St. Elizabeth

At 67 years old, Ken Foltz had never been hospitalized in his life. One morning in January, however, he noticed that his heart didn’t seem to be beating in the proper pattern, so he went to his primary care physician who sent him to a cardiologist.

“I was told to go to the hospital — that it was not an emergency but an urgency,” says Foltz, who learned that he needed to have his mitral valve repaired. Initially, the cardiac surgeon suggested the typical sternotomy that involves cutting through the breastbone, but then he met Mario Castillo-Sang, M.D., a nationally leading cardiac surgeon with St. Elizabeth Heart & Vascular Institute. He specializes in performing a minimally invasive approach to mitral valve repair surgery.

“When I heard of this option, I was tickled pink,” says Foltz. Though he knew that any heart surgery involves risk, he felt much better about this course, which involves an inch-and-a-half incision on the right side of the chest and one in the groin. Foltz went home two days after surgery.

“It went smoothly,” says Foltz. “I’ve had dental work that was more painful.”

Historically, Castillo-Sang points out, there’s a misconception that mitral valve leakage does not hurt people. That’s false.

“That’s akin to going back to the 1970s when people were diagnosed with diabetes and were told, ‘Just watch what you eat and here’s some insulin,’” says Castillo-Sang. “We later discovered that you lost your feet, your eyes, your kidneys; you got strokes & heart attacks. So, now we’re all about treating diabetes aggressively and early.”

The newest guidelines from the American Heart Association now aggressively promote the early referral of mitral valve patients so that the heart doesn’t suffer damage. According to Castillo-Sang, roughly 3% to 4% of the population have either mild, moderate or severe mitral valve disease.

“We only treat when it’s severe because those are the people who are susceptible to heart damage,” says Castillo-Sang, who is an advocate for early intervention to repair failing mitral valves before long-term damage occurs. By repairing the valve, the patient’s life expectancy resets to a normal person of the same age. While late intervention provides quality of life and comfort, it doesn’t impact the bigger picture of prolonging life.

Approximately 40% to 50% of people will have no symptoms initially and if they do, they often chalk it up to aging. This is why clinicians need to be keen about asking the right questions during annual exams. Those exams are critical because doctors can examine the chest and listen for a heart murmur. If that’s detected, an echocardiogram and evaluation by a specialist is warranted.

“A murmur is a flag,” says Castillo-Sang. “It’s a sign that something’s wrong, like when your car starts making that rattling noise but is still running.”

If nothing is done about mitral leakage, even if you’re asymptomatic, both the upper and lower chambers of the heart will suffer. Once the upper chamber enlarges, then the lower one does, too.

“It loses its sweet spot for contraction, like an elastic band,” Castillo-Sang explains. “When you lose that power, if enough time has passed, you don’t get it back. That’s when you go into chronic heart failure.”

Last year, Castillo-Sang and his colleagues performed more mitral valve surgeries than anybody in the tri-state area.

“We operated on a lot of sick patients — some with as high as an 81% chance of dying because they were in shock or had devices keeping them alive. They all made it home,” says Castillo-Sang. He praises the surgical team, the anesthesiologists, and the ICU care the patients received afterwards. To have that level of expertise in your own back- yard without having to travel to Cleveland, LA or New York says a lot. “Dr. Mario Castillo-Sang brings an incredible skill set to an already excellent team of cardiothoracic surgeons at St. Elizabeth Healthcare,” says Garren Colvin, St. Elizabeth Healthcare’s president and CEO. “His expertise will allow us to expand our abilities to provide leading heart care to the Northern Kentucky community and beyond.” 

St. Elizabeth Healthcare is located at 1 Medical Village Dr., Erlanger, KY 41017. For more information, visit