TERRE HAUTE —
Regina Nieft calmly entered Union Hospital early Thursday, confident and hopeful that the complicated cardiac surgery scheduled for most of the day would improve and extend her life.
She placed her future in the hands of cardiac surgeon Tamim Antaki, anesthesiologist Scott Samson, perfusionist Steve Peterson, and a team of highly trained nurses who took Regina through five procedures: a coronary bypass; repair of two leaky heart valves; the biopsy of some lymph nodes, and a biopsy of her left lung.
Regina agreed to share her story with the Tribune-Star to help raise awareness during February, designated as American Heart Month, an initiative undertaken by the American Heart Association to battle cardiovascular disease and to educate Americans on how to live hearth-healthy lives.
Heart disease is the leading cause of death for both men and women in the United States, killing an estimated 630,000 Americans each year, according to the American Heart Association. Most Americans probably know someone who has had heart disease or a stroke.
A longtime smoker, Regina, 48, gave up cigarettes about a month ago in preparation for her surgery. She relied on a portable oxygen tank to assist her breathing because of poor lung function due in part to heavy smoking. And she relied on the care of her husband, Ron, a Terre Haute native. The couple, who have been married 28 years, moved to Rosedale from Milledgeville, Ga., in part to go through the surgery, and also to be closer to a granddaughter who lives in the Wabash Valley.
“We moved here because of the doctors, and my granddaughter’s here,” Regina said during a visit to Dr. Antaki’s office a few days before the surgery. “That’s one reason why I’m having this surgery, is to be around a little longer.”
Regina said she had a childhood case of rheumatic fever, and she has been told that the illness weakened her heart valves later in life. Being a smoker contributed to her declining health.
Dr. Antaki explained that rheumatic fever most likely contributed to the deterioration of Regina’s heart valves, which developed scaring. An echocardiogram of her heart function showed that the mitral valve and aortic valve were not completely closing, allowing blood to leak between the chambers in her heart.
In Regina’s case, her mitral valve on the left side has a combination of problems; it is too tight, and it is leaking severely, causing a blood-flow problem. The aortic valve between the left ventricle and aorta also is leaking, causing blood to back up into the left ventricle.
“So, you can see how much mechanical problem this heart has,” Antaki said Thursday as he reviewed Regina’s examinations. “It’s pure plumbing and heart mechanics.”
Dr. Antaki said he prefers to repair a heart valve if possible, fixing the defect that is causing the problem. But in Regina’s case, the valves needed to be replaced with biologic valves made from pericardial tissue.
“We will correct the mechanical problem with the heart,” Antaki said of the procedures for the interior of Regina’s heart. “When it comes to heart valves, it’s a mechanic problem.”
On the exterior of her heart, the bypass surgery was needed because the heart’s muscle is fed with a network of small arteries that supply nutrition. If those arteries become blocked, the heart has inadequate blood flow and it becomes weak. That can turn into congestive heart failure because the heart is not working effectively.
And, a cumulative loss of heart function leads to heart attacks, which can slowly kill the function of the heart.
A long morning
Regina’s preparation for the surgery took a few hours. She was transferred into one of the two new surgery rooms around 8 a.m. The cardiac surgery nursing team of Kelly Hill, Nicole Johnson, Lori Dowers and Kay Smith took care in her preparations, and Dr. Samson administered the anesthesia that put Regina into a deep sleep while a breathing tube was inserted so that her breathing could be controlled during surgery and recovery.
Samson remained in the room monitoring her sedation throughout the surgery.
Shortly after 10 a.m., an incision was made in Regina’s left leg to remove a portion of a superficial vein to be repurposed in the artery bypass. Scott Kunz, a registered nurse first assistant, inserted an endoscopic device into Regina’s leg that allowed him to see the interior of her leg on video as he located the vein and sealed off the smaller branches while not damaging the vein.
Kunz carefully dissected a segment of the vein about 14 inches long. He then inspected it for leaks and set it aside for use by Dr. Antaki in the bypass phase of the surgery.
