UCI Doctor Uses Newest Non-Surgical Method to Clear Faulty Aortic Valve
When doctors at UCI Medical Center discovered that Martha Ewbank’s aortic valve was nearly fused shut and that she was too ill for open-heart surgery, they proposed repairing her faulty valve, not with a scalpel but with a catheter and a balloon.
The non-surgical procedure, known as an aortic valvuloplasty, was performed for the first time in Orange County earlier this week by Dr. Jonathan Tobis, associate professor of medicine. The procedure--which uses a catheter and a balloon to enlarge narrowed, diseased valves--was pioneered a few years ago by French doctors as an alternative to open-heart surgery. It has been performed only about 100 times worldwide, primarily in France, Tobis said.
Tobis had never performed an aortic valvuloplasty before. In fact, he had never even seen the procedure performed. But he knew something had to be done to help his 78-year-old patient, who was suffering not only from the valve dysfunction but also from coronary and kidney diseases.
“This patient was so sick, we thought the risk of surgery was so high to be prohibitive,” Tobis said. “We felt in this case it was less traumatic to at least try this.”
Put Before Committee
Tobis said he called the chairman of the human subject review committee--which oversees experimental or unconventional procedures on patients--and said, “This lady’s dying.”
After he got approval, Tobis recalled Thursday, he made a few phone calls to other Southern California physicians who have used the still-experimental procedure. He also asked Dr. Tom Dorsey, a St. Joseph Hospital radiologist who has performed a similar procedure on children, to assist him. The valvuloplasty was performed Tuesday.
As director of the medical center’s cardiac catheterization laboratory, Tobis each year performs about 70 angioplasties--a widely accepted non-surgical procedure using a catheter and balloon to clear blocked coronary arteries. The valvuloplasty, he said, was not as difficult to perform as a coronary angioplasty. The patient “tolerated it pretty well” and suffered no complications during the procedure, although she remains in guarded condition in the cardiac care unit, he said.
Valvuloplasty is a new treatment for aortic stenosis, a condition in which the three-flapped aortic valve has narrowed because the flaps have fused together at the outer edges, he said. A healthy aortic valve allows the heart’s left ventricle, the strongest pumping chamber, to push oxygen-rich blood out of the heart and into the aorta, the body’s biggest artery. The aorta then feeds the blood to the brain and the rest of the body. If the valve is diseased and too narrow, not enough blood gets through, Tobis said.
Employing many of the techniques used in angioplasty, valvuloplasty involves threading a catheter with a deflated plastic balloon through a vein in the groin up to the aortic valve, Tobis explained. Positioned at the valve, the balloon is then inflated with air pumped through a syringe and poked through the aortic valve, cracking open the fused valve flaps, he said.
Before the advent of valvuloplasty, the only treatment for aortic stenosis was open heart surgery to cut out the diseased valve and replace it with a mechanical valve, he said.
The major danger of valvuloplasty, Tobis said, is that cracking open the fused valve could dislodge pieces of tissue that then would be carried through the circulatory system, possibly causing a stroke or heart attack.
About three valvuloplasty patients have died in France, Tobis said. But, he added, those deaths did not occur during the procedure and were the result of complications later.
Valvuloplasty is of no help to a patient who has an aortic valve that is incompetent, or too loose, and surgery is the only treatment available, he said.
Growing Acceptance Seen
Tobis said he sees growing acceptance of the technique in the future, but it will never become as commonplace as angioplasty because valve dysfunction is rarer. Aortic stenosis “is not that common a problem, but it’s certainly not insignificant,” he said. Still, the development of the catheter procedure “is an extension of making medicine less invasive,” he said.
Tobis said his patient, Ewbank, agreed to the new procedure after he advised her of the risks and his inexperience. He said that he also told her that surgery would be even riskier.
Ewbank was brought into the medical center on the edge of cardiac arrest by paramedics last week after she suffered heart problems at a Garden Grove nursing home, Tobis said. When she came through the emergency room doors, her pulse was only 20 beats a minute, and her blood pressure was dropping, he said.
Still weak, Ewbank admitted in an interview from her hospital bed Thursday that she was a bit nervous to be the first valvuloplasty patient in the county but said she is glad to have avoided open heart surgery.
