New Valve, New Hope

By Tammy White

Donna Rogers and her husband Casimer were visiting family in New York when she began to experience chest pain as she breathed. They returned home, and Donna was admitted to the hospital. She was put under the care of a pulmonologist, whose treatments temporarily eased her symptoms.

However, as time went on, Donna began to feel tired and weak. Her symptoms progressively worsened, and she was readmitted to the hospital. 

Believing Donna’s condition could be heart-related, McLeod Cardiologist Dr. Anil Om decided it was time to consult the McLeod Structural Heart Team. 

The Structural Heart Team specializes in minimally invasive and surgical treatment of patients with structural heart disease. Structural heart disease refers to defects in the heart’s valves, walls or chambers. These defects can be present at birth or develop with age.

To determine the root cause of Donna’s symptoms, the team ordered a series of tests, including a transesophageal echocardiogram (TEE). This test, which produces pictures of the heart using high-frequency sound waves, revealed the problem – a leaking aortic valve. 

This meant the leaflets on Donna’s heart valve were not closing tightly enough, allowing blood to leak back into her heart. 

Shortness of breath is one symptom patients can experience when this happens, making everyday tasks difficult to manage. Other symptoms patients might encounter include fatigue, chest pain, fainting or an overall feeling of weakness.

The challenge was to determine the best surgical option for Donna. At 83 years old, any option requiring a long, extensive surgery would not have been in her best interest. Donna’s aortic valve had previously been replaced in 2018 with the transcatheter aortic valve replacement (TAVR) procedure.

McLeod Structural Heart Cardiologist Dr. Ravi Parikh and McLeod Cardiothoracic Surgeon Dr. Srinivas Kolla closely reviewed all of Donna’s imaging. This included the TEE and a CT scan of the heart which is routinely performed prior to any TAVR procedures for planning purposes. They then discussed the case with colleagues throughout the country. 

A decision was made as to the safest route to present to Donna and her family ­– an option that combined the skills of Cardiothoracic Surgery and Structural Cardiology to minimize Donna’s time on the surgical table and optimize her recovery.

“Removing Donna’s leaking valve would have been too extensive of a surgery,” explained Dr. Kolla. “The surgical option we proposed was the placement of a new valve inside the old valve.” 

The main concern with this method was the increased risk for a heart attack. Once the new valve was in place it would push the leaflets of the old valve to the side, which could then block blood flow to the arteries supplying the heart with blood. 

To prevent this risk, Dr. Kolla surgically removed the leaflets from the old heart valve.

Once the leaflets were removed, Dr. Parikh and McLeod Structural Heart Cardiologist Dr. Brian Blaker implanted Donna’s new valve. Using X-ray technology, the new valve was precisely positioned over the old diseased valve. Once in place, the new valve was released and started working immediately. 

“This surgery, as it was performed, was a first-time procedure in South Carolina,” said Dr. Parikh. “Structural heart procedures, including TAVR, emphasize a team effort. This case could not have been accomplished without the physicians and staff working together for the patient's benefit. All the team members bring their experience and expertise for the best care of the patient.”

Once cleared by her physicians, Donna returned to one of her favorite activities - walking in her neighborhood. 

“Casimer and I walk twice a day with our dog, Bo,” said Donna. “Every day helps build my endurance. I am so thankful for the excellent care I received from Dr. Kolla, Dr. Parikh and the McLeod Structural Heart Team.”

The McLeod Structural Heart Program has been replacing diseased heart valves using the TAVR procedure since 2017. The Structural Heart team members include Cardiothoracic Surgeons Dr. Srinivas Kolla and Dr. Cary Huber; Structural Heart Cardiologists Dr. Ravi Parikh and Dr. Brian Blaker; and Anesthesiologists Dr. Daniel Fox, Dr. Robert Savage and Dr. Robert R. Casella. 

The McLeod Heart and Vascular Institute offers a Valve Clinic at the office of McLeod Cardiology Associates to meet the medical needs of patients diagnosed with valve disease. In the clinic, each patient is evaluated by a team of cardiac experts to diagnose the type and severity of the valve disease and develop a treatment plan specific to the patient’s condition. For questions on the McLeod Valve Clinic, call 843-777-8258.