Antaki said the procedure to harvest the vein used to be the most painful part of the bypass for the patient. That was mainly due to the lengthy incision that was made along the leg. The new procedure is done through a one-inch incision, with carbon dioxide gas pumped in to inflate the area around the vein, making more room for the procedure. The small incision that becomes the only outward sign of the vein harvesting also has a much lower incidence of post-operative infection.
Another critical stage of the surgery occurred after Dr. Antaki opened Regina’s chest cavity to reveal her beating heart. Antaki inserted tubular instruments called cannulas into the proper blood vessels to bypass the heart and lungs by use of the heart-lung machine that keeps the patient alive during open heart surgery.
When Antaki gave the order, the perfusionist, Peterson, cooled Regina’s blood and administered drugs to stop her heart. Peterson monitored the heart-lung machine as it drew blood from Regina, added oxygen and removed carbon dioxide, and then pumped the blood back into her body. He monitored and adjusted the machine to ensure proper blood pressure and flow during the surgery, and to maintain blood gases.
Peterson has worked in surgery for 45 years and as a perfusionist for 40 years. He has participated in more than 5,000 heart and lung surgeries. He also has developed computer software that electronically charts the perfusion record in real time.
It was around 11:14 a.m. when the heart-lung machine took over the life flow of Regina’s body. Dr. Antaki packed some ice slush onto her heart to preserve the heart, which no longer had electrical or mechanical function. In addition, the perfusionist on command would administer a cold solution with chemicals to stop the heart from any activity, and to protect the heart muscle. A few minutes later, he removed the somewhat melted ice, and was then able to perform the cardiac surgery, which lasted into the afternoon.
A team effort
During the surgery, nursing team leader Pam Dreher oversaw the actions of the surgery team and explained the process to onlookers. With its expansion two years ago, Union Hospital now has two surgery rooms for the cardiac team, and the latest technology to perform the surgeries.
“As technology grows, we grow with it,” Dreher said. “This is a big step for us with all of the new equipment.”
The cardiac surgery team has 10 members, she said, and that is enough staff to allow two cardiac surgeries at the same time. In fact, two heart surgeries were scheduled simultaneously on Friday, plus additional standby.
Dreher said she, herself, has experienced a heart procedure, and she said that she is confident in the skill of the surgical teams at the hospital.
“With us being a small group, I feel the patients get more personal care,” Dreher said. “It’s not like some of the bigger Indianapolis hospitals.”
She said she foresees growth for cardiac surgery in Terre Haute, and technology keeps up with advancements in treatment.
Amazingly, after the five hours that Regina was on the heart-lung machine and a total of eight hours in surgery on Thursday, she was ready to have the tube that assisted her ventilation to be removed Friday afternoon. She will remain in the intensive care unit for two or three days, where her recovery will be monitored continuously, but her progress surprised even Dr. Antaki.
Two days later
By Saturday afternoon, Regina was talking to visitors in the intensive care unit. She said that she had some soreness in her chest from the surgery, but she was able to breath deeply.
Nurse Candy Herron called Regina’s progress “remarkable.”
Herron is assigned to the hospital’s critical care unit where she and up to seven other open heart nurses are responsible for the patients. In the first 12 to 18 hours after a patient’s surgery, one nurse is assigned solely to that patient’s care, she said.
“We wake her up, get her to breathe, see that she has good blood circulation and activity,” Herron said. “We get them awake and off the ventilator as soon as we can.”
Dr. Nabil Mnayari, a partner of Dr. Antaki, was with Regina on Saturday, working on her post-operative progression.
“She’s going good,” Mnayari said.
Antaki also gave credit to Dr. John Yacoub, a local cardiologist who diagnosed Regina’s problems and referred her to Antaki.
“He’s the guy who figured out she was in deep trouble,” Antaki said.
Terre Haute is fortunate to be a city with a number of heart surgeons who not only work here, but reside here, he said.
“There are three heart surgeons who live and practice in town,” Antaki said, adding that he is amazed when people think he resides in Indianapolis, and travels here to practice medicine.
“It does mean a lot to the patients here, to know that we are committed to living here and serving in the community,” Antaki said.
