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New Directions

Issue: Fall

On the Other Side of the Lens: Photographer Turns Focus to His Heart

John Keith, Photographer

When John Keith, a professional photographer for 26 years photographed Dr. Keith Horvath performing cardiac surgery in 2009, he focused his lens on the process, the teamwork and the surgeon’s hands, but not on the patient. “I didn’t pay much attention,” Keith admitted wryly. A few months ago, he wished he had.


Keith, 61, was about to become the patient. He was diagnosed four years ago with aortic stenosis, a condition that accounts for most valve replacement surgeries. Healthy heart valves operate like gates in each of the heart’s four chambers; when working well, they open smoothly to let the blood flow in one direction, then close. With aortic stenosis, the aortic valve is narrowed, often stiffened, and no longer opens and shuts as it should. Keith’s condition was discovered during a routine physical; a cardiologist confirmed it through an echocardiagram.


At the time, surgery was not recommended because Keith had none

­of the typical symptoms, which include shortness of breath, fainting and chest pain. But a few months ago he did experience chest pain and learned he finally would need valve-replacement surgery. A friend recommended Dr. Horvath, who he remembered from his earlier photo shoot at the hospital.


Dr. Horvath, who has performed close to 5,000 valve surgeries, is chief of cardiothoracic surgery at the NIH Heart Center at Suburban Hospital, which was established five years ago in collaboration with Suburban Hospital, Johns Hopkins Medicine and the National Institutes of Health. Since its inception, the Heart Center has achieved excellent outcomes in terms of fewer complications, lower mortality rates and fewer readmissions after surgery than most hospitals, based on data from the Society of Thoracic Surgery National Database. Dr. Horvath also conducts leading-edge research at the National Heart, Lung, and Blood Institute across the street from Suburban Hospital.


“I appreciated the amount of time Dr. Horvath spent with me,” noted Keith. “He showed me the calcium deposits on my echocardiogram and explained how they interfered with the function of my aortic valve.” Most people have tricuspid (three-leaf) aortic valves; Keith was born with a bicuspid valve (two-leaf), which is more at risk for eventual calcium buildup.

According to Dr. Horvath, many patients, like Keith, never notice any symptoms; the condition is generally discovered in a doctor’s office. “The calcification sets up a turbulence like a rock in a river,” he explained. That turbulence can be heard as a murmur, leading to a diagnosis.


Valve replacement patients need to make a choice: mechanical or tissue valves. Both have special considerations. Patients with mechanical valves, which last forever, must take coumadin, a blood thinner, for the rest of their lives. Keith chose an animal valve (which can be porcine or bovine) that can last about 20 years. Dr. Horvath believes that if Keith needs a replacement valve, the procedure will more commonly occur percutaneously—through the skin without opening the chest—a far quicker, less invasive procedure now undergoing clinical trials.


Meanwhile, heart patients at Suburban Hospital have one huge advantage. They are cared for with the Universal Bed Model, a unique concept in care that has already shown marked benefit. Patients stay in one room for their entire stay, from post-op intensive care through discharge, with the same care team from start to finish. It is a plan that enhances patient satisfaction and safety.


Five days after his surgery, Keith was back home, full of praise for his care. “The hospital staff was terrific,” he said. “They were so competent, so generous and so quick to respond. I’m glad I chose Dr. Horvath and Suburban Hospital.”


Dr. Keith Horvath was named a Top Doctor by U.S. News & World Report in July. Find more Suburban Hospital Top Doctors at http://health.usnews.com/top-doctors. 


To Learnmore | To see and hear Dr. Horvath talk about treatment for a common type of valve disease involving the mitral valve, go to http://www.suburbanhospital.org/HealthInfo/chatArchive.aspx.


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