David Singleton’s heart story begins with a case of COVID-19 in 2021 that left the 41-year-old construction company truck driver struggling to breathe.

He eventually recovered from the viral infection but the breathing problems persisted and, if anything, got worse.

His doctors suspected it was long COVID. After a cardiac stress test and echocardiogram showed irregularities, he underwent a transesophageal echocardiogram – a specialized technique in which an ultrasound probe is passed down the throat and into the esophagus, where it provides much clearer images of the heart and valves.

The TEE revealed the problem – Singleton had severe aortic stenosis and would need surgery to save his life.

“I looked at my wife and said, if I’m going to have this done, I’m going to have it done by the best,” Singleton said.

With a referral from his doctor, he drove two hours from his home in Port Huron to Ann Arbor to see cardiac surgeon Robert Hawkins, M.D., M.Sc., at the University of Michigan Health Frankel Cardiovascular Center.

Meeting leaders in cardiovascular care

From that first visit, Singleton knew he had made the right decision.

“I was terrified but, from the time I walked in, I felt care from the staff, I felt love, I felt compassion and that is so important to me,” he recalled.

“Meeting Dr. Hawkins, his bedside manner was everything I wanted. He gave me the facts straight, without beating around the bush. He was honest about what I was going to be facing. I felt that I could trust him.”

In aortic stenosis, the aortic valve doesn’t open fully due to a thickening of the valve leaflets. This thickening makes it hard for the leaflets to open and close, which decreases blood flow from the heart to the body and can ultimately lead to heart failure.

Depending on a patient’s symptoms and severity of disease, treatment options include open surgical aortic valve replacement and minimally invasive transcatheter aortic valve replacement, also known as a TAVR.

“David came to us as a very high-risk patient, both medically and due to his anatomy,” Hawkins said.

“In patients who need valve replacement or repair, one of the biggest challenges is those who can’t have TAVR because they have a small aortic root. His was the smallest I’ve ever seen.”

Singleton had advanced bicuspid aortic stenosis – a congenital defect that is often discovered later in life – further complicated by a very small aorta and aortic root.

The aortic valve in a healthy heart has three flexible leaflets; Singleton had only two leaflets which had thickened and calcified, forcing his heart to pump harder to get oxygenated blood through the extremely narrowed valve and into his body.

He was nearing heart failure and would need extensive open surgery to enlarge the aortic root and replace the diseased valve.

Preparing for surgery

Following more testing and imaging at the Frankel CVC, Singleton headed back to Port Huron and back to work until his surgery, which was scheduled for three months later to give him time to complete some necessary dental work, cardiac testing and pulmonary rehabilitation.

Hawkins and Frankel CVC’s heart failure specialists monitored him remotely, aiming to get him into the best physical condition for surgery.

Not many surgeons do these very complex cases, so we are really glad he came to us. He worked hard to get through the surgery, and I’ve just been so thrilled with how well he’s done.”

– Robert Hawkins, M.D., M.Sc.

Despite optimizing Singleton’s medications, the health of this father of 12- and 3-year-old girls continued to deteriorate.

A week before his scheduled surgery, Singleton and his wife returned to Ann Arbor for pre-op testing. He could barely walk.

“We tried our best to optimize him, but the valve disease was so critical we just ran out of time,” Hawkins said.

“It was a very difficult operation.”

A most complex case

For Singleton’s small aortic root and valve annulus (the base of the aortic root), Hawkins used a breakthrough enlargement technique developed by Frankel CVC cardiac surgeon Bo Yang, M.D., known as the Y-incision/rectangular patch root enlargement.

With this procedure, surgeons enlarge the aortic root with a synthetic material patch and insert a larger prosthetic valve. This improves blood flow, quality of life and long-term survival.

Singleton’s surgery stretched to 10 hours as the surgical team worked to enlarge his aortic root enough to enable successful placement of the 25mm mechanical On-X heart valve needed to support his stature.

Given Singleton’s age, Hawkins chose this mechanical valve which requires less blood thinners and typically lasts 30 or more years, hopefully sparing his patient the need for surgery in the future.

Following surgery, Singleton was placed on extracorporeal membrane oxygenation, an advanced heart-lung bypass machine that maintains blood flow and oxygenation to the body’s vital organs allowing the heart and lungs to rest.

He would remain in intensive care on ECMO for four days, and on a ventilator for 10. Slowly, but surely, he began to improve.

On the road to recovery

“It was a slow build back up, learning to walk again,” Singleton said. “Dr. Hawkins and his physician assistants would check me over every day, explain how things were going, what’s next. Through it all, the staff were absolutely incredible. I couldn’t have asked for better care.”

“My personal goal when I left (the Frankel CVC) after surgery was to go trick-or-treating with my 3-year-old for her first time, and I did it!”

Back home in Port Huron, Singleton worked through cardiac rehabilitation, taking his recovery one step at a time – first a short walk to the mailbox, then a trip to the grocery store, then a quarter mile, then a half mile.

Just after surgery, Hawkins met with Singleton's wife and candidly explained how difficult the surgery had been. He had a less than 50% chance of surviving through the night, he gently told her.

“When I went back for my follow-up about a week after leaving the hospital, I walked from the parking garage into Dr. Hawkins’ office, and he just couldn’t believe that,” Singleton proudly recalled. “He called me a miracle because I went from basically 50 percent chance of living to walking in just a month’s time."

"Not many surgeons do these very complex cases, so we are really glad he came to us,” Hawkins said.

“He worked hard to get through the surgery, and I’ve just been so thrilled with how well he’s done. We’ll continue to follow him for the long term to make sure he continues to do well.”

A bright future ahead

Because he has a mechanical valve, Singleton will have to take blood thinners for the rest of his life.

He now walks regularly and is back at the gym, a healthier, happier version of himself. And much to everyone’s delight, he can hear his heart ticking when the room is quiet.

He also has his sights set on a new career. Singleton has gone back to school, studying full time at St. Clair Community College to earn an associate degree and certification as a radiologic technologist.

Given his experience, and inspiration from Hawkins and the care team at the Frankel CVC, he plans to pursue a career in cardiac imaging.

“The heart is where my heart leads me because the best way to say thank you to someone is to pay it forward,” he said. “If one day I can take care of someone like I was taken care of by Dr. Hawkins, that’s the ultimate thank you in my eyes.”