Lisa Trigg can be reached at (812) 231-4254 or lisa.trigg@tribstar.com
Multimedia
Related Videos
Related Photos
-
Critical care: Tubes lead in and out of Regina Nieft's chest as a heart surgery team led by Dr. Tamin Antaki replaces two of her heart valves and creates a bypass. Jim Avelis
-
Post-op care: Union Hospital registered nurse Candy Herron talks with open heart patient Regina Nieft as Nieft recovers in the hospital's intensive care unit Saturday. Joseph C. Garza
-
Making way: Anesthesiologist Scott Samson (center) keeps track of a catheter he is inserting in Regina Nieft’s neck as open heart surgery starts. With Samson are RNs Lori Dowers and Kay Smith. Tribune-Star/Jim Avelis
-
Readout: The top line shows Regina Nieft’s heart rate before surgery began on Thursday. Tribune-Star/Jim Avelis
-
Keeping watch: Perfusionist Steve Peterson watches monitors as Regina Nieft’s open heart surgery progresses on the table on the right. A computer program developed by Peterson eliminates the painstaking note taking by hand involved in keeping track of data needed by his profession. Tribune-Star/Jim Avelis
-
Starting over: Regina Nieft is wheeled into the Union Hospital operating room for surgery to replace two heart valves and create a heart bypass. Tribune-Star/Jim Avelis
-
Flatline: Regina Nieft’s heart has stopped beating. A machine operated by profusionist Steve Peterson is now doing the work of supplying oxygen to her body. Tribune-Star/Jim Avelis
-
Doppler: An angiogram using the same principal as Doppler radar shows the regurgitation of blood back through a damaged heart valve. Tribune-Star/Jim Avelis
-
Going in: Regina Nieft’s heart lays exposed as Dr. Tamim Antaki begins the hourslong surgery to create a bypass and replace damaged valves. Tribune-Star/Jim Avelis
-
Detailed work: Tamim Antaki uses special eyewear to illuminate and magnify the work he does inside and on Regina Nieft’s heart during open heart surgery Thursday morning. Tribune-Star/Jim Avelis
Discussion
VIDEO: Mending Broken Hearts
Incidence of heart disease keeps surgical units busy
- Multimedia
-
-
VIDEO: SPPRAK segment airs on NBC News
About 9 million national TV viewers got a very positive image of Terre Haute Monday night, thanks to a tiny not-for-profit group and the Vigo County School Corp.
-
VIDEO: Wabash Valley residents start flood cleanup process
Several Wabash Valley counties are assessing damage as a result of flooding along the Wabash River, Eel River and Big Walnut Creek.
-
VIDEO: Happy Birthday Paul Dresser
The banks of the swollen Wabash River weren’t so far away Monday as several people gathered at the Paul Dresser Home in Fairbanks Park to celebrate what would have been the celebrated songwriter’s 155th birthday.
-
VIDEO: Massive explosion at fertilizer plant rocks Texas town
An explosion at a fertilizer plant in the town of West, Texas, on Wednesday night has flattened buildings and injured dozens, according to local officials.
-
VIDEO: ISU's Brown delivers winning block
Two years ago, Indiana State knocked Evansville out of the Missouri Valley Conference men’s basketball tournament via a last-second shot. On Friday? It was a last-second swat.
-
VIDEO: No Arop, no energy, no victory for Sycamores
Indiana State’s men’s basketball team wanted to use its last home game of the season Wednesday as a springboard to success in next week’s Missouri Valley Conference tournament.
-
VIDEO: ISU crashes at Missouri State
Indiana State earned the pole position in the Missouri Valley Conference men’s basketball standings last weekend and had its first chance to lead a lap.
But at JQH Arena on Tuesday, the Sycamores crashed in the first turn.
Missouri State afforded ISU the respect it earned as conference leaders with an inspired effort. The Bears’ defense had ISU on its heels for the majority of the contest, and a late comeback effort by the Sycamores fell short in a 67-65 loss. -
VIDEO: Sycamore stress test: ISU survives Southern Illinois
The Sycamores started flat – down by 12 four-minutes-into-the-game level of flat – and needed some heroes to infuse the energy needed to keep their Missouri Valley Conference title hopes alive.
Comes the hour, came Khristian Smith. Later, it was R.J. Mahurin. And then, on ISU’s last possession, who else but Jake Odum?
