"Ross Me, Baby": Dr. Paul Stelzer's Ross Procedure Helps Me Say Goodbye to My Congenitally Bicuspid Aortic Valve and the Shortness of Breath That Went with It
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All Photographs by Chad Hunt Unless Otherwise Indicated - http://www.chadhuntphotography.com
Surgery Date: 12/11/06
E-Mail Stretch here: stretch@stretchphotography.com

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Please click on the frame above for background on my aortic valve disease. For more on the Dr. Stelzer and the Ross Procedure, click here. A very nice view of Ground Zero from the Cafe of the Milleneum Hilton, shot by Noni. We arrived in New York from Richmond on Thursday, 12/7/06. She and I stayed in this hotel from the time of my discharge on 12/17 until we flew back to Richmond on 12/21. Having arrived at the Mountaintop, Noni and I sought out an audience with The Great and Powerful Stelzer. Photo by Noni. I thought the diverse languages made this sign interesting. Photo by Stretch.
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OK... the only way Noni would let me NOT show a butt-exposed-hospital-gown picture was if I would show this one. Photo by Noni. Kristin Ellis, a nurse practitioner in the cardiology department, beginning my pre-op on Friday, 12/8/06. Photo by Noni. A nice portrait of Kristin, who said I was weird because my blood pressure was *not* elevated just three days before open heart surgery. Photo by Stretch. Pre-op blood draw... Photo by Stretch.
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They can cut my chest open all they want, just don't stick any needles in me. Photo by Stretch. One of the very friendly staffers in the Beth Israel X-Ray department during my pre-op visit. Photo by Stretch. My favorite cardiothoracic surgeon, Dr. Paul Stelzer, and I in his office after I finished pre-op. Photo by Noni. Noni and I with Joey and Sylvia Asgur, friends from ValveReplacement.com. They live in New York so we all met for lunch two days before my surgery. Joey had a Ross Procedure by Dr. Stelzer in September 2001. I hope that five years from now I'm doing as well as he's doing!
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Me napping 12/9/06, two days before surgery, in the apartment Beth Israel Hospital provided for us... just across the street from the entrance to Cardiac ICU. Photo by Noni. The most beautiful woman in the world. Photo by Stretch. Noni and I in Battery Park on Sunday, 12/10/06. Photographer unknown. Me in front of the Apple Store Fifth Avenue, just off Central Park, on Sunday, 12/10/06, the day before my surgery. Open 24/7/365 for when PC users awaken in the middle of the night with a sudden and uncontrollable desire to Switch. Don't laugh, it will eventually happen to each of you. Photo by Noni.
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Noni and my friend Kurt, both PC users, shown here in the Apple Store, slowly being assimilated into the Collective. Kurt came up to NYC from Philadelphia for my surgery. Photo by Stretch. Me, my friend Bill, and Noni, Sunday, 12/10/06. Bill came to the city from Richmond for my surgery. Photographer unknown. The nice thing about taking this shot was that it took me several tries to get it lined up properly. Photo by Stretch, Sunday 12/10/06. Kurt, me, and Bill in the Beth Israel apartment the night before my surgery. I'm on the phone chatting with another friend. I don't think Kurt was happy with the toppings for the pizza we'd just ordered. Photo by Noni.
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Noni and I in the surgical intake waiting room at Beth Israel Hospital, 5:20am on the morning of my surgery. Noni, me, Kurt and Bill, right before the nurse called me into the prep area. In the surgical holding area. I don't know the name of the nurse to the left, but she was very nice. The anesthesiologist, Dr. Mohan Obilisundar, is to the right. He was amazing. Thankfully, he let me call him by his first name. Me and my good friend Chad Hunt, a very talented young photographer who was gracious enough to photograph the entire surgery, and only a few days after he had returned home after an assignment for Mens Journal in Afghanistan. The procedure was only about 5 and a half hours, but with travel time and pre-surgery work, Chad ended up putting in a good 12 hour day. Check out his web site here. Photo by Noni.
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A few minutes before they wheeled me into the OR. Photo by Noni. Hurry up and wait... We arrived at the hospital at 5:30am; surgery was supposed to start at 7:30am; they wheeled me into the OR at about 7:20am. Notice Dr. Obilisundar's hands on the bed rails. Time to go... Noni's laughing in the background after she commented that only a rude American would call an Asian doctor by his first name. Nice to go into surgery with a smile on my face...
