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Evo Terra: Heart disease is a topic in which I have more than a passing interest. It's part of my family's medical history on all sides. So I'm quite excited to chat today with Kathleen Jones, from Cape Fear Heart Associates. She's been working in cardiology since 2006, with a focus on structural heart disease. This is Healthy Conversations Podcast, the show by New Hanover Regional Medical Center. I'm Evo Terra. I think most people are familiar with the term heart disease, Katie, but we're here to talk about structural heart disease, which now makes me wonder, are there other flavors of heart disease that I should be aware of?

Kathleen Jones: You know, the heart is such a wonderful organ and there's all different parts to it. There are actually a lot of different aspects to the way that it works electrically with the heartbeat, with blood flow, with its strength, with having the arteries. So there's lots of different diseases of the heart, but they all relate to each other,

Host: Right. Cause they're all connected. It's the same tissue that's having it. When we hear about it, it's just the, we call it heart disease, but there's something more to it. So what should we do? We have heart disease? Well, I don't think that explains enough. So how do we know which particular type of heart disease we might actually have?

Kathleen Jones: When a person comes to a cardiology expert, we do a lot of different tests and EKG. We do ultrasounds which are called echocardiograms. We do more advanced testing for arteries. We do heart monitors to look at the heartbeat. And from that testing is where we can find what's actually going on to give somebody a symptom of heart disease. And most commonly people have similar symptoms, whether it be palpitations or shortness of breath or chest pain, those are the similar symptoms that are hallmarks for all cardiac disease. And it's our job to figure out what causes that. What I focus on is the structural heart aspect, which touches coronary artery disease, like heart attacks. It touches the heartbeat issues and it touches heart failure. But structural heart is more about the actual muscle and the inside of the heart and how that can get diseased and how we have certain new advanced procedures to treat that.

Host: Let's talk about some of those treatment options that are specific to structural heart disease. W what do you, what is most common out there right now?

Kathleen Jones: Valvular heart disease is one of the most common structural heart issues that we deal with. We have four heart valves separating each compartment of our heart, and they work like doors that open and close that help the blood go through the heart, help it go forward. So it doesn't back up. One of the most common Valvular diseases that we hear of is something called aortic stenosis. And the aortic valve is the last exit door of the heart. And the word stenosis means that it is closing it's tightening, and the heart has to work really hard to get the blood out of the heart, through that tightening heart valve. So we try to do what we can to help that. And medications really don't treat Valvular heart disease. So we have to think, well, what does? A lot of times it's open heart surgery. That's the standard of care for heart valve disease, but that's a very taxing treatment. It's open heart surgery. And as we get older, people don't survive open heart surgery because it's so taxing on the body. They've come up with some unique and inventive ways to replace a heart valve that we don't have to actually open up the body. We actually go through, what's called a catheter. The term catheter just means tube. And what we do is we actually use a tube that goes into an artery in the body, and that artery leads us to the heart. And we have small devices that we use that actually go in the heart, and then insert a heart valve and replace.

Host: Wow, I'm just picturing that, right. I'm going back to Sci-fi from when I was a kid where we shrinkable down to the size of the body and stay away from the heart and that pumping back and forth, but we're able to actually go in with that little tube, and it's more complicated than this, but I'm just going to say, swap out a heart valve with one that's faulty to one that is, what is it mechanical? Is that what it is?

Kathleen Jones: Mechanical valves are a standard, very old standard, and they actually are the most durable heart valves that they are, but that's only through open heart surgery. The heart valves that we use actually have a little bit of metal and a little bit of tissue. And because we're going through an artery, what's wonderful about these devices is that it, that the heart valve is actually collapsed in on itself when we first insert it. And we don't remove the old valve, what we do is we take this kind of scrunched up device, and we put it where the old heart valve is. And then we open up that device. We stretch out the metal and press it into the heart so it can replace the valve, but the old valve stays there as well.

Host: It's almost like scaffolding is helping to support?

Kathleen Jones: Exactly. And we've gotten some, you know, we started doing this procedure probably in the early two thousands was when it was very experimental and they were actually studying it closely and putting it in people and we've come a long way. Initially, we were only using this heart valve for people who had no other options. They were very sick, other medical issues going on. They were older. And what we were finding was that the heart valves were doing great, even though the people might not have survived from their other medical issues, the heart valves looked great. So then we started opening up the options to other people who might not be high risk for procedures. We've seen that the heart valve itself is, the longevity of it is almost comparable to a surgical bioprosthetic heart valve, not the mechanical heart valve, they are different, but we've got some great results and people are doing really well.

Host: Great news for me, because as mentioned heart disease is what my family has to deal with. Most of my grandparents on my mother's side at least were members of the Zipper Club as they called themselves. And anyway, as I continue to age, cause that happens, this is an interesting idea. You know, maybe I won't have to go through the same sort of traumatic experience that they did when things give out. Curious, you mentioned that we don't have to do it for the most severe cases, but if someone has a heart murmur or some other condition where there's an issue with the valve, not fully sealing, would that be a viable option?

