August 25, 2014

UAB interventional cardiologists offer innovative solution for patients unable to risk major surgery
Advanced intravascular ultrasound techniques combined with expertise available at UAB give cardiologist ability to locate and attack complex calcium buildup problems.

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mae kramerDothan's Mae Kramer, 78, had a left main artery blockage caused by a severe buildup of calcium. She was considered a high-risk surgical candidate, but UAB's intravascular ultrasound capabilities made it possible for her to have a stent placed near the heart as part of a minimally invasive procedure and correct a potentially fatal condition.Athens resident John Welch has 7 acres of land, a woodworking shop and rental properties to keep up, “plenty of things to do that require activity,” said the hardworking 87-year-old.

But Welch recently experienced a heart attack a day after working on an addition to the back deck of his home. He had experienced pains for a few days, but his complaints were of shoulder pain and burning lungs. Tests showed that Welch had significant calcium buildup in his left main artery; surgeons and interventionalists in Huntsville and Tuscaloosa told him an open heart procedure was the only option they could offer him.

Because of his age and comorbidities, including kidney failure and chronic obstructive pulmonary disease, no one wanted to risk major surgery.

Out of options and experiencing frequent intense pain, Welch visited University of Alabama at Birmingham Professor of Medicine Massoud Leesar, M.D.

“We were told there was a special doctor here in Birmingham who works on the left side of the heart, in the aorta,” said Welch’s wife, Doris. “Our doctors told us we needed to get here and see him quickly.”

UAB’s advanced imaging techniques combined with Leesar’s knowledge of the left main artery gave Welch a chance. On July 29, Leesar used a minimally invasive procedure to place a left main artery stent in Welch’s heart. Welch went home two days later.

“We have advanced imaging techniques, including intravascular ultrasound, which really give us a tremendous tool to see where the problems are and how to tackle them,” said Leesar, section chief of Interventional Cardiology in UAB’s School of Medicine. “A lot of hospitals do have intravascular ultrasound, but interpreting the results and performing stenting in the left main artery requires a special kind of expertise. We have that here, and it makes us comfortable doing these types of difficult procedures.”

As part of the procedure, UAB interventional cardiologists initially perform an angioplasty and then an intravascular ultrasound on the patient to form the best plan to make the procedure successful.

Leesar’s team has completed a number of these types of cases recently, including on 78-year-old Mae Kramer of Dothan.

Kramer had what she termed “excruciating” pain in the center of her chest that she also felt in her left arm.

“It felt like I had a charley horse in my chest,” she said.

Kramer also had left main artery blockage, a severe buildup of calcium, which was blocking blood flow. Leesar placed two stents in the left main artery of Kramer’s heart to correct the problem.

“I was surprised I even had a problem with my heart,” Kramer said. “I’ve always been active; I still do 30 minutes a day on a treadmill religiously, and I always watched what I ate and never smoked. The doctors told me I was the least likely of people to ever have a heart attack. It just goes to show it can happen to anyone.”

  “I was surprised I even had a problem with my heart,” Kramer said. “I’ve always been active; I still do 30 minutes a day on a treadmill religiously, and I always watched what I ate and never smoked. The doctors told me I was the least likely of people to ever have a heart attack. It just goes to show it can happen to anyone.”
Leesar says age and other risk factors played a significant role in both Welch’s and Kramer’s conditions.

“As we age, calcium builds up in our arteries,” Leesar said. “When you have kidney failure, as Mr. Welch does, that also causes calcium to build up in the arteries. In many cases, patients can have an angioplasty to repair these issues; but sometimes the calcium buildup is so severe that it makes it very challenging to do angioplasty.”

The comorbidities many elderly patients face also make this procedure a challenging one. For instance, Welch had to have his procedure delayed for a day while he was in the hospital because doctors did not believe his creatinine level was low enough to do it safely. They flushed his kidneys for 24 hours, a step his wife believes showed the true value of the comprehensive care he received at UAB.

“I was so appreciative that they recognized that his creatinine level was an issue and decided to hold off another day on the procedure,” Doris Welch said. “Every one of these little details is what brings a patient like John home. The nursing staff and doctors who helped us navigate through all of this – I just can’t say enough good things about them.”

Visit UAB Medicine to learn more, or call 205-934-9999 or 800-UAB-8816 to schedule an appointment.
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