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One final kiss... ...and away we go! Chad made this photo just a few moments after they wheeled me into the OR. Notice the clock indicates about 7:23am. I'm not really this pale... it's the OR lights above me. Dr. Obilisundar is getting ready to start a a radial arterial line in my right wrist. The nurse to the left is preparing EKG sensors.
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Helbert working on my arterial line while Dr. Obilisundar says, "You're getting sleeeepy.... Veeerrrryy sleeeeppyyy..." (Not really) The sensors on my head are part of the INVOS Cerebral Oximeter system, which, according to the company's web site, http://www.somanetics.com, "noninvasively and continuously monitors changes in the regional oxygen saturation of the blood in the brain." More on this amazing critter here. I was still pretty much awake and aware at this point. Nice shot of some bright red arterial blood, ever so gently purloined by Helbert DeCastro. Still awake at this point, but without a care in the world... Must be the drugs.
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A good look as the Swan-Ganz after it's been inserted in my jugular vein. The catheter runs all the way down into the right side of my heart and provides the OR team with continual monitoring of the heart functions during surgery. Still not asleep... just resting my eyes... I remember looking up as Chad made this photograph. I couldn't feel the Swan-Ganz. OK... here we go. I don't remember this mask going over my face at all...
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...although I do very vaguely remember giving Chad the thumbs-up. "Godspeed, John Glenn... preparing for lift off." Here Dr. Obilisundar is starting intubation. An illustration of proper, and improper, placement of the intubation tube can be found here. The wonderful Helbert DeCastro shaving off what little chest hair I had. Heart Rate 78, arterial BP 102/69, pulmonary arterial pressure 23/13, pulse oximetry 99. I have no idea what the rest means, but I think we're good to go.
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OK, so now we have the cerebral O2 monitor on my forhead, eye protection, what I imagine is a suction tube in my nose, the white intubation tube and black transesophageal echocardiogram (TEE) tube in my mouth, and the Swan-Ganz catheter in my jugular vein. This is Gary Lehrer, the perfusionist who ran the cardiopulmonary bypass machine during my surgery. The bypass machine allowed allowed Dr. Stelzer to stop my hear from beating so that he could operate on it. Three cheers for Gary! Dr. Obilisundar working on the exact placement of the TEE sensor in my esophagus. The TEE images the heart during surgery from the posterior side, through the wall of the esophagus. The images it creates are similar to those of a fetal ultrasound.
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One of the surgical nurses, waiting for the game to begin. Tubes that will later carry blood between my body and the cardiopulmonary bypass machine, also known as the heart-lung machine. According to the clock, the prep has taken a little over an hour, thus far.
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Dr. Stelzer is to the right in this shot. He's being assisted by the scrub nurse, whose first name is Sharon, but whose last name I do not know. Dr. Stelzer in the OR just before suiting up. The first incision, which was made about 8:45am.
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The yellow instrument is used like a soldering iron to cauterize blood vessels as they are cut, preventing them from bleeding. Notice the cellophane-looking wrap covering my chest area. This is plastic impregnated with Betadine, the sterilizing solution. Dr. Stelzer told me that the plastic sticks to the skin and slowly soaks it with Betadine throughout the procedure to keep the wound isolated from any skin bacteria that might want to crawl in and cause infection.
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Once the skin is opened up, the sternum, or breast bone, has to be sawed in two so the surgeon can get to the heart. This cutting of the sternum is called a sternotomy. Dr. Stelzer and Sharon, the scrub nurse, opening up my chest... My heart is covered by yellowish fatty tissue. The red tissue around the heart is the pericardial sac, which along with the sternum protects the heart. It has also been opened to access the heart, and will be kept open with the stay sutures, going in here.
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Dr. Stelzer cranking my chest apart with a rib spreader. The whitish tissue, below the heart in this view, is my ascending aorta, which had a 5cm aneurysm, repaired by Dr. Stelzer in about ten minutes after completion of the Ross Procedure. Each of the next few photographs looks very similar, but notice that the size of the heart changes in each one, as the heart beats and inflates with or releases blood. Here is it full of blood. Here it has pumped most of the blood out and is therefor much smaller.
