing, your car, or an
industrial plant, that is to prevent backflow. Right in
the middle of your heart, we have two Mercedes
Benz insignias, the aortic and pulmonary valves. The
most common heart valve operation in adults is
replacement of the aortic valve (the valve between
the heart’s main pumping chamber, the left
ventricle, and the big artery leaving the heart, the
aorta). A small percentage of these cases are for a
bicuspid aortic valve, a congenital abnormality of the
valve (the person was born with only 2 leaflets,
instead of the normal 3; no Benz!). Even fewer cases
are because the valve became infected or the aorta is
aneurysmal (severely enlarged). Most commonly,
though, the aortic valve degenerated with time. As
we enter our 60s, 70’s, and 80’s (those so-called
golden years), the valve starts to show signs of wear
from the 100,000 cardiac cycles/day (over 2 billion
openings and closings by your 60th birthday!). This
degeneration appears as valve leaflet thickening and
then calcification when evaluated by
echocardiography (or echo, ultrasound of the heart
structures and function). It is, by far and away, the
most common cause of new murmurs in older
individuals (by older, I mean those of you with
acquired wisdom).
The valve can fail in 3 ways: stenosis
(narrowing of the valve opening because the leaflets
won’t open fully), regurgitation (leakage because
the leaflets don’t fully close), or both. The most
common complaints include chest pressure with
exertion, heart failure (shortness of breath with
exertion), or passing out. If you develop these
symptoms, your primary care practitioner will
become suspicious based on your exam because you
will have a prominent heart murmur (a whooshing
sound caused by turbulence during each heart
cycle). Most of the time, the murmur is noted
years before any symptoms develop. The echo
study is noninvasive, free of radiation, and often
diagnostic for the cause of the murmur.
Surgical replacement of the aortic valve
has been around for over 50 years. In fact, the
first surgical valve replacement was performed in
Portland by Dr. Albert Starr, and until the 1990s, the
mechanical valve he designed was still being
implanted. Surgical Aortic Valve Replacement
(SAVR) is the 2nd most common open heart
procedure performed (after coronary bypass
surgery), and both mechanical valves (carbon
leaflets) and tissue valves (pig heart tissue) are used.
The type of valve is chosen based on the patient’s
age, life expectancy, risk of taking blood thinners
(for the mechanical valves), and for young women,
anticipation for future pregnancy.
Despite 50 years of experience and
advancements in surgical and anesthetic techniques,
there remains serious risks to the operation and
being on the heart-lung machine while the heart is
stopped. In 2005, the first aortic valve replacement
not requiring cutting open the chest was performed
in France. This less invasive procedure, Transcatheter
Aortic Valve Replacement (TAVR), was approved in
the US in 2011. Early on, patients who were turned
down or high risk for SAVR, were the only ones
approved for the new procedure. In 2016, however,
new research led to FDA approval for moderate risk
patients and low risk patients are currently being
studied. Because the transcatheter procedure can
only implant tissue valves, which only last 10-15 years
before needing replacement, there will always be a
need for the surgically placed mechanical valves
(which can last for more than 30 years). At St.
Charles Heart & Lung Center in Bend, we have two
experienced doctors (Drs. Matt Slater and Dr.
Saurabh Gupta, both
recruited from OHSU)
who have been seeing
potential candidates for
TAVR in the Valve Clinic
since last summer and
performing TAVR since
the fall.
I believe that if we lived
to be 150, we would all
need aortic valve
replacement, and Drs.
Slater and Gupta would
be our mechanics.
Joyce Dowdy
Presents...
February Visiting Specialists
1st - Dr. Barrett - Bend Urology
2nd - Dr. Rushton - Baker Podiatrist
6th - Dr. McLellan - Bend Carido
13th - Dr. Rushton - Baker Poiatrist
22nd - Dr. McLellan - Bend Carido
27th - Dr. Rushton - Baker Podiatrist
Joyce and Ronald Dowdy just
celebrated their 60th Wedding
Anniversary in August. They
have three children, 9
grandchildren and (25)/ 22
living great grandchildren.
Joyce lived most of her life in
the Willamette Valley. She has
always lived on a farm or ranch. The Dowdy’s raised
registered pigs, Cotswold sheep and Cattle. Joyce gave
many local dairy farmers vacations by milking their cows.
Joyce was a bus driver, bean boss, strawberry boss in the
summers. She was homeroom Mom for all of her kids. So
everyone remembers Joyce as the School Mom.
Joyce and Ronald took many animals to the Lane County
Fair. The crowds most enjoyed the brand new baby pigs
born at the fair. The Dowdy’s moved to Grant County in
2006 to be near their family. We have 49 at our family
gatherings now.
Joyce is a joyful person who makes many people laugh.
She is a #1 joke teller with an awesome sense of humor.
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