In 1951 Eileen Marr, my great-grandmother, sent a letter to a heart specialist in desperation. She had just read an article in Life Magazine, where an expert had commented on how they had begun to perform heart surgeries more often, and had seen higher rates of success than ever before. In her mind, this was the only way her son could go back to living a normal, healthy life.

“Altogether 200 patients have been operated upon with an overall mortality of fewer than 11 per cent,” Dr. T. R. Van Dellen wrote, “this death rate is not startling because more than this number would have succumbed because of the defect without operation.”

The response she received was not what she had hoped for. “At the present moment I regret to say that we do not feel that our work has progressed far enough to warrant our trying the operation on people,” wrote Harold Wiggers, director of the Albany Medical Centre in New York, where up to that point these heart surgeries had only performed on rodents. 

“Barring unforeseen difficulties, we have, however, great hope that it will not be too long before this operation for the replacement of diseased heart valves can be employed to alleviate the distressing conditions in people such as you have described in your letter,” he continued. 

Her son, Barry Marr, was suffering from a disease that not much was known about at the time. What we now know is that he had a valve disease, a condition that affects about three per cent of the population. 

“Around my 10th birthday I was apparently having trouble keeping up with the other kids when playing. Our family doctor decided to have me seen by a heart specialist at SickKids,” Barry Mar said. This was when doctors discovered he had a valve problem, telling his parents he would not live to see 40. 

A child’s determination to keep moving

In the heart there are four chambers and four valves. They keep the blood moving through the heart in the correct direction and prevent the backflow of blood. 

Valvular heart disease (VHD) has two different categories. Stenosis is when any of the valves are unable to open properly to let blood flow. Regurgitation is when any of the valves prevent the backflow of blood.

Marr had stenosis valve disease. In his case one of the valves only had two of what are called leaflets; most people have three. These leaflets are what open and close when your heart beats, which allows the blood to flow. Having a valve disease can cause the opening of the valve to become narrow or blocked, leading to blood flow being impacted. 

The treatment Marr was told to follow? 

Complete bed rest. 

The reality was that at the time, treatment for valve disease wasn't fully known yet. Most cases were, and continue to be, seen in people 65 or older, not children, and often do not show symptoms until it’s too late to treat.

Dr. Neil Patel has been a doctor at Ross Memorial Hospital since 2017. He said that even just in the last five to 10 years he’s been practicing, advancements in cardiac care have happened drastically. 

He’s found in regard to heart failure where reduced heart function is seen, there are multiple medications that can be used to treat it. “There's quite a few medications that are involved in reducing mortality. They're using hospitalizations (and) very strong evidence (when talking about the success of medications). They’ve also, at this point, become pillars of management for congestive heart failure.”

In terms of arrhythmias (an abnormal or irregular heartbeat) Patel said there’s new ways of monitoring and managing the condition. For those who have a defibrillator or pacemaker (or a combination of the two), “(they) now have capabilities to be monitored from a remote location… patients themselves are able to send notifications to the company.” For many in the Kawartha Lakes region, their heart can be monitored from as close by as Peterborough. 

Just keep moving

Marr listened to doctors for the first little while, staying in bed for six months not even being allowed to get up for meals or school. “I thought I was lucky because I did not have to go to school, but I got fooled when a teacher came in each week” he said. 

Eventually he was allowed to walk around upstairs, slowly begin using the stairs, and ultimately be allowed to go back to school. He wasn’t allowed to walk though, instead he had to take the bus that was primarily used by kids suffering long-term effects from polio. 

However, it wasn’t long before he went back to fully participating in the activities he had been forced to stop, against doctor’s orders and his parent’s wishes. “I remember that a friend of my father went home from work, sat in his chair, had a heart attack and died. I decided at that moment that I was going to go out and play as much as I wanted because life is short. I played street hockey, baseball, hide and seek and didn’t worry about what was happening,” he said, which led to his mother having a nervous breakdown, worried that he would drive himself to death. 

“In hindsight, I was probably ahead of my time,” Marr joked. 

