Complications of the heart

Man’s live-saving cardiac surgery was tricky — for the must unusual reason

Doctors at Memorial Hermann Southeast Hospital knew Gary Wingfeld was a high-risk candidate for a procedure to replace his damaged heart valve.

Wingfeld, 70, was admitted to the hospital April 20 after suffering a heart attack, and he was on a ventilator to help him breathe. He’d had various health issues in the past, including another heart attack and a mini-stroke.

But there was also a more complicated matter: His heart wasn’t where it was supposed to be.

The Clear Lake resident had his left lung removed when he came down with double pneumonia as a child. Over time, his heart moved into that vacant space in his chest and rotated clockwise, he said.

“My heart is in the left side of my body, toward the back,” Wingfeld said. “And it’s turned backwards.”

The team at Memorial Hermann Southeast Hospital knew Wingfeld’s atypical anatomy made replacing his aortic valve more difficult and that his deteriorating health added to the risk. But they decided to take on the challenge after six doctors discussed Wingfeld’s case over a conference call.

The team carefully planned out the minimally invasive procedure that Wingfeld needed, using medical images to determine the unusual angles they’d need to take to reach his heart. That preparation helped them replace his aortic valve without any complications.

Wingfeld is now back home and doing “very well,” said Dr. Nadish Garg, an interventional cardiologist at Memorial Hermann who performed the procedure.

“He met us a couple of times when he came back, and he looked like a new man,” Garg said. “We were very happy that we pushed for this procedure.”

Dr. Periyanan Vaduganathan, a Memorial Hermann cardiologist who has been treating Wingfeld since 2009, said his longtime relationship with Wingfeld helped the team determine the procedure was worth the risk. They were confident Wingfeld would recover if they replaced his aortic valve.

“He’s alive today because we were able to do this procedure,” Vaduganathan said.

A unique anatomy

Wingfeld grew up in Louisville, Ky., and he came down with double pneumonia at 12. Doctors needed to remove his left lung because the illness caused extensive scarring.

Most people can live a normal life after having a lung removed — a procedure known as a pneumonectomy — but they’ll have decreased lung capacity.

“They told me at the beginning that I would not be normal,” Wingfeld said. “Well, see, that’s a bad word with me, even at 12 years old.”

Wingfeld didn’t let the surgery slow him down. In high school, he lifted weights and ran for the cross-country and track and field teams.

As an adult, he moved to Louisiana, where he met his wife, Connie Wingfeld, and then to Houston, where he started the plastics manufacturing company Republic Bag Co. He remained active by swimming, playing softball and golfing. He also loves to fix up old cars.

As he got older, though, Wingfeld started to have heart problems. He had his first heart attack in 2001 and started seeing Vaduganathan in 2009. Over the next 12 years, he needed various procedures for irregular heartbeats, blockages and other heart issues.

“He has been patient with multiple different problems and challenges, but we have kept him going,” Vaduganathan said.

In 2020, Wingfeld was setting up for a socially distanced graduation party for his daughter outside his home when he collapsed. He suffered a ministroke.

“My health started going down the tubes from there,” he said.

Wingfeld started feeling short of breath more often after his mini-stroke. He’d need to stop and catch his breath when he took the garbage to the curb. His doctors changed his medications, but he continued to struggle.

On April 16, he felt some tightness in his chest. The feeling subsided after a bit, but he continued to have trouble breathing for the next three days, until his wife convinced him to go see a doctor.

Vaduganathan was out of town, so Garg examined Wingfeld instead. Garg knew right away that something was wrong.

“He was extremely weak. He couldn’t even get out of the chair to go to the door,” Garg said. “He was in bad shape.”

Tests showed that Wingfeld had a heart attack a few days earlier. He was still in poor shape, so Garg took him to the cardiac catheterization lab. More testing revealed that Wingfeld had severe aortic stenosis and needed a new aortic valve in his heart.

