The seventy-seven-year-old patient, Mr. S., had lived with chest discomfort for twenty years. Since bypass surgery or stents were not an option, his cardiologist managed to ease his discomfort through multiple medications. Yet the cause of the symptoms remained unknown.
According to a recent article in the Inquirer, about eight years ago his shortness of breath increased and he began to develop atrial fibrillation. Electric shock and a blood thinner restored his heart to a normal rhythm.
During this period an echocardiogram showed that his heart function was normal. The patient also had a condition called mitral regurgitation whereby the heart’s mitral valve does not close properly. Blood then flows back into the heart. In severe cases, blood is precluded from moving through the heart or into the rest of the body, causing fatigue and shortness of breath.
The patient’s condition remained stable for a few years until he became anemic. His hemoglobin count had fallen, which could have meant internal bleeding. This possibility was explored through a gastrointestinal (GI) workup. No signs of GI problems were evident.
The doctor decided to cautiously restart the patient’s blood thinner medication. It helped to improve his anemia, but his other symptoms continued.
A while later Mr. S. contacted his doctor because he suddenly had difficulty breathing. He was hospitalized with congestive heart failure. Mr. S. received furosemide, a diuretic. Furosemide reduces swelling that results from heart failure.
Upon further evaluation, the doctors determined that the patient was not experiencing atrial fibrillation and that his anemia had stabilized. However, there was an increase in his heart murmur activity.
An Increase in Symptoms
Although the patient’s heart function was still normal, there was a further increase in mitral regurgitation. These results were compared to the results of his examination a year ago. During the year, his symptoms had increased from mild to moderate/severe.
The patient was tested by cardiac catheterization which again identified non-critical blockages. However, the doctors did discover increased lung pressure caused by the increase in mitral regurgitation.
Because of the patient’s anemia and other comorbidities he was not a candidate for heart surgery. The patient was able to leave the hospital with appropriate adjustments to his medications.
He saw his cardiologist the following week, as he appeared at the office feeling unwell. He was barely able to walk and had severe shortness of breath. The doctor’s reaction was that he wanted to give his patient the best possible option.
He decided that the best option was a referral to an interventional cardiologist (IC). Interventional practitioners utilize catheterization and imaging techniques to diagnose vascular issues.
An Amazing Solution
The patient was referred to Dr. Brian O’Murchu, head of IC at Temple. The doctors wanted to determine whether the patient would qualify for a mitral valve clip.
The clip is a fairly new procedure. It is attached to the mitral valve through a catheter that is placed in an artery of the leg and removed once the clip is in place.
Mr. S. was tested by a 3D transesophageal echo to determine if he was eligible to receive the clip. The test revealed that his mitral valve leaflet was ruptured. The leaflet attaches the mitral valve to the heart. The rupture prevents the valve from closing properly, raising pulmonary pressures that caused the same symptoms experienced by Mr. S.
The physicians decided that the best solution would be to attach the mitral valve clip.
A Successful Solution
The MitraClip has a five-year history of being used on over eighty-thousand patients. It is noteworthy that conditions improved in a greater number of patients who opted for the clip than for those who did not.
The improvement in his condition began immediately on the first day after the procedure. Mr. S. was no longer short of breath, and his condition has remained stable for the past two years. Remarkedly, he no longer had chest discomfort.
His doctor, David Becker, is a cardiologist in Flourtown, Pennsylvania. Dr. Becker went a step further by listening, caring, and referring his patient to physicians who found the solution. Mr. S. told Dr. Becker that he can enjoy life now.