Kathleen Jones: Yes, it can be. But what we want to make sure of is that we don't replace a valve too early. So having a heart murmur does indicate that there might be something going on with the heart valves. And like I mentioned earlier, we do some tests to figure out, well, what does that murmur from? Which valve is it from? And how severe is that disease valve? You have to keep in mind is that our replacement valves, the longevity is not as good as our original valves. So when we replace it, we have to make sure that it's time to replace it. And usually that disease has to be severe. Now, some people with vascular disease, they don't have any symptoms with mild disease or even moderate disease. We only see people get sick from vascular heart disease when it's pretty severe.

Host: So, chances are, they would be good candidates for a situation like this because of the nature and progress of the disease. Let's talk about recovery. You mentioned earlier that since we're not opening up the chest cavity, we're not doing open heart surgery here. I imagine recovery is vastly different.

Kathleen Jones: Oh, it absolutely is, open heart surgery say, about four to six weeks until somebody's actually back to doing some normal activities. For this procedure, we have people come in, they stay one to two nights in the hospital on average, and then they go home. Most of their discomfort is where we go in with the catheter, the tube into the artery. And that gets better within about seven to 10 days. So most of our patients are feeling much better by day 10. And then they're back to their normal activities and feeling a lot better. We do follow up quite closely and usually by the fourth week after their surgery, and they are doing much better after day 10, but usually after the fourth week, I commonly get, I feel like a million bucks. That's one of the most amazing parts of this advanced technology is that we're able to replace a valve and people recuperate really quickly. And the mortality rates are significantly less compared to open heart surgery, which is amazing.

Host: It really is. Do we have to stop the heart for part of the procedure?

Kathleen Jones: They do for about five seconds to get the valve into place. And again, this is a very technologically advanced procedure. In fact, it's just one Doctor that does it. There is a cardiologist, a thoracic surgeon. There is an imaging cardiologist that takes the pictures while we are adjusting and placing the heart valve appropriately.

Host: It is completely fascinating and such a vast difference in where we were just 20 years ago, and probably even five or 10 years ago. Looking forward and knowing how quickly advancements in this is taking place right now. What are you excited about on the horizon? I don't know. We can't make predictions and we're not, we don't want to do that, but we know that at the rate of which medical technology is advancing, what's got you interested and excited about what we can do five years from now?

Kathleen Jones: Well, right now we're using this procedure mostly for the aortic valve, but we have three other heart valves in the heart that have diseases as well. And we've been looking at ways to help those valves through the catheter as well. Instead of doing open heart surgery, we do have a mitral valve procedure that we do as well. For leaky heart valve, not a tight valve, but a leaky heart valve where we put a little clip on it to tighten up the heart valve instead of having it leaky. But it's just really exciting that we're, we're advancing to do treatment of the heart through catheters, without opening up patients is just amazing. And like I said, they're looking at doing similar procedures to the other three valves in our heart as well.

Host: Katie, I'm terribly excited about this entire prospect. It makes me feel maybe for the first time ever pretty good about growing old. As a person with a history of heart disease. Of course I have many of my ancestors that I can look back on and discuss what they've been through. I know in some other cases, they wind up being on these drugs to help, you know, lower their risk of having a heart attack eventually. But I know that we've got some new products on the market, if you will, which can reduce the amount of drugs that we have to take, to keep heart disease under control. Can you talk about that for just a moment?

Kathleen Jones: Specifically, the heart disease, including the heart rhythm, one of the most common diseases we come across as AFib, it's out there in the media commercials about it. How do we treat it and how do we prevent a risk stroke? And that's the big thing with AFib is there's this risk of stroke. Right now, the only way we can help reduce risk of stroke effectively is with blood thinners like Coumadin or Warfarin, Xarelto, Eloquence. These are pretty dangerous medications because they've been in the blood. So a lot of people don't like to use them. But what we've found is that we can reduce the risk of stroke by using some of these intracardiac devices and doing a procedure with structural heart in particular, there's a device called the Watchman. It's like a plug for part of the heart. There's part of the heart muscle, that little pocket almost, and blood can get caught up in that pocket. And that's how clots can form. And when we look at a AFib and how strokes happen well, it's from blood clots, where do those blood clots form? A lot of that clot is from this little pocket of muscle in the heart. So we've developed this plug that allows us to seal off that pocket. So we effectively decrease the risk of stroke. And if we can do that, we can get people off of blood thinners. And right now we're focusing on people who have dangerous being on blood thinners, people who bleed people who fall, we're trying to figure out a way to reduce their stroke risk. And the Watchman device has allowed us to do that.

Host: Fascinating times we live in Katie. Thank you for all of your information today.

Kathleen Jones: Oh, you're welcome. Thank you so much.

Host: Thanks again to Kathleen Jones for joining me today from Cape Fear Heart Associates, to learn more about Cape Fear Heart Associates, and the high level of cardiac care they provide. Please visit in nhrmcphysiciangroup.org. Thank you for listening to this episode of Healthy Conversations Podcast, the show by New Hanover Regional Medical Center. I am Evo Terra. If you found this episode helpful, please share it on your social channels and be sure to check out our entire library of past episodes, which you can find at nhrmc.org.