It’s not uncommon for some physicians to treat members of the same family, but surgeons don’t typically perform open heart surgery on three, first-degree relatives, all within a six-month time span. That is, however, exactly what Cardiac Surgeon Christian Shults, MD, did after meeting the Miller family.
Dr. Shults met Tim Miller after Annapolis-based, MedStar Health Cardiology Associates’ Cardiologist Scott Katzen, MD, referred him for surgical care for an ascending aortic aneurysm. Tim, 57, a technical sales leader who works out of Northern Virginia, had been regularly seeing Dr. Katzen after learning about his heart murmur several years earlier.
“I remember thinking, I don’t have a heart murmur,” Tim recalls when he first learned of his condition. “It’s my brother who has always had the heart murmur.”
But the murmur was real, related to an aortic aneurysm, and Tim began seeing Dr. Katzen for echocardiograms and regular monitoring. In the spring of 2018, he was told he would need surgery to fix his aneurysm, now 5.2 cm in size, and at risk for rupture or dissection. He also was told he would need repair or replacement of his aortic valve, secondary to a bicuspid valve.
Tim scheduled surgery with Dr. Shults for Aug. 15, 2018.
No one was more surprised than Jeff Miller, 53, Tim’s younger brother, when he learned his elder sibling needed heart surgery.
Jeff had always known about his own heart murmur. The Ellicott City, Md., resident was diagnosed with a bicuspid aortic valve in high school and had yearly check-ups since he was a teenager.
In the summer of 2018, Jeff saw Dr. Katzen, who ordered an echocardiogram. “As soon as the echo was over, Dr. Katzen walked in and told me ‘You have the same thing your brother has, let’s get a CT scan as soon as possible,’” Jeff recalls. The CT scan confirmed Jeff also had a 5.2 cm ascending aortic aneurysm in almost the exact same location as his brother’s. His aortic valve, though, was intact and would not need replacement.
Dr. Katzen called Dr. Shults about Jeff’s case and surgery was set for Oct. 3, 2018.
Tim and Jeff’s mother, Carolyn Miller, 81, had a known heart murmur, but over the years it had grown louder. Based on her sons’ recommendation and praise of Dr. Katzen, along with his proximity to her home on Kent Island, Md., she sought his care as well. It was on the day of Jeff’s surgery that she learned of her severe mitral valve stenosis. Once again, Dr. Katzen made a referral to Dr. Shults.
Carolyn, who in addition to her five children, has 14 grandchildren and 12 great-grandchildren, admitted to experiencing increasing fatigue and lightheadedness. She met with Dr. Shults who told her a new mitral valve would help with that.
With the holidays fast approaching, Carolyn looked ahead to the New Year and set a surgery date of Jan. 16, 2019.
Three Complex Cases
Dr. Shults is well versed in the surgical treatment of complex aortic, coronary artery, and valvular heart diseases. Even so, open heart surgery on three immediate family members was a first for him.
After reviewing Tim’s transthoracic echocardiogram, which showed calcifications and significant aortic stenosis, Dr. Shults recommended replacement of his valve as well as an ascending hemiarch repair of his aneurysm. The procedure involved carefully replacing his ascending aorta all the way to the arch with a graft, as well as replacement of his aortic valve with a bovine pericardial valve.
“I do this to get all the aneurysm out,” explains Dr. Shults. “This leaves the patient with no aneurysm at all.”
The three-hour operation involved deep hypothermia to 28 degrees Celsius, clamping the base of the aorta, and creating circulatory arrest for optimal operating conditions while providing cerebral protection.
Less than two months later, Dr. Shults performed the same graft repair on Jeff. “Jeff’s aneurysm was in the exact same spot at Tim’s,” says Dr. Shults. “But his valve was in good shape and not stenotic at all.” Jeff, however, had 80 percent blockage in a diagonal artery, which required bypass. In January, the Miller family was back at the Hospital Center when Dr. Shults replaced Carolyn’s mitral valve with a bovine valve. Her severe mitral annular calcification made open surgery treacherous, so he selected a unique approach: he opened her left atrium and surgically placed a transcatheter valve.
Tim, Jeff, and Carolyn are doing well and continue to see Dr. Katzen on a regular basis.
“Dr. Shults told me I would feel better, and he was right,” Carolyn says. “I feel 100 times better since my heart surgery.”