Rare Infection Leads to Dan's Brain and Heart Surgery at Age 33

It can be easy to take your health for granted when you are young. But after a harrowing health experience in his early thirties, Dan no longer feels that way.

“Since my surgeries, it really hits home how important it is to spend time with the people you love because you don’t know what the future holds,” says Dan, who lives with his wife, Marcella, in the Atlanta area. “That’s the heavier part of what I’ve learned. On the lighter side, I’ve learned that getting stuck in a long line at the grocery store is not a big deal. I’ve gained a better appreciation of what a real problem is.”

In 2023, Dan faced a series of health challenges that would forever change his perspective on life.

At first, it just seemed like a bad cold, with symptoms that came and went. Over the next two weeks, however, Dan’s fever spiked as high as 105 degrees. A bout of the chills and concerning blood test results convinced him and Marcella that it was time to go to the hospital.

The couple chose nearby Emory Decatur Hospital, where the emergency medicine team responded quickly to Dan’s concerns. Turns out, he didn’t have a cold. He had mitral valve endocarditis, a bacterial infection of one of the heart’s four valves.

In healthy, young people like 33-year-old Dan, mitral valve endocarditis is rare. It can happen when germs enter the bloodstream during a routine dental cleaning or an injury that breaks the skin. The bacteria can attach to the heart valve if the person’s immune system doesn’t respond quickly enough.

“The worst headache of my life”

Doctors put Dan on antibiotics to fight the infection. However, Dan had a more immediate problem. This one started with an epic headache—the worst of his life. A brain scan detected a blood clot and bleeding in Dan’s occipital lobe, the part of the brain responsible for processing visual information.

Doctors concluded that a piece of infected tissue had traveled from his mitral heart valve to the occipital lobe. There, the infection lodged inside the artery walls, causing them to leak and bulge. It’s a condition called a “mycotic aneurysm.”

The care team quickly transferred Dan to the Neurointensive Care Unit (ICU) at Emory University Hospital. The next day, he and Marcella met with neurosurgeon Michael Cawley, MD to discuss treatment options.

Dr. Cawley is an expert in treating mycotic aneurysms.

“I was lead author on a 2022 study that showed mycotic aneurysms are more dangerous than experts previously thought,” says Dr. Cawley. “Until recently, doctors prescribed antibiotics to treat these infected aneurysms. Our study showed that when you do that, the aneurysm will grow or rupture about half the time, which can be life-threatening. Based on our study, we recommend the more aggressive treatment approach of surgery.”

Dan’s recollection of this part of the story is fuzzy—he was sedated in the neuro ICU and unable to fully engage in decisions about his care. Many of those decisions, including what type of surgery Dan should have, fell to Marcella. At the time, they were newlyweds just six months into their marriage.

“Dr. Cawley recommended an open surgery, where he would open up part of Dan’s skull to access the occipital lobe, remove the clot and repair the artery. But we had other options, too,” says Marcella.

“It was so overwhelming to consider the potential risks and benefits of each approach, and I was scared,” she adds. “Dr. Cawley gave me time to ask all my questions, do my research, and talk to Dan and our parents about what to do. It was empowering to be part of the decision-making process.”

Marcella ultimately opted for the open surgery, which took place the next day.

“Our surgical team used real-time imaging and a high-powered microscope to guide the surgery,” Dr. Cawley says. “Accuracy is critically important because you are operating on the part of the brain that is responsible for visual function. If you are off by even a millimeter, you increase the risk of permanent vision loss.”

Follow-up testing revealed that the aneurysm and blood clot were gone, and Dan’s vision was intact. But his journey wasn’t over. Although the brain surgery was successful, the original infection had damaged his heart valve, setting the stage for another major operation.

Dan spent six weeks recovering at home before going to Emory Saint Joseph’s Hospital for robotic surgery to repair or replace his damaged heart valve.

Soon after arriving, Dan and Marcella met with Michael Halkos, MD, MSc, chief of cardiothoracic surgery at Emory Healthcare.

“Dr. Halkos and his staff did a phenomenal job walking me through the process,” Dan says. “Still, it was weird and scary to be 33-years-old and holding a folder labeled ‘Your Guide to Cardiac Surgery.’”

Even though the experience felt surreal, Dan trusted he was in excellent hands.

"Robotic mitral valve surgery is something these doctors do multiple times a week, and Saint Joseph’s is a leading facility for this type of surgery,” he explains.

In fact, Emory Saint Joseph’s Hospital is one of the highest-volume centers in the country for robotic mitral valve surgery, says Amalia Jonsson, MD, one of the cardiac surgeons who performed the procedure with Dr. Halkos.

“Robotic surgery allows our surgeons to visualize and maneuver in tight spaces inside the heart,” Dr. Jonsson says. “This makes it ideal for valve repair, which we prioritize in young people like Dan. A repaired mitral valve can potentially last forever, whereas a new valve can sometimes lead to future surgeries or the need to be on long-term blood thinners.” 

Whether they could repair the valve would depend on how much healthy valve tissue remained. Thankfully, there was enough. During the procedure, the surgeons removed the infected tissue, then repaired the valve using tissue from the pericardium, the sac around Dan’s heart.

“At many institutions, surgeons would have replaced the valve, but our experience made a repair possible,” Dr. Halkos says. “Our nurses took great care of Dan during his postoperative stay, and he was home for dinner just three days later.”