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How to Repair a Broken Heart

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Doctors make the worst patients,” says Dr. Sean Ryan.

And he should know. Long before he was a doctor, he was a patient. The president and managing partner of Vascular Surgical Specialists, Ryan operates out of Chester County and Paoli hospitals, where he treats abdominal aortic aneurysms and carotid and peripheral artery diseases, among other things. He was just 3 years old when he underwent a complicated surgery at Children’s Hospital of Philadelphia. He’d been diagnosed with coarctation of the aorta, a birth defect that limits the flow of oxygen-rich blood to the body, slowing growth. “Without that [condition], I would’ve been in the NBA,” Ryan jokes.

But it was no laughing matter. He could’ve sustained permanent heart damage or gone into heart failure. The condition was missed by Ryan’s first pediatrician. But Ryan is the youngest of eight, so his mother knew a thing or two about babies. She took Ryan to another doctor, who diagnosed him quickly.

Ryan remembers CHOP’s kind nurses, a Betadine bath to clean his skin, and meeting his surgeon. “He explained that he was going to open up my chest and fix me,” Ryan recalls. “I thought, ‘You will do no such thing.’”

Ryan’s scar stretches from his chest to his back. “I told my kids it was from a light-saber injury sustained during the Clone Wars,” he says.

CHOP’s pediatric cardiologists successfully repaired the coarctation of Ryan’s aorta, but there was nothing they could do about his second congenital heart defect: a bicuspid aortic valve. Common and not always critical, bicuspid aortic valves have two flaps instead of three, so surveillance is required. Ryan had regular echocardiograms to monitor the valve’s efficiency.

“Just 20 years before I was born, most people with my heart conditions died in their 30s.”

Ryan was 26 when cardiologists at Lankenau Medical Center determined that his aortic valve needed surgical repair. The 1996 procedure was cutting-edge for its time. In the past 25 years, treatment of bicuspid aortic valves has grown by leaps and bounds, says Dr. Clay Warnick, Ryan’s current cardiologist. Via state-of-the-art imaging systems, physicians now monitor the integrity and efficiency of the entire aorta. “Back then, we just looked at the valve,” says Warnock, the director of cardiovascular services at Chester County Hospital. “Now, we look at the whole aorta—including the root and the valve—as one apparatus.”

Valve replacement with catheters and the TAVR procedure pioneered by Penn Medicine are among the other revolutionary advances. But Warnick says that replacement isn’t the only option for bad valves. “Right now, there’s a movement to preserve patients’ native valves,” he says. “The valve you were born with is still the best valve because it’s immunocompetent. A prosthetic valve can become infected. If we put in a new valve, we are, in some ways, trading diseases.”

According to Warnick, Ryan’s Lankenau doctors did an excellent job repairing his valve. Eight weeks after surgery, he was back to full strength. In his fourth year at Thomas Jefferson University’s medical school at the time, Ryan had to decide on a specialty. Cardiology seemed like an obvious choice. “But I was seduced by surgery,” he says.

Ryan went on to a thriving career as a vascular surgeon—and none of his four children have a congenital heart defect. “I’ve basically lived a normal life, and that’s because I live in the United States and have access to excellent medical care,” he says. “Just 20 years before I was born, most people with my heart conditions died in their 30s.”

Ryan gets echocardiograms, though not as regularly as he should. “I have to get a script written and go through insurance, which is a hassle,” he says.

Still, Ryan knows that his bicuspid valve will deteriorate over time. In all likelihood, he has another surgery in his future. When the time comes, he knows a few good doctors to call.

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