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Here, again, it is full of blood. And here, again, nearly empty. Interesting how they use my lower body as a work bench, where various instruments are within easy reach. Dr. Paul Stelzer, cool as a cucumber, with his hands in my chest. Did I mention that I love this guy??
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Here they're basically replumbing my circulatory system, diverting my blood flow from my heart and lungs and into the heart-lung machine, which will do the job of both organs so Dr. Stelzer can work in a motionless, bloodless operative field. Because the pumping motion of the heart-lung machine can reportedly damage red blood cells, Dr. Stelzer took two pints of blood from my body before I went "on pump," and returned them to me after I went "off pump," thus allowing that blood to avoid the machine entirely. A potassium solution has been introduced into my coronary arteries to stop my heart. The heart-lung machine is now keeping me alive.
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The tubes are clear PVC. The bright red blood is returning ot the body, having been oxygenated by the heart-lung machine. The dark blood is deoxygenated and is heading to the HL machine. Here Dr. Stelzer has performed an aortotomy, opening up my ascending aorta. Notice the ice slush sitting on the heart. This is to help keep the heart muscle cool. The lower temperature lowers the amount of oxygen the muscle needs, thus protecting it during the five-plus hour potassium induced cardiac arrest. The extent of the calcification of the valve was very clear once it had been removed. Dr. Stelzer has now opened up my pulmonary artery in order to harvest my pulmonary valve and move it over to the now vacant aortic position, the signature steps in the Ross Procedure. Notice the yellow Swan-Ganz catheter in there.
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As the pulmonary valve is removed, we can see right down into the right ventricle of my heart. If I'm not mistaken, the light coloured, string-like tissue visible inside the heart are the chordae tendineae, tendons linking the tricuspid valve with the heart's papillary muscles. You can see why the chordae tendineae are also known as "heart strings." All the yellow tissue is fat. Surprisingly, Dr. Stelzer told me that one reason my surgery was fairly easy was because I had relatively little fat around the heart. My pulmonary valve, now removed from my heart.
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Dr. Stelzer is measuring the diameter of the pulmonary valve to compare against the aortic valve. The two valves must be nearly identical in size for the Ross Procedure to be successful. Voila! My perfect former pulmonary valve, holding water just like it's supposed to. The valve will soon function as my new aortic valve. Once it's implanted, it will be known as an "autograft." Dr. Stelzer continuing to suction out any residual calcium deposits inside my heart.
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Dr. Stelzer checking the diameter of the aortic annulus to ensure that the autograft, my old pulmonary valve, will fit properly. The aortic annulus being prepared for implantation of the autograft. A great shot of my pulmonary valve, left, awaiting implantation into its new home- my aortic annulus. Here and in the next two images we can see the white piece of Teflon felt that Dr. Stelzer sews into the aortic annulus to help support the pulmonary valve once it's implanted as an autograft.
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Notice that most of the lines are flat. I'm not breathing and my heart is not beating. The heart-lung machine is doing all the work.
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Cardiothoracic surgery's sump pump: the heart-lung machine. At this moment, my heart is without a pulmonary valve- not a good situation. A cryopreserved human donor valve will take the place of the valve that was in my pulmonary position. I hope that the expiration date is the date by which it's supposed to be implanted... not the date it will stop working for me! For more on cryopreservation click here. My blood bubbling through the heart-lung bypass machine, and being oxygenated in the process. The PVC plumbing between me and the HL machine.
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Left to Right: Dr. Charles Gellar, who assisted Dr. Stelzer, Sharon, and Dr. Stelzer. Drs. Gellar and Stelzer and their technology. That's my head is just peeking out from below the blue drape. The donor pulmonary valve, soon to be mine, once it's implanted as an "allograft." I don't know much about the donor, except that she was a 40 year old woman. I'm very, very thankful for her and her family. They taped this to something in the OR for safe keeping during the surgery.
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The Great and Powerful Dr. Paul Stelzer. Did I say that I love this guy?? ;) This and the following are two very interesting pictures. Normally, the coronary arteries feed out of the ascending aorta just past the aortic valve. Since there are not outlets for the coronary arteries in the the autograft's conduit tissue, Dr. Stelzer must puncture the conduit and then attach the coronary arteries to it. As one of the holes was being cut into the conduit, the scalpel nicked one of the leaflets in the autograft. Dr. Stelzer repaired the leaflet with sutures and tells me that it should be a non-issue.