All three played a role in a 66-65 win for ISU.
-
VIDEO: Indiana State gets 1,400th win in school history, Odum tops 1,000 career points in rout of No. 16 Creighton
The realistic hope for Indiana State’s men’s basketball team going into its game against No. 16 Creighton was to get a win — by whatever method or whatever margin necessary — and get itself back into the Missouri Valley Conference race.
-
VIDEO: ISU knocks off No. 15 Wichita State
After a nonconference season in which unfancied Indiana State defeated Miami and Mississippi, many observers stood on the sideline waiting for the Sycamores to get a similar victory in Missouri Valley Conference play before they saw fit to declare them a legitimate MVC title threat.
The wait is over.
-
VIDEO: Sycamores' aggressive rebounding plays big part in pulling away from SIU
Indiana State's M-and-M combination continued to carry the Sycamores' women's basketball team Thursday night in Hulman Center.
The duo of Anna Munn and Racheal Mahan combined for 30 points, helping ISU improve to 11-5 overall and 3-2 in the Missouri Valley Conference with a 72-57 victory against Southern Illinois. -
VIDEO: Workmanlike Sycamores drop Bradley 68-53
The intricacies of help defense aren’t going to show up on any highlight shows.
But far as Indiana State’s men’s basketball team is concerned, help defense is as pretty as any breakaway dunk or a crowd-pleasing blocked shot. -
VIDEOS: ISU's Odum breaks Miami in OT
Indiana State’s men’s basketball team never put its hammer away against Miami in the Hawaiian Airlines Diamond Head Classic on Tuesday.
The Sycamores kept pounding at the rock. Figuratively, yes. But literally too as ISU’s faced an imposing Hurricanes’ front line.
The rock cracked in the last minute. And it broke in overtime.
Jake Odum converted a leaner in the lane with 0.8 left as ISU defeated Miami 57-55 in overtime to take third place in the Diamond Head Classic.
-
VIDEO: ISU’s upset bid slips through turnover-prone fingers
Indiana State point guard Jake Odum cut a forlorn figure outside the Sycamores’ locker room after a 62-55 loss to No. 18 San Diego State in men’s basketball Sunday evening.
-
VIDEOS: Indiana State fights past Ole Miss in overtime at Hawaii
Hakaka … it’s the Hawaiian word for “fight.”
Not unlike a Hawaiian volcano roaring to life, Indiana State’s men’s basketball team was able to summon its inner Hakaka on Saturday against Mississippi in the opening game of the Hawaiian Airlines Diamond Head Classic. -
VIDEOS: Sycamores have work cut out for them at Diamond Head Classic
All you have to do is take one look at Indiana State’s team hotel to realize ISU’s participation in the Hawaiian Airlines Diamond Head Classic is a tad different from your average road trip.
-
VIDEO: So far, so good for Sycamores
Perhaps the most important conversation new Indiana State football coach Mike Sanford had on Monday wasn’t with the administration, the alumni and the assembled media at his introductory press conference, but a talk that came after it.
-
SLIDESHOW: Flash Back: 2012 in Pictures
Tribune-Star photographers Joseph C. Garza, Jim Avelis and Bob Poynter showcase their favorite work of 2012.
-
VIDEO: ISU women add athleticism, experience with 2013 recruiting class
As a team stocked full of underclassmen continues to grow and gain some NCAA Division I women’s basketball seasoning, those players will blend with four recruits who will likely be ready to make a big impact for coach Teri Moren in 2013-14.
Sullivan native Rhagen Smith, daughter of former Sycamore basketball standout Maria (Stockberger) Smith, will be the only true freshman of the four. The 6-foot-2 forward is joined by 5-1 junior-college point guard Ricquia Jones, junior-college wing Jasmine Grier and Kansas State transfer Stephanie Wittman. -
VIDEO: Indiana State University police officer leads rescue of student from burning car
On a typical day, Indiana State University police officer Chris Heleine might deal with theft reports, well-being checks or property damage accidents.
