April 24, 2013

Susan Murray had no reason to suspect she had heart disease. A year ago, she thought she was in nearly perfect health. She exercised regularly and went on major hiking trips just about every year.

It was on one of these trips that she found herself having to stop three miles in, about half her usual routine. At first, she wrote off her shortness of breath even when it continued in exercise class. But her instinct told her something just wasn't right.

As it turns out, something wasn't right. Thanks to the collaboration and capabilities of cardiologists and surgeons at TriHealth Heart Institute, Murray's relatively rare condition was diagnosed and treated successfully.

Murray's primary care physician, Douglas L. Moore, M.D., of Madeira Family Practice, ordered a heart ultrasound, and after receiving the results sent her to the TriHealth Heart Institute immediately. He then monitored Susan's progress via MyChart (an electronic medical records program).

It was Richard L. Callihan Jr., M.D., a TriHealth Heart Institute cardiologist, who ran the additional tests needed to verify the problem: a subaortic membrane. This congenital problem blocks off blood flow out of the heart, and is usually diagnosed in childhood but is sometimes found later in life.

"We ran studies to determine the exact nature of the problem, and it was fairly clear that a surgical procedure would be required to remove the excess tissue below the aortic valve," Dr. Callihan explains. "But because we focus on team-based care - which tends to deliver better outcomes for patients - the next step was getting one of our surgeons involved."

Assembling the Team

That's when J. Michael Smith, M.D., a cardiothoracic surgeon, entered the picture. Dr. Callihan contacted him to see if a minimally invasive procedure might be an option for Murray.

This is a perfect example of the kind of collaboration that distinguishes TriHealth Heart Institute.

"The fact that Dr. Callihan asked the question shows how we always try to cover all the bases," Dr. Smith says. "I can't know everything that's available in cardiology, and cardiologists can't know everything that's possible in cardiac surgery."

Part of TriHealth Heart Institute's team approach is its joint valve clinics, where cardiologists and surgeons consult on the best treatment option for patients with heart valve disease.

"We're really doing a great service to our patients," says Puvi M. Seshiah, M.D., another cardiologist involved in Murray's care. "There are no egos involved. We share our combined experience to help deliver the best result for our patients."

The cardiologists and surgeons caring for Murray even collaborated on her diagnosis. Dr. Seshiah arranged for Dr. Smith to be present during Murray's testing, and for another cardiologist, John Wilson, M.D., to provide the special anesthesia required. Even when the physicians can't all be in the same room, digital technology allows diagnostic images to be shared electronically, so all physicians can see exactly what is happening inside a patient's heart before a procedure.

Delivering Advanced Care

Robotic surgery was ultimately used to repair the structural defect in Murray's heart. Robotic surgery isn't performed by a robot, but by a surgeon using a robotic system with a camera that enhances visibility and dexterity. Instead of traditional open surgery with a large chest incision, robotic cardiac surgery is performed using a few tiny incisions to perform the same procedure.

This type of minimally invasive surgery is an area of expertise for TriHealth Heart Institute. Dr. Smith alone has performed more than a thousand procedures robotically.

Benefits to patients include less pain and faster recovery. The procedure was a success. As can sometimes happen, though, Murray's body initially rejected the graft placed in her heart's mitral valve. But the team collaborated again to perform the necessary repair, and in less than a month Murray was back to work.

Murray's latest tests showed she's doing extremely well. She's feeling great - and is grateful for the expert, compassionate care she received.

"When you're in the land of uncertainty like I was at first, the faster you can find out what your options are the better," Murray says. "Knowing that all my doctors were talking to each other and working together, with my primary care physician staying connected via MyChart, gave me great comfort."

Originally published in Unity, Winter 2013