When Jeffrey Kistler began gasping for air at night, the suspected cause was sleep apnea. But when the problem persisted, worsening when lying down and getting better when he sat up, he went to the emergency room, which prompted abundant follow-up tests involving his heart.

The 44-year-old fork-lift driver from Griffith, who has a long list of family members with heart problems, eventually learned he had a golf ball-sized aneurysm in his aortic artery along with some extensive valve damage.

With the aneurysm already well beyond the limit doctors deem dangerous enough to require surgery, Kistler prepared himself for open-heart surgery, getting his life in order, as he says, and talking to family members for what he thought might be the last time.

He also had to choose the type of replacement valves to be used to repair his heart. A mechanical valve could last the rest of his life, but being a foreign object, it might cause bleeding, infection or other problems and would require him to take a blood thinner for the rest of his life.

He chose a human cadaver's valve because a cow's or pig's valve wouldn't last as long as he needed.

Cardiovascular and thoracic surgeon Dr. David Jayakar, of St. Catherine's Hospital in East Chicago, had Kistler choose the type of replacement valve he wanted as a backup even though he fully intended to do what few surgeons will -- repair all three of the faulty valves instead of replace them.

Jayakar explains there are four valves in the heart. The first one -- the tricuspid valve -- and the third one -- the mitral valve -- are easily repaired and are done so at about 20 to 30 percent of U.S.hospitals. The second valve -- the pulmonic valve --rarely gets diseased and is rarely operated on. But the fourth valve -- the aortic valve -- is much more difficult to repair, because it works against the highest pressure in the body, and most surgeons opt to replace it instead. In fact, less than 3 percent of institutions in the United States, he says, actually repair the aortic valve.

But repair over replacement, though difficult, is much better for the patient, Jayakar says. Not only does the valve last longer, but complications from being on blood thinners are nonexistent, and this route carries the least chance of infection.

Jayakar says he hasn't before seen a case quite as severe as Kistler's, or one with a more positive outcome.

"This man had a picture-perfect result," Jaykar says.

"After we repaired his valves, on multiple echocardiograms -- the test we do to test the valve -- his valve was perfect. All four valves were back to normal."

Soon after the surgery, Kistler lost 40 pounds, mostly retained water from the congestive heart failure that Jayakar says he didn't even realize he'd had.

"He was water-logged, but he didn't even know it," Jayakar says.

"After surgery, that's when people knew how sick he was because once the valve started working and the heart failure was treated, he lost a considerable amount of water ... 40 pounds of water just came out over the next month, and then the real Mr. Kistler came out."

Kistler says the whole experience has been a wake-up call.

"It's definitely changed my life," he says.

"It's made me think a little bit more about things and how things are a little bit more important than I remember them being before."

PULLOUT BOX

Jeffrey Kistler

Diagnosis/Symptoms: Aneurysm on aortic artery and valve disease in three of the heart's four valves.

Physician: Dr. David Jayakar, cardiovascular and thoracic surgeon at St.

Catherine's Hospital in East Chicago.

Treatment: Using the Tyrone David Procedure, named for the Canadian surgeon who pioneered it, Jayakar repaired the tricuspid, mitral and aortic valves. The aortic valve repair is most significant because of the difficulty involved.

Jayakar also repaired the aneurysm with a plastic tube.

What You Should Know: Unfortunately, Jayakar says, most patients with valve disease don't even know that repair over replacement is an option at all. "If you need valve surgery," Jayakar says, "discuss the option of having repair versus replacement with your surgeon or physician ... and find a surgeon who is well-versed and has good experience in repair." Jayakar says valve disease is common. With the Baby Boomers coming of age, he expects the frequency of valve surgery to surpass bypass surgery.

For more information: To learn more about repair versus replacement of heart valves, call (219) 392-1700 or visit fixmyheart.org.