The changes in 67-year-old Michael Devine were increasingly worrisome for his wife Rosalie. She observed him walking the other direction to avoid hills and stairs. During a recent trip to Shanghai, he needed to rest after walking half a block. Doses of nitroglycerin to control angina (chest pain) were also growing more frequent.
"It was gradual, so he wasn't even aware of it," Rosalie said. "Travel was becoming more stressful because I worried something might happen (to him) when we were out of the country or on a cruise where we wouldn't have access to good medical care."
Now semi-retired, the couple's work in the wine brokerage business has taken them across the globe. They moved to Manhattan Beach 28 years ago and started a small enterprise in their living room using a rented typewriter. Today Michael Devine & Associates sells wine to nearly every major cruise line and airline worldwide, including American Airlines, United Airlines, Delta Air Lines, Alaska Air, ANA, British Airways, Singapore Airlines, Royal Caribbean, Carnival Cruise Lines, Celebrity Cruises and Cunard Cruise Line.
For Michael, decades of working seven days a week, entertaining clients with rich food and wine, and smoking had taken their toll. His lifestyle and family history of heart disease had created a potentially lethal combination, manifesting itself in a growing number of health problems.
During the last six years, Devine had undergone four angioplasty procedures under the hand of interventional cardiologist Douglas Carlson, M.D., Torrance Memorial Medical Center. During these procedures, Carlson had placed nine stents in Devine's coronary arteries to open blockages. This past summer, clouded vision in Devine's left eye led his ophthalmologist Ron Gallemore, M.D., to suspect he had suffered a small retinal stroke, likely caused by a blockage of his carotid artery. Carlson recommended Devine undergo an echocardiogram and MRI, which revealed two major blockages of his carotid artery and a condition known as aortic stenosis (narrowing ofthe aortic valve, which causes decreased blood flow to the heart). While a normal aortic valve is two to four centimeters square, Devine's had narrowed to .6 centimeters square. These issues, and skyrocketing blood pressure, put Devine in the category of "critical," the most severe grade of cardiac cases. Carlson recommended Devine undergo aortic valve replacement as soon as possible.
"I was justifiably shaken by the news," Devine said. "I had several friends who had undergone this procedure at some of the foremost medical institutions in the county and had a lot of complications. Six months later one of them is still in pain. Another had a lot of swelling and lost the use of his hands due to nerve damage during the surgery."
Prepared to travel across the world to find the most skilled surgeon available, he first asked Dr. Carlson who he would trust if he needed the procedure done on himself. His recommendation would take Devine just a few miles from home to John Stoneburner, M.D., a cardiothoracic surgeon at Torrance Memorial Medical Center. After further research and consideration, Devine took his advice and now calls it the "best decision" he ever made.
According to Rosalie, having a clear picture of what to expect provided immeasurable peace of mind throughout the entire process.
"Dr. Stoneburner and the entire team at Torrance Memorial took the time to make sure we knew exactly what we were going to experience prior to and following surgery once we left the hospital," she said.
In mid August, Stoneburner replaced Devine's shrinking aortic valve with a heart valve made from bovine pericardium (tissue from a cow heart). The bovine valve doesn't require lifelong use of blood thinning drugs as did previous artificial valves. It also has better blood flow dynamics and is easier on the heart.
During the procedure he also cleaned out calcification that had built up in Devine's aortic artery. Stoneburner was trained at Baylor University under the team of the world-renowned cardiac surgeon Michael Debakey, M.D., (one of the first surgeons to perform coronary artery bypass surgery). Although he has performed thousands of aortic replacements, he also sees many patients who need the procedure, but like Devine, are fearful of open-heart surgery and refuse treatment.
"The natural cycle of aortic valve stenosis is that it worsens over time. Without valve replacement, patients continue to deteriorate and become more sedentary," Stoneburner said. "I've seen people totally transformed from this procedure. Patients should be more afraid of the consequences of not having the operation."
Stoneburner and Carlson credit the success of the Torrance Memorial Lundquist Cardiovascular Institute's Cardiovascular Surgery Program to its multi-disciplinary team approach.
"We bring together cardiologists, cardiothoracic surgeons and anesthesiologists to discuss and determine how to best optimize each patient for anesthesia, pre- and post-operative care and rehabilitation to guarantee the best possible outcomes," said Carlson.
Four days following the procedure, Devine was relieved to return to his home on the Manhattan Beach Strand with virtually no pain, aside from the site of incision. Today he is pain free and has also experienced the unexpected bonus of improved vision in his left eye from 20/30 to 20/20. Formerly unable to exercise, he now routinely uses his home elliptical machine. The couple is also planning a trip to Europe in the next few months.
"I feel better than ever," Devine said. "My whole body has changed. My fingernails used to fall out all the time. Now they are healthy. I also have a lot more energy." Rosalie is relieved to see "less stress in his face."
According to Stoneburner, aortic stenosis often sets off a chain reaction that can impact other organs, even vision. However, many people with aortic stenosis don't realize they have it until it's too late. He urges heart patients to be proactive about their health. "Ask your cardiologist for an echocardiogram if you have any unusual symptoms such as chest pain, shortness of breath or a newly discovered heart murmur," he said.
Devine now boldly encourages others who need the procedure to follow his footsteps. "With the right surgeon, I say go for it. It will change your life," he said.