Rare heart surgery al­most main­stream

The Weekend Australian - Travel - - Health - Clara Pi­rani Med­i­cal re­porter

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.’’

Pic­tures: David Sproule (above) and Lyn­don Mechielsen

Jeff Copeland, above, has had life-long car­diac surgery, the latest a new tech­nique con­ducted by spe­cial­ist Ho­may­oun Jalali, above left.

Heart mir­a­cles:

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