But Wednesday was not a typical day. -
SLIDESHOW: Veterans Day Parade 2012
Terre Haute’s annual Veterans Day parade down Wabash Avenue on Sunday, Nov. 11, 2012, concluded with an 11:11 a.m. post-parade ceremony and 21-gun salute at the VFW Post 972 at 12th and Mulberry streets.
-
SLIDESHOW: General Election 2012
Photos by Tribune-Star photographers Bob Poynter, Joe Garza and Jim Avelis. Check back for more photos.
-
SLIDESHOW: Sandy delivers snow to East
-
VIDEO: Sandy brings more snow to Appalachian Mountains
Snow continues to fall in the Appalachian Mountains thanks to superstorm Sandy, leaving an estimated 150,000 people without power.
-
VIDEO: Mammoth storm Sandy plunges NYC into darkness
Much of New York was plunged into darkness Monday by a superstorm that overflowed the city's historic waterfront, flooded the financial district and subway tunnels and cut power to hundreds of thousands of people.
-
SLIDESHOW: Hurricane Sandy brings wind, water
Damaging winds and storm surges from Hurricane Sandy began affecting Massachusetts on Monday.
-
VIDEO: Shakin’ Things Up
Trucks rumbling through the city streets have university officials hoping for good vibrations this weekend.
-
VIDEO: Famous Hoosier horror legend to appear at Linton haunted house
Sammy Terry, the spooktacular entertainer who captivated Hoosier television viewers every weekend in the 1960s, ’70s and ’80s, is ready for some new “frightmares” — and his search is returning him to Linton.
-
SLIDESHOW: This year's 15 hottest toys
Is it too early to start your holiday shopping? Not according to Toys R Us, which just released its "Hot Toy List" for 2012. Check out the top 15 toys that made the list. Find all 50 at toysrus.com/hottoys.
-
VIDEO: Mark Bennett: Terre Haute featured in ‘strange, offbeat, evocative, wonderful movie’
Some people hold a fond memory of Terre Haute. Some even dream of escaping to Terre Haute to start a new life.
- More Multimedia Headlines
-
Coffee Run Leads to Hatchet Hitchhiker Arrest
Probe Begins After Conn. Commuter Trains Crash
NTSB Begins Investigation Into Conn. Train Crash
Conn. Commuter Trains Collide; 60 Go to Hospital
Fmr. IRS Head Insists No Politics in Targeting
Lotto Fever Sweeps the Country
Raw: Texas Gov. Flies Over Tornado Damage
NM Mom Chases Down Child Abductor
Raw: Obama Sits Down With Elementary Kids
Raw: Driver Ejected From Truck, Over Bridge
CDC: Fecal Bacteria Common in Swimming Pools
Raw: Gun Scare Mars Cannes Film Festival
China, Others Want What's Under the Arctic Ice
Dying Man's Blinks Lead to Murder Conviction
Raw: Germany Protestors Picket Barbie House
$1 Million in Jewels Stolen at Cannes Film Fest
Horse Saved From Slaughter, Goes on to Win Big
Raw: Bear Falls From Tampa Tree
Ousted IRS Chief: Errors Not Caused by Politics
Officials Arrest Man in Idaho in Terrorism Case
Twiggy, the Water Skiing Squirrel
Sailor Surprises His Mom At Her CU Denver Graduation Ceremony
Official: ‘Amazing’ No One Was Killed In CT Train Crash
Coffee Stop Leads To Arrest Of YouTube Sensation Wanted For Murder
Bearded Dragon Reunited With Owner
Marine Reunited with Warzone Companion
Raw: Crash Sends Car Into Fla. Pool
Beyonce Is Pregnant!
SF baseball player overpaid $500,000 RETURNS money -- and team says KEEP IT
Dad returns from Afghanistan, surprises family during Rays' first pitch
See Jennifer Lopez's New $10m Hamptons Mansion
Woman tricked into taking abortion pill
Emma Watson Goes Pantless
IRS scandal: Republicans seek to tie Obama to agency's woes
Play of the Day: Flipping to Safety
Pregnant Kim Kardashian Squeezes Her Swollen Feet Into Stilettos
Top Videos of the Week: Angry Taco Bell Guy, Glacier Moves on House, Dog Hates Baths
Cindy Crawford Stuns At Cannes
