When Division I softball player Kaitlynn Dawson started feeling dizzy during a workout in 2017, she never considered that her heart might be the cause. She was only 19, after all, and she'd always had symptoms like shortness of breath with exercise, though her inhaler never really seemed to work.
So, Kaitlynn was surprised when a sports physical and heart screening at Sam Houston State revealed she had a bicuspid aortic valve – a common congenital defect in which the aortic valve is made of two parts instead of the normal three parts, or leaflets, that keep blood from flowing back into the heart or leaking.
At the time, Kaitlynn's valve was leaking a little bit, though it didn't appear to be causing major problems. A year later, she collapsed when she was heading out on a run.
Kaitlynn was faced with a difficult decision – one that would affect the rest of her life. She had two surgical options:
- Open heart surgery dividing her sternum, in which we’d place a mechanical valve that would last forever but would also require her to take blood thinners. Or we could giver her a biologic valve, which may require replacement years later but would allow her to avoid blood thinners.
- Minimally invasive aortic valve replacement, in which we make a two-inch incision between the ribs to replace her valve. UT Southwestern's team has performed more of these surgeries, also known as mini thoracotomy surgical aortic valve replacement (SAVR), than surgeons at any other hospital in Texas.
Leaky valves typically happen in patients age 50 and older. For them, the choice is primarily based on their current health – can they survive open surgery or is it too risky?
But at age 19, with a softball career and a lifetime ahead of her, Kaitlynn needed a personalized care plan that kept her swinging now and would protect her quality of life in the future.
We invited Kaitlynn to describe how she ultimately made her choice and to share her experience.
‘I started surgeon shopping’
When I was first diagnosed with the bicuspid valve, I was told I'd probably need heart surgery in my 50s or 60s – something to be aware of, but nothing to worry about right away. I took the news in stride and didn't think much about it until the summer between my sophomore and junior years of college.
I started on a run one day, and I couldn't breathe. I keeled over. I knew something was very wrong.
I was referred for an echocardiogram, which showed that the valve was leaking a lot. The doctor told me I'd need open heart surgery within two months, not four decades. It was pretty shocking to go from "you're fine" to you need major surgery.
But I'm not one to sit around and become negative. Instead, I started "surgeon shopping."
I'm fairly savvy about medical terminology – I plan to apply to veterinary school this spring – so I interviewed several surgeons to learn about the types of valves they use and the advantages of the surgical techniques they offered.
My aunt worked for a company that collaborates with hospitals across the country, and she asked her colleagues who was the best surgeon for heart valve replacement. They referred us to Dr. Doolabh at the Clinical Heart and Vascular Center at UT Southwestern. Right away, we knew he and his amazing staff were our perfect match. They treated us like family, not just patients.
Choosing the best valve and surgery for me
When Dr. Doolabh laid out the surgical options, there was a lot to consider when making my decision. However, I couldn't allow myself to be negative. I told myself, "When I survive this, I will have an amazing story and a super-cool scar to go along with it!" So, at first, I leaned toward the open procedure, which comes with a can't-miss scar down the middle of the chest.
But for young women like me, there are a few things to consider about mechanical valves:
- I'd have to take blood thinners for the rest of my life to prevent blood clots. Unfortunately, they're not considered safe for pregnant women. While I had no immediate plans for motherhood, I didn't want to close that door. And I didn't want to risk a bleeding incident if I got injured on the softball field.
- Opening the chest causes scar tissue to develop over time. If I needed another heart surgery in the future, excessive scar tissue may make that surgery more difficult. Plus, each time I have my pericardium (the thin sac around the heart) opened, the more complex the heart surgery would become.
- Open heart surgery would sideline my sports career for a year. I'd have to rebuild the stamina and conditioning that helped me win a spot on the Bearkats softball team, not to mention missing classes as I recovered.
When Dr. Doolabh mentioned all the benefits of mini thoracotomy SAVR and tissue valves, that option just seemed to make sense for me. I could get an effective, aesthetic procedure that still offers a cool (but much smaller) scar, with half the recovery time and much less pain.
