Tony Merriweather

Tony Merriweather lay on a table in an operating room in Saint Marys Hospital in Rochester listening to the voices around him as they prepared to open his chest and repair his heart. One by one the voices introduced themselves, explaining to Tony the role they would play in his care. A woman said she had given him medication to help him relax. He didn't think it was working.

"I was very nervous, "says Tony. "I'd never before been in a situation where I felt helpless. And I wasn't sure what to expect after surgery."

Tony is totally blind, but he never let his lack of sight become an obstacle to living a full life. Now, at 35, he was facing a surgery that he worried could become a true obstacle to the life he knew. If the operation went as expected, his Mayo Clinic surgeon would be able to repair a leaky heart valve and Tony's life would return to normal. If the valve couldn't be repaired and instead had to be replaced with an artificial valve, Tony's life would change. There was a chance he would have to give up activities, such as running and beeper softball, which gave him tremendous satisfaction. He might have to take medication with unpleasant side effects or face multiple surgeries.

Tony had good reason to be nervous. He had a lot to lose. He had built a wonderful, active life with his family, wife Helen and his daughter Brittney, 11. He had students and colleagues eagerly awaiting his return to teaching at the South Carolina School for the Deaf and Blind. And he had friends counting on getting their teammate back on the beeper softball field.

Then the anesthesiologist told Tony he was beginning to administer anesthesia. And the worries disappeared. Tony would wake the next day to a world still full of possibility and hope — thanks to a relatively new procedure and a team of Mayo Clinic caregivers determined to do all they could to heal the heart of a man who had touched theirs.

Discovering a problem

Ten years earlier, in 1994, Tony Merriweather was 25 years old and in the best shape of his life. He was running with the United States Association of Blind Athletes, posting strong times in 400-, 800-and 1600- meter races. He was hoping to qualify for the Paralympics, a competition for disabled athletes sponsored by the Olympic Organizing Committee and held two weeks after each Olympic Games in the same host city. When Tony began having difficulty breathing during his workouts, he decided it was because he wasn't training hard enough. So he upped his training schedule to include twice-a-day workouts. But the breathing difficulties didn't go away.

"At that point, my coach and I agreed I should have a physical," says Tony. "I saw my regular physician, and he asked me when I had been diagnosed with a heart murmur. I was clueless. I'd never been told I had a heart murmur."

A heart murmur is an abnormal sound a physician hears when listening to a person's heart through a stethoscope. Many murmurs are harmless, but some indicate a problem with one or more of the heart's valves. Tony's physician referred him to a cardiologist, and further testing revealed he had a bicuspid aortic valve, a congenital heart defect that can eventually lead to aortic regurgitation. In this condition, blood pumped out of the heart leaks back into it, keeping the heart from pumping efficiently and leading to symptoms such as fatigue, poor exercise tolerance, and shortness of breath — the main symptom Tony had been experiencing.

"My cardiologist told me I had a leaky valve which caused my heart to have to work harder than most people's," says Tony. "Though he encouraged me to stay active, he recommended I stop running competitively. I was devastated."

Though giving up his dream of competing in the Paralympics was a great disappointment, Tony found a silver lining in his diagnosis. "You hear about athletes who just collapse because of an undiagnosed heart problem. I was lucky mine was found early. If I'd kept up my training, it could have been me collapsing on the track."

Instead, Tony made adjustments in his life. He began taking procardia, a medication that relaxes the blood vessels to reduce the heart's workload. He saw his cardiologist once or twice a year for testing to ensure the valve was still functioning adequately. And he found new forms of exercise to replace competitive running, including walking, weight lifting and playing beeper softball (a modified version of softball in which the ball beeps and the bases buzz, giving blind or visually impaired players the cues they need to play the game).

Taking the next step

Over the years, Tony's valve function steadily deteriorated. His cardiologist began talking with him about the two surgical options available to treat aortic regurgitation: replacing his leaky valve with either a mechanical or tissue valve. A tissue valve would last 10 to 15 years but would eventually wear out and need to be replaced, requiring another operation. A mechanical valve would last throughout Tony's lifetime, but would require him to take coumadin, a blood thinner. Because the medication stops the blood from clotting, people who take coumadin are vulnerable to excessive bleeding. It can be a dangerous medication for an athlete; even more so when the athlete is blind.

Joseph Dearani, M.D.