Initially, though, doctors weren’t sure he was well enough to undergo a procedure. On top of that, the unique location of his heart made it more challenging. They told him there was nothing they could do.

“That’s when the tears started rolling down my eyes,” Wingfeld said.

A complicated procedure

Vaduganathan returned from vacation a few days later and met with Wingfeld in the hospital. Wingfeld pleaded with him for help.

“He’s known me a long time, and this was the first time I could see that fear in his eyes,” Vaduganathan said.

Wingfeld’s condition continued to deteriorate, though, and soon he needed to be placed on a ventilator to help him breathe.

Vaduganathan and Garg took part in a conference call with four more doctors to discuss Wingfeld’s case. They told the other doctors they felt the procedure was worth the risk.

They believed Wingfeld would get better if they replaced his aortic valve, which had narrowed to the point where it was restricting blood flow.

“We kind of used our judgment and took a chance for the patient,” Vaduganathan said.

Wingfeld needed a minimally invasive procedure known as transcatheter aortic valve replacement, or TAVR. During the procedure, a surgeon inserts a catheter into a blood vessel in the patient’s groin and guides it to the patient’s heart. The surgeon then threads a replacement valve to the heart.

Wingfeld’s anatomy made preparing for the procedure more challenging, Garg said. Sonographers are trained to take images of the body’s organs and tissues at certain locations, but Wingfeld’s heart was in a different spot.

“When the heart is not in the right position, you are hunting for something, trying to take pictures,” Garg said. “It’s very hard to get the correct alignment for the assessment.”

Those images were crucial to helping Garg and his team determine the angle they needed to take to Wingfeld’s heart. A CT scan showed his heart was rotated 50 to 60 degrees from its normal position.

“We’re used to going in a certain position, a certain location,” Garg said. “Now you have to imagine that everything’s rotated, so you have to compensate for that and go in that direction.”

That preparation was critical for Garg and his team. It was like knowing in advance that they were going to encounter a detour while driving, he said.

Overall, Garg said the procedure went “surprisingly well” given the challenges they were facing.

“We did not have any unanticipated roadblocks,” he said. “We had prepared that we had to position our catheters in a certain direction, and that just worked very well.”

‘A night and day difference’

Wingfeld’s condition improved quickly after his aortic valve was replaced. He was taken off the ventilator the next day, and he returned home May 1.

“On the way home, the more I thought about it — you know, coming close to death — I just broke down,” Wingfeld said. “I had no idea it was that bad.”

Over the past few months, he’s been in physical therapy to rebuild his strength. His heart function has improved by approximately 50 percent since the procedure, Vaduganathan said.

Vaduganathan said Wingfeld still has a leaky mitral valve, but that issue has also improved over the past few months. He doesn’t believe Wingfeld needs another procedure at this time.

Both Garg and Vaduganathan said they’re glad they took a chance on having Wingfeld undergo TAVR. Vaduganathan said his longtime relationship with Wingfeld and his family made the decision easier.

“If I had not had that rapport with (Wingfeld) — if he was a brand-new patient who came into the ER — I might have hesitated,” he said. “But here, I knew him well. I knew there was only upside.”

Wingfeld is also grateful his doctors were able to pull off the complicated procedure.

He’s already feeling much better; he’s no longer having trouble breathing the way he used to, and he’s back to fixing up cars. He’s looking forward to being back to full strength so he can do yardwork, cut his grass, clean his pool and take on other chores at home.

“It’s a night and day difference. I’m stronger. I’m more calm,” he said. “I think they bought me 10 more years, and I appreciate it.”

Photos by Kirk Sides/Staff photographer Gary Wingfeld tightens a bolt on a wheel assembly on his vintage 1994 C4 Corvette. He was able to return to his favorite pastime, restoring cars, after his surgery.

Even as a child, he didn’t let health problems slow him down, says Wingfield, who had his left lung removed after coming with double pneumonia in his youth.