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After all the cutting's done it's time to sew everything back together. This shot shows of some of the eighty-odd sutures that from now on will hold the autograft in place as it functions as my aortic valve. Like my pulmonary valve, the donor valve is checked with saline to make sure it functions properly before it is implanted. About eighty more sutures going in, this time attaching the pulmonary allograft (human donor valve) to my heart.
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Now that everything's sewn back together, and my heart has a new aortic valve (the autograft), and a new pulmonary valve (the allograft), it's time to remove the tubing that diverted my blood into the heart-lung machine. The rib spreader has been removed. The blue and white wires are the leads for an external pacemaker, in case my heartbeat needs to be regulated after surgery. They will be removed about 2 days post-op.
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Now... for the blood and gore... Much like repairing any other broken bone, my sternum had to be wired back together before the incision in my chest was closed. Dr. Stelzer tells me that the material under the wires is a gauze called a laparotomy pad. Its purpose is to catch the blood oozing from the needle holes created as the wires are put in to close the sternotomy. The pad was removed before the wound was closed. After a sternotomy, a patient is not supposed to drive for about six weeks. I cheated a few times... Closing the wound...
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Drs. Obilisundar and Stelzer checking out the TEE imaging of my heart after the Ross Procedure. I think Dr. Stelzer has a smile beneath his mask. A final view of the wound, now closed, at about 2:00pm. Getting ready to ship out to cardiac intensive care...
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The last photograph from the operating room... Noni made this photograph only a few minutes after I arrived in cardiac intensive care to begin my recovery. Cardiac ICU again, under the watchful care of Marcie. Photo by Noni.
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Four hours later and I'm still asleep and still intubated. Photo by Noni. My first post-surgery kiss, the day after surgery. Photo by Bill. Noni made this picture just after I moved from CICU to a cardiac stepdown room at 5:30pm on Tuesday, 12/12/06, the day after my surgery. For some reason, for a few days the bottoms of my feet hurt like absolute hell when I would stand up, like someone had beaten them with a baseball bat. It was the greatest pain I felt throughout the surgery and recovery. Sitting up, looking human again, and eating my veggies, two days post-op. Photo by Noni.
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Four days post. I swear my I'm not this fat in real life. Due to retention of fluids, I put on nearly 15 pounds during my hospital stay. Lasix and another med helped me lose all that by the time I was discharged. Photo by Noni. Dr. Stelzer paying a visit and a chat three days post-op. Photo by Noni. On post-op day four I got an echocardiogram to make sure everything was holding together well. This was the view through my hospital window. Photo by Noni.
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Taking a short walk around the cardiac stepdown unit, five days post-op. Photo by Noni. Taking a rest during the walk. Photo by Noni. I guess a sign like this was in every room on the floor, but I decided to personalize mine a bit. Photo by Noni. WIth a pot of flowers (courtesy of the good people at ELOPE, Inc.) and Sarah James, a cardiac nurse practitioner, on the day of my discharge, Sunday, 12/17/06.
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Checking e-mail, one week post-op. Photo by Noni. This was the view from our room in the Milleneum Hilton, overlooking Ground Zero, the World Financial Center, the Hudson River, and, eventually, New Jersey. Photo by Noni. Not only would I be lost without my wife, I'd be sockless! Photo by Stretch. No, she's not sniffing... she's kissing. What a woman. Photo by Stretch.
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Dr. Stelzer checking me out one last time before Noni and I leave New York on 12/21/06. The one downside to my surgery is that I don't have as many excuses to call or e-mail this guy as I did in the weeks leading up to the operation. Photo by Noni. In addition to the scars on my chest, I ended up with a spot on the back of my head from staying in bed so much. Photo by Noni. The day after Christmas, about two weeks post-op... getting back to my sexy-self. Photo by Noni. Fifteen weeks and six days post-op... I ran the Monument 10k (that's 6.2 miles) in 1:09:03. Before my valve replacement, I could only walk 2 blocks without stopping to catch my breath. 'nuff said.