Valve Surgery Has Made Me a Better Doctor

"Valve surgery has made me a better doctor," says anesthesiologist Stewart Perlman of Baptist Hospital in Nashville, Tennessee USA. The valve replacement procedure he underwent in 1987 to correct a leaky aortic valve left him feeling that "there isn't any reason for people to experience anxiety or pain associated with surgery." His main focus since that life-saving surgery has been helping patients to relax before their procedure and easing their pain.

A normal aortic valve has three leaflets that help shut off blood flow when the valve is closed. Dr. Perlman's native valve had only two. When blood was forced out of his left ventricle and into his aorta, the valve didn't close completely and blood would leak back into the heart. Left untreated, back flow of blood against the walls of the left ventricle would eventually stretch it and lead to congestive heart failure . In Dr. Perlman's case, blood was also hitting the wall that separates the two ventricles (septum). Part of the conduction system that is responsible for generating heart rate runs along the septum. With some of this blood hitting the septum, Dr. Perlman's heart would beat fast-sometimes 150 to 160 times a minute at rest! Physical activity only made it worse. And Dr. Perlman was an avid golfer, swimmer, runner, and weight lifter. As he put it, "It's very uncomfortable having your heart beating so fast."

A bout with the flu and visit to the doctor in 1985 brought him to a cardiologist. Additional testing revealed the congenital defect that typically brings on symptoms somewhere between the ages of 30 and 50. Dr. Perlman thought he'd have another 10 years before surgery, however, two years later—at age 32—his left ventricle began to enlarge. He talked with his surgeon about use of a donor valve because Dr. Perlman didn't want to be on Coumadin® for the rest of his life. During the procedure, however, the surgeon was unable to use a donor valve and instead implanted a St. Jude Medical® mechanical valve. He also repaired an aneurysm, just above Dr. Perlman's aortic valve, at the site where the two main coronary arteries begin. Everything went fine, and six months after surgery, Dr. Perlman's life was back on track.

He's changed his thinking about Coumadin®. "I'm not happy about having to take medication every day, but I've shifted my thinking about that," he said. "I think about the things I can do…not the things I shouldn't do." Golf, which has been a lifelong passion, has become his physical activity of choice. "I focus on physical activity that doesn't put me at risk of bleeding or bruising-that's it," he maintains. "It's my choice."

Dr. Perlman's love of golf persists. Living in Nashville gives him the luxury of golfing year round. He laughs about his first golf outing after surgery. He was nervous about his swing that day and whether it would cause him chest discomfort. So he swung slower and golfed better than ever, much to the dismay of the others in his foursome.

When he's not golfing, in the Operating Room, or with his family, Dr. Perlman volunteers to talk with patients before surgery. In plain terms he confides, "My brush with heart disease and my valve surgery have made me doubly appreciate life. Fear of the unknown is a patient's biggest anxiety. If I can help them with that, I'm happy to do that good deed, or 'mitzvah,' as we call it in the Jewish faith."

On January 13, 1997, Dr. Perlman and his family (wife Suzy, a former intensive care nurse he met during residency; Alan, 16; Daniel, 13; and Abby, 10) celebrated his 10th valve surgery anniversary with literally hundreds of friends. Not too long ago, while visiting the Twin Cities (Minneapolis and St. Paul, Minnnesota USA), Dr. Perlman toured St. Jude Medical's worldwide headquarters to see how heart valves are made. "During my visit I saw incredible pride in the people who manufacture the valves," he said. "There's an amazing amount of precision in what they do; the quality assurance practices are unbelievable. I walked away from the visit feeling totally comfortable with what's keeping me alive."