A tuneup for the heart

"Out in the barn, saddle up the stallion. Swing the doors open wide, give him plenty of room."

These are the first few lines of the song “New Horse” by Steve Olof Larson. These lyrics could perhaps symbolize the renewed energy of the 71-year-old musician and retired elementary school teacher after facing a handful of health challenges. Steve had been experiencing bouts of low energy and shortness of breath that he thought were due to asthma and having Valley fever — an infection caused by inhaling certain fungal spores in the air.

Steve was evaluated by Dr. Sathya Pokala, a pulmonary disease specialist affiliated with Sharp Grossmont Hospital, who noticed something peculiar — a heart murmur. Dr. Pokala referred Steve to Dr. Dimitri Sherev, an interventional cardiologist affiliated with Sharp Grossmont Hospital’s Burr Heart & Vascular Center.

“After urgently evaluating Mr. Larson, we confirmed on an echocardiogram that he had severe aortic valve stenosis,” says Dr. Sherev. “His symptoms of shortness of breath and fatigue were consistent with heart failure related to severe stenosis of his main heart valve.”

Additionally, a cardiac catheterization performed at the Burr Heart & Vascular Center confirmed that the aortic valve was severely narrowed. Steve’s cardiovascular care team explained two options to him for addressing the narrowed valve.

“We could either replace his valve via open heart surgery, or by a new minimally invasive interventional technique called TAVR,” says Dr. Sherev.

The TAVR procedure
TAVR, which stands for transcatheter aortic valve replacement, is a minimally invasive procedure to replace a faulty valve located in the top part of the heart. The heart is like the body’s pump — keeping oxygen-rich blood flowing to the organs so that they have the energy to work properly. Heart valves keep blood flowing in the right direction. Sometimes, these valves can narrow, reducing blood flow. When the heart’s aortic valve narrows, this condition is known as aortic valve stenosis. One of the most common causes of aortic valve stenosis is calcification, or hardening, of the valve. Over time, calcium deposits can build up and narrow the valve opening, preventing it from functioning normally.

“When the valves cannot open properly, it makes it harder for the heart to move the blood, which can eventually lead to symptoms such as chest pain, dizziness and the shortness of breath that Mr. Larson was experiencing,” adds Yvette Espiritu, a physician assistant affiliated with Sharp Grossmont Hospital’s Burr Heart & Vascular Center, who also cared for Steve.

“In recent trials with similar patient characteristics, TAVR outperformed surgical aortic valve replacement with 75% improvement of clinical outcomes for patients with aortic valve stenosis,” says Dr. Sherev.

After thorough discussions with his care team, Steve chose to proceed with TAVR.

“Going through a tiny opening in his thigh, we were able to thread a prosthetic valve through Mr. Larson’s artery to his heart,” says Dr. Sherev. “Once inside the heart, we put the new valve in to replace the damaged valve. This new valve allows for better blood flow from the heart into the circulatory system and out to the rest of the body.”

“I don’t remember being frightened,” says Steve when thinking back about the procedure. “It was a relief. Everyone was talented and skilled — there was such an incredible amount of competence around me. Everyone was in the right spot doing the job they were meant to be doing.”

Life after TAVR
“Mr. Larson’s procedure was successful, and he was able to go home the next day,” says Dr. Sherev.

Prior to the procedure, Steve’s heart was only able to pump 20% of blood out to his body. Now, with the prosthetic valve in place, he has 100% restored blood flow.

Dr. Sherev recalls that one of the first comments that Steve made after the TAVR procedure was that he “felt like a new person with more energy and drive.”

“On a follow-up visit I had with Mr. Larson, he brought me a CD of his music,” recalls Dr. Sherev. “I was happy to see him creating and recording new music again.”

Steve is also appreciative of his restored health and how it has influenced his artistry. He usually starts the day playing his guitar, typically after waking up in the morning to strum out melodies fresh in his head. Now, like the lyrics in his song, he can do so with the vigor of a stallion, and with the doors wide open.

“After the procedure, I remember noticing dramatic things happen, like finally getting a good night’s sleep. Also, when I played my guitar and sang, I felt really strong. My breathing was stronger. I could do what the song wants me to do.”

The TAVR procedure is also performed at Sharp Chula Vista Medical Center and Sharp Memorial Hospital.