The evolution of valve disease care

After a time, things went back to normal. Marr met and married his wife, Pauline, and went on to have three children and eventually five grandchildren and two great-grandchildren. The couple would eventually settle in Omemee to raise their family, and they would remain there for the rest of their lives. During the next couple of decades, regular checkups went fine, from an outsiders view it was hard to tell Marr had a heart condition. 

Until 1988. It was discovered that the valve had deteriorated to a point where surgery was needed to implant a pig valve. This procedure allows doctors open up the sternum and replace the affected valve with one from a pig or cow.  

“My chest bone was opened from basically my neck down to almost my stomach. When I woke up, I had tubes coming out of everywhere. I didn’t know until then that they used piano wire to put my chest back together,” Marr said. 

Today, doctors try to use less invasive intervention options, given the list of risks from open heart surgery is high. Pig and cow valves often don’t last more than 15 years, which often sways surgeons from this form of treatment. 

For those, like Marr, with valvular diseases, there are lot more minimally invasive treatments available today. Where Marr had his chest completely opened for his surgery, Patel said that’s not often the case anymore. 

“They have now come up with a lot of lesser invasive options, which include your transcatheter (aortic valve implantation), different approaches to aortic valve replacement, mitral replacement. They are being done more and more and being selected by patients and physicians where they feel like there's evidence to improve their mortality and quality of life.”

The transcatheter aortic valve implantation (TAVI) is the standard treatment for severe aortic stenosis. Now, instead of replacing the diseased valve, they place a new valve directly inside the old valve. The biggest benefit is that unlike open-heart surgery which usually means being in critical condition for many doctors to perform it, with TAVI even those with low-risk stages of valve disease can have the procedure.

According to Heart Valve Voices Canada, TAVIs are performed around 10,000 times a year across the country. 

Patel said even for major heart surgeries, a lot of things can be done laparoscopically now. This only involves using small incisions, a thin tube equipped with a camera and specialized long surgical tools. Like any procedure, Patel notes that being able to use a less invasive procedure is dependent on the anatomy of the patient’s disease. 

Advancing heart disease detection

While the average lifespan for a pig valve before replacement is 15 years, Marr made it to 28 years. In 2016 he started to experience a new, unusual feeling in his chest, followed by pain. 

He was in critical condition, and his surgeon, the same one who performed his original surgery, did not like his chances of survival. “The doctor said later that he had never seen a valve that still worked in that condition. The valve was only hanging together by a piece of skin,” Marr said. 

Instead of another pig valve, doctors put in a combination pacemaker and defibrillator. A pacemaker controls heart rhythms to make sure the heart beats at a normal rate, it is able to either slow down or speed up the heart to get to this rhythm. The defibrillator monitors that rhythm and can shock the heart if it senses a dangerous rhythm.

Patel has found even being able to diagnose heart conditions has become easier to do and can help to prevent patients from reaching a critical stage. One service offered at Ross Memorial Hospital in Lindsay is nuclear cardiology. It’s a non-invasive medical imaging field that uses small, safe amounts of radioactive tracers to assess myocardial blood flow, evaluate heart function, and detect coronary artery disease.

“We're a community hospital, but access to communications to different hospitals when you need procedures done is very seamless now,” Patel said, noting that updates to RMH’s electronic medical records over the last five years is another important factor in treating heart health. 

In any disease, starting treatment is important. Patel said about five years ago with how slow communication between different hospitals and specialists was, it could leave a patient waiting two weeks for a surgery, now that time is down to about one week. 

As well Patel and some colleagues have been using AI to help with evidence-based treatments. “Over the last six months or so (we’ve) gotten access to something called OpenEvidence …it's basically ChatGPT for physicians (that) basically allows us to look at what's evidence based.” This information can help to inform a physician on what the best course of treatment to follow is. 

Patel said in the next five years there will be more advancements in cardiac care, and the way heart diseases are treated will continue to change. “Cardiac care is getting more and more complex as we go. I think when we have evidence for these medicines (and treatments) that updates on a daily basis, it allows us to appropriately apply cardiac care and look after our patients.”

This story was originally written in 2025, when I had the privilege of speaking with my grandfather about growing up with heart disease and connecting it to innovations in heart health. Barry Marr died in 2025 at age 84.