Monday, 10 Mar 1997   ...   Incision Decisions
      Updated on September 2nd, 1997

I had done a lot of searching the Net on the subject of congenital heart disease, particularly in in reference to anomalies of the coronary arteries. Though Dr. Jayne used the words "abnormal" and "strange" to describe my case and gave me warnings such as "it could kill ya", I couldn't comprehend the severity until I could put a gauge to it and compare it against a range of known cases. Through my research I became familiar with the term "myocardial ischemia", a deficiency of blood flow to the heart. Though no one actually told me so, I wondered if this wasn't the cause for all the concern.

Prolonged or severe ischemia can lead to death of the heart muscle served by the narrowed artery. That is called a myocardial infarction, or, in more common parlance, a heart attack.

But then there is me ... not even a single recognizable symptom. Just last Summer I was able to withstand 400m repeats at an average pace of 66 seconds and 200m repeats under 30 seconds per. Sure there was some very hard breathing. And under the all-out conditions of an occasional 400m trial I would feel that odd, but familiar, burning sensation in the pit of my sternum - it was nothing that a few more weeks of training wouldn't chase away. I had no reason whatsoever to suspect that my heart was working harder than normal under such physical stress.

Most cases of sudden death do not occur during strenuous physical exercise, but rather during rest or usual daily activities. This is because a relatively small portion of one's time is spent in vigorous activity. However, strenuous physical activity does increase the risk of sudden death and cardiovascular mortality In the athlete younger than 35 years, hypertrophic cardiomyopathy is the most common cardiac condition associated with sudden death. Right ventricular dysplasia, idiopathic left ventricular hypertrophy, coronary anomalies, premature atherosclerosis, and Marfan syndrome compose the majority of the remaining causes of sudden cardiac death in athletes.. In the athlete older than 35 years, coronary atherosclerosis is the leading cause of sudden death followed by those conditions responsible for sudden death in the younger athlete.

Silent Ischemia ... Athlete's Heart. Was this the danger Dr. Jayne was alluding to? Abnormal arrangement of the coronary arteries alone would probably not induce "sudden death". The increased size of the arteries are a clear indication of compensation and ultimately survival. That leaves only the question of how much reversed flow exits through the left anterial descending artery into the pulmonary artery. With such a tight stenosis at that anomalous junction, how significant could it be?

Last week as I mused about whether or not to undergo heart surgery, I began to contemplate the possibilities for improved performance once I was recovered. I imagined what it would be like to apply what's left of my short-distance speed to longer distances having the benefit of "normal" endurance for once in my life. Having the LAD artery reconnected to the aorta might allow me to go beyond the level of fitness I've experienced up to this point. So ... What if?

With as much prompting as my cardiologist has given me over the last two months, the analysis of my Stress Test/Echocardiogram should not have surprized me. It was obvious that the heart wall appeared weak under such minimal stress and though Dr. Jayne suggested that another test might be necessary to get a high-definition image of the arteries, it was clear to the other cardiologist running the test that the moving images from the ECG displayed enough objective evidence. Surgery is not to be considered an option in my case. It's no longer a matter of IF I should have the surgery, it's WHERE and HOW SOON! It seems I have been extraordinarily lucky thus far ... nothing more. My condition: Ischemia due to anomalous origins of the left coronary artery from the pulmonary artery (ALCAPA). In cases like mine, sudden death, particularly in athletes, comes without symptoms and totally without warning. It was a similar condition that killed Pete Maravich at the age of 40. With the help and support of my friend, Vikki, I am working out the details this week for open-heart surgery to be done at Dartmouth-Hitchcock in Hanover, NH toward the end of March. I assume my cardiologists are not going to let me delay it much more than this.

In reality, I still can't fathom what I'm about to undergo. It's out of my control ... I can't even call it denial. I've been so healthy all my life, and still feel fine right now despite not running more than 3 times in 11 weeks, that I just can't imagine what it will feel like to recover from heart surgery and to look in the mirror at that huge scar I will have down the center of my chest. But it's just as well because I have no anxiety about it at this point.

Thursday, Mar 13th 1997   ...   Visit With The Surgeon

I met with Dr. Lawrence Dacey, the surgeon who will perform my bypass operation. He seemed extremely confident in his work and that was enough for me. I also got to view the angiogram film in detail for the first time. It was incredible! I witnessed the stream of oxygenated blood being wasted as it passes out the pulmonary artery and into the lungs. Those fire hoses I have for coronary arteries are pushing blood around at a tremendous volume just to make up for it.

The plan is simple. He will ligate the left anterial descending (LAD) artery which is currently attached to the pulmonary artery. Then he will detach one of the inner mammary arteries from my chest wall, which feeds directly off the aorta, and attach it to the LAD artery. The flow from this artery should provide enough pressure to move blood in the proper direction again and restore to the LAD, the function in feeding the myocardium. Lastly, Dr. Dacey will close off the pulmonary artery with sutures from the inside. There will be no attempt to change the arrangement of the left circumflex artery from where it is attached from the right side. It is apparently quite functional as is. The entire operation will take from 4 to 6 hours

Over time the strong collateral flow that currently feeds into the LAD with diminish. The inordinate size of all three arteries will eventually be reduced as the LAD will correctly provide all of the oxygenated blood to the central heart wall as it was originally intended.

Date:       Fri, 14 Mar 1997 Subject:   Overdue bio ... and surgery Dear Dead Folks, What a blast it was tracking down those ancient PRs of mine. Looks like I've had "runner's" block since the age of 35. But that is soon going to change! The surgery on my alien-made blood exchanger is on for the 26th of March. I am very confident in my surgeon, Dr. Lawrence Dacey, and the entire facility at Dartmouth-Hitchcock. No sense waiting another month, let alone another year as I had been thinking, since my two choices were to get it done or to become totally sedentary and take my chances of surviving. Me sedentary? Yah, sure! I have every intention of making it back to this "World Of The Running Dead", the great DRS. But in case I don't, I'll just try my best to be clever and deliver one more post somehow. There must be some way I can program this Mac to launch a message from the other side ... Much Later. Peter dellaFemina Readsboro VT

Analysis

Open Heart Surgery

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