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March 04, 2013

Cardiologists repair leaky valves without open-heart surgery

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Earlier this year, when leaks around Louise Calhoun’s replacement mitral heart valve kept her from walking more than a few feet before needing to rest, University of Alabama at Birmingham cardiologists used a minimally invasive procedure — available in Alabama only at UAB — to repair the leaks and give Calhoun back her independence.

In October, Calhoun was one of the first people in the state to have a percutaneous paravalvular periprosthetic leak repair by physicians in UAB Heart and Vascular Services, home to the state’s largest and oldest heart valve disease treatment program.

Only weeks after the procedure that used plugs originally designed to repair holes in children’s hearts, Calhoun is thriving.

“It is really wonderful for me because I wouldn’t be living today if they had not done it,” she said. “I was just in that bad of shape.”

Calhoun, 70, has had heart problems since contracting rheumatic fever as a child. Her mitral and aortic valves were replaced in 2009, but she never felt 100 percent.

“I was a lot better than I was before they were replaced,” she said. “But, I was always short of breath. I went back to the doctor because I couldn’t breathe. My cardiologist in Tuscaloosa found my leaky valve and sent me to Birmingham.”

Oluseun Alli, M.D., director of the structural heart program at UAB, and the interventional cardiologist who treated Calhoun, said that leaks around replacement valves are relatively uncommon, those as severe as Calhoun’s are even more rare.

“In the United States, about 60,000 valves are implanted each year,” he said. “About 5-10 percent will have some type of leak, which are basically gaps or defects around where the valves are sewn in. A lot are trivial and go away with time. In about 1-5 percent of cases, they become long lasting. In about 3 percent of those cases, they are symptomatic.”

Alli said valve leaks can cause red blood cells to be destroyed. This lays the groundwork for hemolytic anemia or hemolysis, where the patients need blood transfusions just to keep their blood volume up. They can also cause heart failure that creates shortness of breath and makes doing simple tasks difficult.

For Calhoun, the leak was causing heart failure with difficulty breathing. Her frail health and numerous other open heart surgeries meant repairing her mitral valve leak with an open procedure was not an option. Alli offered her the option of repairing the leaks in the cardiac catheterization laboratory using minimally invasive percutaneous interventional leak repair.

“I had a hard time with the surgery to replace the valves, and I didn’t feel like I could go through open heart surgery again,” Calhoun said. “When he told me he thought he could fix it without having to do open heart surgery again, I was thrilled.”

Alli said Calhoun fit the characteristics of the patient for whom this procedure was designed.

“It’s the sicker patients we offer this to,” he said. “The patients who get this type of intervention have had several heart surgeries. They may have coronary artery disease with prior bypass operation. They may have kidney problems or lung problems, and they are sometimes quite frail. They’re usually not candidates for redo surgery because of their multiple medical problems. Research data suggests these patients have a tough post-op course, with higher morbidity and mortality rates, because this may be their second, third or fourth cardiac operation with no guarantee that the leaks will not recur.”

Alli said physicians began looking at various ways to correct leaks around replacement valves in the 1990s without having patient undergo redo surgery. While not always a perfect seal, the plugs used to close holes in hearts, especially in children and in some adults, fit well enough to correct the leaks in most cases.

“We aim to take the leak from severe to trivial, trace or none,” he said.

Alli was able to repair Calhoun’s leaks, and she tolerated the procedure well. Her prognosis and symptoms are now much better.

While patients who come in with hemolysis may take time to get back to what they were doing before the procedure, Alli said most patients who come in with heart failure feel dramatically better immediately following the procedure.

“They’re able to walk around the halls and are in much, much better shape right away,” he said.

That was the case for Calhoun.

“When I got back to my room right after the procedure, I could tell a difference,” she said. “I could breathe better, and it was just wonderful. Before, my niece had to get a lot of my groceries and things for me. I just couldn’t do it. Since Dr. Alli fixed my valve, there’s a 100 percent difference. I can do my own grocery shopping, and I’ve just done really well.”