York County Medicine Summer 2019 - 11

YO R K C O M E D S O C . O R G

Normally, the aortic valve has three flaps, or leaflets, which
allow the blood flow in one direction, away from the heart, by
opening and closing. When a valve is damaged or diseased, it
can significantly impair blood flow in the proper direction and
compromise the heart's ability to pump efficiently, causing fatigue
and general strain on the muscle. Over time, this may result in
arrhythmias or heart failure, causing patients to get short of breath
and seek medical care.
Treatment depends upon the type and severity of the valve
disease. In some cases, surgery is needed either by performing
traditional or minimally invasive procedures such as iSAVR
or iSMVR. My recommendation to repair or replace a valve is
based on several factors, including the patient's general health,
the condition of the damaged valve, the presence of other health
conditions, and the expected benefits of surgery.
When I started my career as a heart surgeon nearly 20 years
ago, it seemed unlikely for most heart surgeries to someday be
performed by using tiny incisions in the side of the chest or groin.
However, it has been one of my most rewarding experiences as a
physician to play an intimate role in developing and refining new,
minimally invasive techniques for qualified patients alongside my
colleagues. Together, we create an individualized plan for both
short-term and long-term wellness.
Although patients may credit their physicians for their survival
and improved quality of life, we are only a part of the equation.
Without patients' trust and commitment in taking an active role
in their health, success is not guaranteed. I am proud of each
patient for their tenacity and resolve - from diagnosis to recovery.
Paula Noggle is one example of such a success story.

iSVR: intercostal Surgical Valve Replacement is
performed for aortic valve replacement, mitral
valve repair/replacement, double valve repair/
replacement (mitral and tricuspid or aortic

A QUICK RECOVERY FROM HEART SURGERY

and mitral) and some coronary artery bypass

Paula Noggle, 52, of Dover, was born with a heart condition
that prevented her bicuspid heart valve from pushing the normal
amount of blood volume into her body. Her condition was
discovered when she was in her thirties, but it never interfered
with her vigorous, daily workouts.

surgeries. Access to valves does not require

Paula knew eventually she would need to have surgery to
correct her heart valve, but perhaps not for years down the road.
When she began feeling lethargic and had difficulty carrying a
basket of laundry, however, she saw her doctor who discovered that
her aortic valve was completely blocked. At that time, Paula was
referred to Dr. Mumtaz, who reviewed several treatment options
with Paula. Eventually, she chose to have the intercostal surgical
aortic valve replacement (iSAVR).

mammary artery. Benefits include:

"An advantage of our heart program is that there's no cookiecutter approach," says Dr. Mumtaz. "The best person to decide is
the patient, and Paula liked the iSAVR approach because it is less
invasive. On average, patients go home in three days. In Paula's
case, because she was in excellent physical shape, she was home in
two days."

* Less chance of blood transfusions

cutting the rib, cartilage, or major pectoral
muscles, and preserves the right internal

* Small incision - 1 to 1 ½ inch incision laterally
* Less trauma
* Less time spent in the ICU and hospital
* Less scarring
* Quicker and earlier recovery

Since her surgery, Paula feels better and has more energy than
she has had in a long time.
SUMMER 2019 | York County Medicine

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York County Medicine Summer 2019

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