Breathing a Sigh of Relief
Mt. Lebanon Woman Breathing a Sigh of Relief
after Having Sophisticated Medical Procedure
“Breathing was becoming extremely difficult for me and I was constantly exhausted. It was a very frightening experience,” Jean recalls.
While her health started to decline a few years ago, Jean’s medical problems began to escalate a year ago. At the time, she was experiencing shortness of breath and a nagging cough. “I thought it was bronchitis or even asthma,” said Jean. “My doctor prescribed several different antibiotics but I wasn’t getting any better.”
It was when Jean didn’t have the strength to walk across the room that she knew something was wrong. She went to the emergency department at a community hospital, where she had a CT scan. Jean didn’t think the tests would reveal anything too serious: she thought she had bronchitis or maybe pneumonia.
But the CT scan showed something much worse. Jean had blood clots in her lungs. Not only that, but her lungs were also scarred from the blood clots. This was a life-threatening medical condition that required urgent care. Jean was transferred to Allegheny General Hospital, where she underwent extensive testing and evaluation by cardiologist Raymond Benza, MD, medical director of AGH’s Advanced Heart Failure, Transplantation, Pulmonary Hypertension and Mechanical Circulatory Support Program, and Robert Moraca, MD, surgical director, Pulmonary Thromboendarterectomy Program.
Jean was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH), a rare condition in which large blood clots obstruct the network of pulmonary arteries that carry blood from the heart to the lungs, ultimately resulting in high pressure and heart failure.
“The pressures in Jean’s pulmonary arteries were about three to four times above normal,” said Dr. Moraca. “This placed an enormous strain on her heart. While medication can temporarily reduce the pulmonary pressures, patients with CTEPH need surgery to have any chance for an extended life. Jean agreed that surgery was her best option.”
Prior to Jean’s surgery, Dr. Moraca, Dr. Benza and critical care physician Subbarao Elapavaluru, MD, spent six months observing and performing several pulmonary thromboendarterectomy (PTE) procedures at the University of Alabama in Birmingham, under the guidance of David McGiffin, MD, one of the nation’s most experienced and prominent PTE specialists. Dr. McGiffin also was present for the first procedure at AGH.
“Our team completed an extraordinary amount of training in this sophisticated procedure to ensure that from the very outset we could perform PTE with the same outcomes as the few specialized centers in the country,” said Dr. Moraca.
PTE is an 8 to 10 hour-long operation that involves opening the chest to expose the pulmonary arteries, connecting patients to a heart-lung bypass machine, and cooling the body.
According to Dr. Elapavaluru, the bypass machine mimics the actions of the heart and lungs, providing oxygen to the blood and pumping it throughout the body. He said lowering the body temperature to around 18 degrees Centigrade (64 degrees Fahrenheit) reduces the body’s need for oxygen, which allows the surgical team to halt the bypass machine periodically to create a bloodless surgical field.
While no blood is being pumped through the arteries, the surgeon opens the vessels and carefully removes the scar tissue blocking the arteries. The on-off process of the heart-lung bypass is repeated until all of the scar tissue is removed and blood flow is restored to the lungs.
On February 9, 2012, Jean became the first patient to undergo this new treatment at Allegheny General Hospital. She did remarkably well during this highly complex surgical procedure and was discharged six days later. Jean’s pulmonary pressures returned to normal and within eight weeks, her breathing and quality of life improved considerably.
“The care I received from AGH’s doctors and nurses was fabulous,” said Jean. “The staff were there for me every step of the way. Even today, they keep in touch to see how I am doing. I hope that other people who have CTEPH won’t be hesitant in having the PTE procedure at AGH.”
Jean’s health improved so much that she was able to return to her job as office and development coordinator for Outreach Teen and Family Services, a local nonprofit organization that provides counseling and educational programs for young people and their families.
“I can’t believe how much better I feel now,” said Jean. “I can breathe normally and I’m finally starting to get my strength back. I’m able to take walks with my daughter again.”
Long-term outcomes for Jean are extremely favorable. While she will have to take blood thinners for the rest of her life, she should not have any further issues with blood clots in her lungs.
Dr. Benza pointed out that for those who are candidates for this procedure, the promise of a successful PTE surgery is significant. “With most patients who undergo the procedure, the pressure in the pulmonary arteries drops back to normal, shortness of breath dissipates and the dangerous right heart dysfunction that typically occurs as a result of the disease tends to resolve completely,” he said. “And most importantly, these results appear to persist over time in most patients.”
AGH is now one of just a handful of U.S. medical centers that has acquired the expertise to perform PTE for patients with CTEPH. Several more surgeries are planned for the coming months at AGH.
“Developing expertise in PTE surgery is an important accomplishment for the Cardiovascular Institute that offers hope to patients from the greater Pittsburgh region who suffer from this very difficult and often fatal pulmonary vascular disease,” said Srinivas Murali, MD, medical director of the Allegheny Health Network Cardiovascular Institute. “It is extremely gratifying to add this important new surgical technique to our capabilities.”