Rare heart surgery almost mainstream
LIT’S not surprising that Jeff Copeland appreciates life more than most. The 35-year-old was born with a frightening number of medical problems, including two holes in his heart, several hernias, and his heart located on the right, instead of the left side of his body.
He was only two hours old when he underwent his first surgery, to treat a condition called exomphalos which occurs when an abnormal hole in the abdominal wall allows intestines and other organs to protrude.
As a child he also underwent surgery to fix two potentially fatal diaphragmatic hernias and a heart operation to treat tetralogy of fallot - a congenital heart condition caused by four heart defects. However, the heart surgery caused complications that would require further surgery more than 20 years later to replace his pulmonary valve.
As an adult Copeland also developed an irregular heart beat, known as arrhythmia, and palpitations.
Only three months ago, Copeland underwent his sixth operation -a relatively new procedure called radio frequency ablation which doctors believe will prevent any further arrhythmias (heart palpitations.) Surgeons also replaced his pulmonary valve for the second time, and repaired his tricuspid valve.
The most recent 12 hour operation was particularly challenging due to the unusual location of Copeland’s heart. I’ve had six operations and certainly at times I’ve felt like a guinea pig,’’ Copeland says.
Throughout it all, Copeland has remained positive and never let his health problems prevent him from being physically active.
I really appreciate life and I always look after my health. I get really angry when I see people who don’t look after their bodies. It’s disgusting. They don’t know how lucky they are, and they take their health and bodies for granted.’’
Copeland’s survival illustrates the great breakthroughs in heart surgery that now allow people born with congenital heart problems to live long and healthy lives.
Homayoun Jalali, cardiothoracic surgeon from St Andrew’s War Memorial Hospital in Brisbane, who performed Copeland’s most recent surgery, says cardiac surgery has greatly improved in the past 30 years. He says Copeland’s case in particular presented a challenge to doctors.
What is really different about Jeff is that in addition to his other heart conditions, his heart is totally rotated to the right side of the chest. The combination of the two is rare. In 12 years in my own practice and treating thousands of people with heart conditions, I’ve never seen another case like it.’’
Copeland’s most recent surgery was the relatively new procedure of radio frequency ablation using cryotherapy.
A gas is delivered through a probe around the area of the heart that causes the irregular rhythm, and deep freezes it for a short period of time. It stops that area of the heart sending the irregular rhythm to the rest of the heart. We also harvested a pulmonary valve from a non-living heart from someone who had died within 24 hours and replaced Jeff’s pulmonary valve, and then repaired his tricuspid valve.’’
Jalali says the treatment should provide permanent relief from arrhythmia. ‘‘ We use a similar procedures probably 50 times a year, but it’s going to become more common.’’
Copeland says that after dealing with the so many health problems, the arrythmia was particularly alarming.
That was an awful fright because my heart started to beat at 220 beats a minute, and my heart was stopping and starting. It would wake me up during the night. I had to call an ambulance and was taken to hospital. I was given drugs but they didn’t work. The arrhythmia got worse over time and I became all bloated. I looked like Elvis for a while.’’
His tricuspid valve began to leak, causing further arrhythmia.
‘‘ I was very depressed about having the surgery this time, but then I thought I’d better just get on with it. I knew it would improve my quality of life.’’ And the radio frequency ablation has significantly improved that.
‘‘ It ablated all the actual scar tissue so that it doesn’t form arrhythmia in my heart. It’s only in the past three to four years that they’ve started to do that, and it will immensely help any other patient who has to undergo any heart surgery. Some of the doctors who normally don’t get very excited, were really excited by this procedure.’’
Copeland hopes cases like his have played a role in helping doctors to improve surgical techniques.
‘‘ The surgical advances today means the procedures are better than in the past, so the outcomes will be better for kids today. That makes me really happy.’’
Jalali says doctors in the UK were also trialling the use of keyhole surgery to repair or replace valves — a procedure that he believes will greatly advance cardiac surgery. In the future may be able to repair the valve without doing another major surgery.’’
Director of the Baker Heart Research Institute Garry Jennings says Copeland’s case highlights the potential of current surgical techniques to repair even the most unusual, or serious, heart defects.
‘‘ About 1 in 10,000 are born with their heart on the wrong side of their chest. Sometimes people are born with all the organs shifted the other way,’’ Jennings says. ‘‘ Less common is when just the heart is on the other side. It’s usually not associated with other health problems.’’
Jennings says arrythmia is becoming alarmingly common.
‘‘ Atrial fibrillation is quite an epidemic. There are two kinds - one which comes out of the blue and the other which is a consequence of the chronic heart problems.
‘‘ Five to 10 per cent of people will develop it by the time they turn 70, and 30 per cent by the time they turn 80. It now accounts for about 15 per cent of strokes and we predicting a threefold increase by 2050.’’
Jennings agrees that treatments such as radio frequency ablation have provided a much needed breakthrough to treat arrythmia. There weren’t many previous treat- ments. There were drugs treatments that were ineffective and sometimes made matters worse. The other way to treat it involved open heart surgery. Now catheter-based procedures have made treatment much more accessible and effective.’’
Both Jalali and Copeland firmly believe that children born with heart defects these days have every possibility of being healthy.
Copeland has completed a science degree with double majors in applied mathematics and atmospheric science, and is starting a masters degree in bio-meteorology.
‘‘ It is vital to have a positive outlook on the future, even if the present is not the best,’’ Copeland says. ‘‘ It’s all about having a passion in life and going after it. I for one will never stop setting goals. My faith, positive attitude and support from my family and fiancee Melanie have kept me going.’’
Copeland is hopeful that improvements in cardiac surgery will spare children with heart problems the many operations that he has endured.
‘‘ Advances in laparoscopic surgery have a lot of potential, and hopefully other patients won’t have to go through all the surgeries that I had to. I would tell any kid diagnosed with a heart condition not to worry; be brave and have courage, it’ll be alright.’’
Jeff Copeland, above, has had life-long cardiac surgery, the latest a new technique conducted by specialist Homayoun Jalali, above left.