Don’t ignore the symptoms: Local man survives after emergency aortic valve surgery at Inova

Living with Heart

Swift decision to perform lifesaving surgery pulls retiree through harrowing experience. Expert physicians and surgeons at Inova Alexandria and Inova Fairfax Hospitals evaluated and treated Mr. Fleet with emergency aortic arch and aortic valve replacement.

Clyde Vogie Fleet (R), shown here with wife Cassandra, survived a near-fatal heart condition and is now thriving after lifesaving surgery and cardiac rehab at Inova

One afternoon last April, Clyde Vogie Fleet was attending a friend’s retirement party at a restaurant in Fairfax when he suddenly felt slightly overheated. Knowing that the party was nearly over and not wanting to draw attention to himself, he went to the restroom to cool off. But the feeling didn’t go away, and he began to sweat profusely. Clyde, a retired senior computer programmer analyst and web content manager with the Department of Defense, had previously been treated for aortic valve dysfunction. However, after receiving a good prognosis, he was no longer being monitored by a physician for it.

The feeling didn’t go away, and Clyde continued to sweat. He ran into a co-worker who inquired, “Clyde, are you doing OK?” He responded that he was not feeling OK. Then another co-worker asked, “Clyde, do you see me?” Clyde said no. Then he blacked out.

After the restaurant called an ambulance, Clyde was rushed to the Inova Alexandria Hospital (IAH) Emergency Room. As he faded in and out of consciousness, the medical team launched into action, performing a CT scan of his head and an EKG.

“We knew something was terribly wrong,” recalls emergency medicine physician Reagan Herrington, MD, FACEP. “His EKG looked like he was having a heart attack, but he said he didn’t have any pain. He was not able to comprehend and express himself like I’m sure he usually does.”

Without delay, Dr. Herrington called cardiologist Narian Rajan, MD, FACC, who determined that Clyde should be evaluated in the catheterization lab. In that golden hour — those fleeting minutes when emergency care is most critical to survival — Rafiq Zaheer, MD, FACC, a cardiologist and Inova Alexandria Section Chief, Cardiology, performed an emergency transesophageal echocardiogram. The advanced imaging procedure revealed a large tear in the aorta, along with massive leakage of the aortic valve, the main valve off the aorta. “This is a life-threatening emergency and can only be treated with emergency cardiac surgery at specialized centers,” says Dr. Rajan.

Dr. Rajan then made a rapid decision to transport Clyde to Inova Fairfax Hospital where he could receive lifesaving surgery, the only treatment for ascending aortic dissection, according to Dr. Rajan. “Every hour that you delay there’s a 5 percent increased risk of mortality,” he says.

Moving quickly, the team stabilized Clyde’s blood pressure, inserted a tube into his trachea to protect his airway, placed him on a breathing machine and transferred him to Inova Fairfax, where a surgical team led by cardiac surgeon Ramesh Singh, MD, was ready for his arrival. The team agreed that in order to save Clyde’s life, he would need to be operated on immediately.

Mending His Heart

Clyde was in surgery until midnight. During that time, Clyde’s wife, Cassandra, learned of her husband’s condition and rushed to the hospital. Other family and friends also came to the hospital to provide comfort and prayer.

In the operating room, the medical team lowered the temperature of Clyde’s heart to 15 degrees to reduce the demand of oxygen so the artificial heart-lung machine could take over blood flow to his brain and to preserve his tissues and spinal arteries. Dr. Singh and his team then performed a complex surgery, replacing Clyde’s aortic arch and aortic valve.

Speedy Recovery

Over the next five days, Cassandra and Clyde’s sister-in-law stayed with him as he recovered in the Intensive Care Unit. The surgery had been a success.

Dr. Herrington says she felt confident that her emergency team would do what was necessary to save Clyde’s life. “At Inova Alexandria Hospital, when a sick patient comes in, our whole team comes together to focus on saving the person’s life,” she says. “Everything has to work perfectly every single time, and in this case it did.”

Clyde bounced back after surgery. At Dr. Rajan’s encouragement, he went through the Cardiac Rehabilitation Program, a medically supervised education and exercise program for individuals diagnosed with heart disease, twice a week for two months. He’s now back to riding his bike and taking care of the yard.

“I am very grateful to everyone at Inova, including the nurses who monitored and took care of me with extreme caution,” he says. “I cannot name everyone that was a part of saving my life. Still, I am very thankful to everyone.”

Heart-Healthy Diet

To optimize the health and well-being of patients who have had a cardiac event, the Inova Alexandria Hospital Cardiac Rehabilitation Program now offers nutrition education. The program provides initial one-on-one counseling sessions and interactive group education classes featuring virtual grocery shopping and cooking demonstrations.

“Oftentimes we see inpatients to provide heart-healthy diet education. Since we have included nutrition services on Wednesdays as part of the outpatient program, we can continue to follow their progress and provide continued support for success,” says Jamie Grandic, RDN, Clinical Nutrition Manager.

The nutrition program was founded on research that shows a heart-healthy diet improves outcomes, including reducing mortality rates, following a cardiac event, points out Srilekha Palle, Director of Rehabilitation Services. It recently added a dietitian to its team to maximize patient outcomes. The program also customizes services to the needs of each individual patient.

“Counseling can be tailored to what the client needs,” says registered dietitian nutritionist Olivia Phillips, RDN. “It’s very helpful because not only is exercise important to their overall lifestyle change, but diet plays a huge role if they’re in cardiac rehab.”

To find out more about cardiac rehab at Inova, call 703-504-3398.

Heart risk assessment

To find out your heart age, take a free five-minute test at inovaheart.org/heart-risk-assessment.