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Repairing aortic stenosis without open heart surgery

June 21, 2018 | UCI Health
Lorelei Herne was diagnosed with aortic stenosis, a condition that was once a death sentence. Now, it's treatable with a one-hour procedure.

Just before Christmas 2017, Lorelei Herne began to feel a strange tightness in her chest. A trip to urgent care led to cardiovascular screening tests a few days later, with the screener advising the 78-year-old Buena Park woman to see a heart specialist.

“He said, ‘I don’t want to scare you, but you need to find yourself a cardiologist,’ ” says Herne.

By the time she came to UCI Medical Center for a cardiovascular evaluation in late January, she had gotten progressively worse, experiencing such shortness of breath she had to sleep sitting up. While lying down during an echocardiogram a few days later, she was gasping for air and had to be given oxygen. She could barely speak to the nurse who was trying to help her.

She was kept overnight until her breathing was stabilized.

Diagnosis: Aortic valve stenosis

By mid-February, Herne had her diagnosis: A stiffening, or stenosis, of the heart’s aortic valve, leading to a weakening of her heart, which was functioning at 37 percent less than normal capacity. Moreover, the failing aortic valve was causing additional leakage of her heart’s mitral valve, says UCI Health interventional cardiologist, Dr. Pranav Patel.

Aortic valve stenosis historically has been a virtual death sentence in many older adults because they rarely have the stamina to withstand open-heart surgery.

Treatment: Transcatheter aortic valve replacement

However, advances in interventional cardiology gave Herne another option, transcatheter aortic valve replacement (TAVR). Instead of opening the chest, a replacement valve can be inserted inside the failing one with small wires threaded through blood vessels in the groin.

“Without the TAVR procedure, she had a fifty-fifty chance of surviving the next five years,” says Patel, associate professor and chief of the UCI School of Medicine’s Division of Cardiology.

Herne agreed immediately. By then she was no longer able to sleep through the night, even sitting up. “I was afraid if I fell asleep I would die,” she recalls.

TAVR a life-changing one-hour procedure

While being prepped for the TAVR procedure on March 28, the UCI Health cardiology team discovered a buildup of fluid on the outside of Herne’s lungs, which further compromised her ability to breathe. She was sent immediately to intensive care, where an interventional pulmonologist removed nearly two liters of liquid and ordered a breathing mask that would force oxygen into her lungs.

A few hours later, Herne was wheeled back to the hospital’s cardiovascular surgery unit for the one-hour TAVR procedure.

“They inserted two lines, little wires, one on the right side of my groin, one on the left side, and pushed one wire all the way to the bad aortic valve and into my heart chamber,” she says. This was followed by the insertion of a new aortic valve made of cow tissue.

“The following day, she was out of bed and walking in the hospital, feeling like a different person,” Patel says.

'A longer, fuller, more independent life'

“To this day it has been a perfect match,” says Herne, who was discharged from the hospital March 30, able to walk on her own, breathe comfortably and sleep in her bed for the first time in three months. Four days later, she drove herself to an appointment to have her income taxes done.

Herne’s energy hasn’t flagged since. She’s gardening again, vacuuming and doing other household chores. She takes walks in her neighborhood and attends church regularly. She’s able to spend quality time with her sons and two grandchildren, not to mention her neighbors and all the friends and family who supported her through her illness.

At a recent checkup, Patel told her the TAVR procedure has “given you the means to live a longer, fuller and more independent life. Whether that’s five, 10 or more years is impossible to know,” she says.

What Herne does know is that anyone with fatigue, tightness in the chest and shortness of breath should get checked out by a cardiologist. “Your heart, you have to have it to live,” she says. “TAVR saved my life.”

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Kathlea Bolduc
June 22, 2018

Very interesting because I had a cow valve put in me at uci about 10 years ago. I am feeling more tired than I used to.

June 26, 2018

Thank you Dr. Patel for saving my sister's life and giving her more yrs to enjoy her family. She looks fabulous!!

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