Tony was leaning toward a mechanical replacement valve when another option surfaced. His cardiologist heard a presentation by Joseph Dearani, M.D., a cardiovascular surgeon at Mayo Clinic, about repairing, rather than replacing, aortic valves. "Mayo Clinic has enormous experience in valve surgery and in valve repair in particular," says Dr. Dearani. "Some of the earliest descriptions of repairing valves come from Mayo Clinic."

The cardiologist called Dr. Dearani to see if Tony might be a candidate for such a procedure. The answer was a resounding yes , so Tony and Helen made arrangements to travel to Mayo Clinic's Rochester campus from their home in Spartanburg, S.C.

"I was immediately very impressed by the size and efficiency of Mayo Clinic," says Tony of his arrival on Dec. 15, 2004. "I had a long list of tests I had to take, and I was amazed by how quickly I was in and out and on to the next test. I was also astounded by the people I met. Everyone at Mayo seems to be cut from the same cloth. They make you feel like you're a relative of theirs, and they want to make sure you're well taken care of."

Two of those people were Dr. Dearani and Naser Ammash, M.D., a Mayo Clinic cardiologist.

Naser Ammash, M.D.

Both Dr. Dearani and Dr. Ammash work in Mayo Clinic's Adult Congenital Heart Disease Clinic, the largest pro- gram of its kind in the United States. The group consists of cardiologists, cardiovascular surgeons, radiologists, anesthesiologists, nurses, technicians and social workers with extensive experience in caring for adults who have congenital heart disease.

"Each patient with congenital heart disease has unique needs," says Dr. Ammash. "Our group is able to draw on the diverse strengths of its individual members to meet those needs. Cardiac patients in particular benefit tremendously from Mayo's team approach to care."

Though Dr. Ammash and Dr. Dearani agreed that Tony appeared to be an ideal candidate for valve repair, they warned him they wouldn't know for sure until his surgery was under way.

"Tony is young and incredibly healthy," says Dr. Dearani. "We always prefer to repair rather than replace a valve in younger patients, especially those who are active. But some valve repairs can be difficult, and even in the best cases we're never 100 percent sure before surgery that it will be possible. Testing only reveals so much about a person's anatomy. A surgeon must actually see the valve before knowing if it is repairable."

Dr. Dearani told Tony he believed there was a 75 percent chance that his aortic valve could be repaired. If it needed to be replaced, Dr. Dearani recommended using a tissue valve rather than a mechanical one.

"Mechanical valve replacement would mean Tony would be on blood thinners the rest of his life," says Dr. Dearani. "That would put an end to many of the activities he enjoyed, and would also make him more susceptible to serious injury from tripping or falling."

Tony agreed, and on the morning of Friday, Dec. 17, 2004, found himself on that operating table in Saint Marys Hospital. Though the pain medications he was taking have blurred the next few days in his memory, he does remember something his wife told him on Saturday: "Dr. Dearani was able to repair your valve."

Home for the holidays

By Sunday, nurses were helping Tony out of bed and down the hallway for some exercise. He found the experience surprisingly difficult.

"I was exhausted and could only take itty-bitty baby steps," says Tony. "I kept thinking 'Why am I so tired? I didn't do anything!'" His physicians assured him his fatigue was normal and that once he was home, he should continue to pace himself. Slowly.

"They told me to take a lot of short walks during the day rather than one long walk, and explained I'd have good days and bad days," says Tony. "On good days, they said I'd feel like a million bucks. On bad days, I'd feel like a nickel. They were right."

One of those million-dollar days came on Dec. 22, when Tony was discharged from the hospital. It meant he would be home to celebrate Christmas with his daughter. Another million-dollar day came just before Valentine's Day, when Tony went back to work as a teacher associate at the South Carolina School for the Deaf and Blind. And this coming summer, he'll be back in position as a shortstop on his beeper softball team.

Though Dr. Ammash and Dr. Dearani agree their work is generally very satisfying, both say there was something special about caring for Tony Merriweather.

"Tony exemplifies our best hopes for cardiac surgery as the procedure has enabled him to continue participating in the activities he enjoys," says Dr. Dearani. "But working with Tony was especially gratifying because he is such an exceptional person. He was an inspiration to everyone who helped care for him."

And to other cardiac patients.

"Tony is a great example to others that a heart problem doesn't have to keep you from living a normal life," says Dr. Ammash. "In spite of having a heart condition — and being blind — he works full time, is physically active and takes great care of his health. As a physician, there is only so much you can do for a patient. So much depends on the perspective of the patient. Tony shows what is possible when you put your mind to it. "

Not to mention your heart.