One thing to note: Tissue valves last about 10-20 years. I will need another surgery after I finish my education, complete my softball career, and have a baby if I choose to do so. At that point, I can get a forever-lasting mechanical valve if I'm ready for that commitment.
About the mini-valve surgery
Dr. Doolabh made a 2-inch incision in my rib cage to access the leaky valve, then removed it and replaced it with a surgically implanted biological valve. The procedure took approximately 2 1/2 hours, and I woke up from anesthesia with no issues. The toughest part of recovery was dealing with the chest tube that helps drain excess fluid out of the body after the procedure.
The tube rests between the ribs and is sutured skin deep, which means it can move internally a little bit. There are a lot of nerves in your rib area, and bumping the tube hurt more than the procedure site.
Cardiac rehab, fast-tracked
My cardiac rehab therapists at UT Southwestern were straight with me – I was looking at approximately six months of rehabilitation to get back to my regular activities. But they said if I was diligent and put in extra work, such as coming to rehab daily instead of every other day, I might be able to cut my recovery in half.
I wanted to get back on the field, so I worked closely with my amazing rehab team to safely complete six months' worth of cardiac rehab in three months.
The first few times I went to cardiac rehab, I was a little anxious about not knowing my limitations and overdoing it. But I quickly learned that the rehab team monitored me closely to ensure my safety. It was emotionally challenging at times, but with their support, I regained my strength and cardiovascular endurance. I stretched, lifted light weights, walked then jogged on the treadmill, and pedaled the "arm bike" (upper-body ergometer). After some hard work, I was back on the Bearkats' field about 12 weeks post-surgery.
Though I wasn't quite 100 percent, I was so grateful to get to enjoy my favorite sport again. I went on to pitch 18 games during the 2018 Bearkats season, including 43.2 innings and two complete games.
Today, almost three years post-surgery, I am finishing college and working full time as a veterinary surgical technician. I've always loved animals – my mom works at a vet clinic, and after filling in for a staff member on vacation, I fell in love with the field.
My experience with Dr. Doolabh and his amazing team has only increased my interest in studying the art and science of surgical procedures.
As for young patients like me who may be facing a medical condition, I have three pieces of advice:
- Listen to your body. You know your body better than anybody else. If something feels wrong, you're probably right – advocate for yourself and get examined by an expert.
- Try to stay positive. Having a positive (but realistic) perspective is essential to a strong recovery. Instead of feeling sorry for myself, I focused on how lucky and blessed I felt to be alive. A negative mindset would have slowed down my recovery, and I was ready to get back on my feet again.
- Think about the long term. Dr. Doolabh gave me all the options and talked me through how my decision could impact my future. Considering all the aspects of each procedure is essential to choosing what's best for you. There is no question in my mind that mini thoracotomy SAVR was right for me – I’d do it again in a heartbeat over open heart surgery.
Expert care, excellent attitude
Kaitlynn is a remarkable woman. Her advocacy in seeking expert care, paired with her positive attitude, led to a full recovery. Every year, she calls our office or sends us a holiday message, and her thoughtful words always make our day.
Kaitlynn is living the life she wants, and a leaky valve couldn't slow her down. We're grateful we got the opportunity to take care of her, and we're so excited Kaitlynn is giving back by taking care of animals in need – all without having to sacrifice any part of her future plans.
If you have questions about valve replacement surgery, or to schedule an appointment with Dr. Doolabh at UT Southwestern, call 214-74-VALVE (214-748-2583). His direct line is answered 24/7 by a registered nurse on his team.
The Magic of Minimally Invasive Aortic Valve Repair
Through a 2-inch incision, Dr. Neelan Doolabh routinely performs aortic valve replacement surgery. With the largest volumes for this surgical approach in the region, Dr. Doolabh has performed more than 3,000 minimally invasive valve repairs or replacements.