It was almost six years ago when Yiftah Geva began taking medication to stabilize his blood pressure. Doctors wanted to investigate the cause of his hypertension and recommended Yiftah, 59, also undergo an echocardiogram.
An avid cyclist and hiker who lives about 30 miles from the port city of Haifa, Israel, Yiftah was surprised when he was diagnosed with hypertrophic cardiomyopathy, a genetic condition that causes abnormal thickening of the heart.
It is estimated that about 1 in 500 people have hypertrophic cardiomyopathy, but many have no symptoms and often go undiagnosed. About two-thirds of patients with hypertrophic cardiomyopathy develop an obstruction, where blood flow through the heart becomes more turbulent due to the thickening of the heart walls and crowding inside the heart.
Although he did not have an obstruction, Yiftah was advised to reduce the intensity of his exercise and monitor his condition.
At first, Yiftah's condition was stable. But over the next few years, it worsened to the point that activities such as mountain biking became more difficult. Soon everyday activities were a challenge. "I began to feel physically limited. My energy level was low, I was dizzy and lightheaded, and felt shortness of breath even during simple activities," he says.
In April 2019, during a hiking trip in the Negev Desert in southern Israel, he became dizzy and lightheaded. A follow-up echocardiogram showed the septum of his heart had become thicker. He was suffering from a significant obstruction in the left ventricle.
Yiftah reached out to a friend, Dr. Gil Bolotin, whom he'd first met in the Israeli Air Force almost 40 years ago. Dr. Bolotin is now director of cardiac surgery at Rambam Hospital in Haifa.
"I was constantly consulting with him, which was very helpful as I went through this journey. He also was the one that connected me with the cardiologist at Rambam," says Yiftah, who established care with Dr. Yoram Agmon, a cardiologist in Israel.
"I was told there were two options: Treat the obstruction with medicine or surgery," says Yiftah.
After six months of trial and error with medications that he says did not show any significant improvements, Yiftah decided to proceed with a septal myectomy, an open-heart procedure where the surgeon removes part of the thickened, overgrown wall, or the septum, between the heart chambers. The goal is to improve blood flow out of the heart and reduce backward flow of blood through the mitral valve.
Yiftah began to research options. Dr. Agmon, he says, highly recommended Dr. Hartzell Schaff from Mayo Clinic. "He said he was one of the best for septal myopathy," recalls Yiftah, who came to learn that Dr. Agmon trained at Mayo Clinic in Rochester, Minnesota.
But Israel has a good health system and Yiftah thought he might want to stay close to home.
"I narrowed my search to a renowned Israeli heart surgeon and then realized that Dr. Schaff was his mentor, too. So all the signs pointed at Mayo Clinic."
As 2019 came to a close, Dr. Agmon reached out to Dr. Schaff and Dr. Steve Ommen, another Mayo Clinic cardiologist who he knew from his time in Rochester. Yiftah connected with International Services at Mayo Clinic, and plans were made for Yiftah's surgery in the spring.
In mid-March, when it was time for Yiftah to travel to the U.S., COVID-19 was declared a pandemic and significant restrictions were in place. "We wore masks, gloves, used a lot of sanitation gel and tried to avoid as much as possible contact with other people," says Yiftah, who traveled with his wife, Sigal, and son, Guy.
When they finally made it to Minnesota, the effects of COVID-19 were obvious. The hotel was empty and stores were closed. The hallways of the clinic ― usually bustling with staff and patients ― were quiet, he recalls.
Although his family accompanied him to his initial preoperative visits, COVID-19 prompted changes to Mayo Clinic's policies. Few elective procedures were being performed.
Yiftah recalls his frustration when "the weekend before the surgery I was told that they may need to postpone it by eight weeks." However, since he had traveled internationally, a special exception was granted, and Dr. Schaff completed the multihour surgery on March 25.
"On the day of the surgery, I had mixed feelings. I was nervous but on the other hand relieved it was going on," says Yiftah.
Perhaps the biggest challenge for Yiftah was not the surgery itself, but the fact that visitation restrictions meant his family could not be with him as he recuperated. "My wife was allowed to escort me to the waiting room, but as soon as I was called to start the preparation for the surgery, she was asked to leave the hospital, and I did not meet her until I was released nine days later," he says.
"It was quite a challenge for me, and it was very lonely," he says, but he commends the staff for their first-class care. "I felt protected and in good hands all the time. I had a team of nurses and doctors who were always available."
Although he had plans to stay in the U.S. longer, because of the pandemic, Yiftah opted to return to Israel to finish recuperating once he was strong enough to travel.
In less than three months, his stamina returned and Yiftah began hiking with friends again. "Having the septal myectomy, I feel like I got my life back. My level of energy is high, and I don't have any limitations," he says. "Dr. Schaff is a master of that specific operation, and this journey changed my life."