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Format: 04/16/2014
Format: 04/16/2014

News

Pittsburgh Woman Thrives After Surgical Innovation at AGH Removes Life-Threatening Blood Clots From Her Lungs

Tuesday, May 8th, 2012

A Pittsburgh woman is breathing much easier today after cardiothoracic surgeons at Allegheny General Hospital (AGH) successfully removed massive, life-threatening blood clots and extensive scar tissue from her lungs using a highly complex surgical procedure called pulmonary thromboendarterectomy (PTE).

AGH is now one of just a handful of U.S. medical centers that has acquired the expertise to perform PTE for patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH), a 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.

CTEPH is a progressive disease that requires surgical intervention to offer patients any chance of an extended life. Such was the case of Jean Magazzu, 44, who became the first patient to undergo the new treatment at AGH in February after she was admitted to the hospital with shortness of breath and in extremely compromised health. Doctors detected pressures in her pulmonary arteries that were five times above normal.

At AGH, Magazzu was evaluated by cardiologist Raymond Benza, MD, medical director of the hospital’s Advanced Heart Failure, Transplantation, Pulmonary Hypertension and Mechanical Circulatory Support Program and cardiothoracic surgeon Robert Moraca, MD. The two physicians led AGH’s effort to become a center for PTE surgery and determined Magazzu was was a good candidate for the procedure.

Prior to Magazzu’s surgery, Drs. Moraca, Benza and critical care physician Subbarao Elapavaluru, MD, spent six months observing and performing several 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,” Dr. Moraca said.

PTE is an eight 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.

Magazzu was discharged from AGH six days following PTE surgery with normal pulmonary pressures, and eight weeks later, her breathing and quality of life has improved considerably.

“In the days leading up to my diagnosis, the shortness of breath was so severe that I could not even hold a conversation without struggling for air. Within a week of undergoing the PTE procedure, there was a noticeable improvement in my ability to breathe. I feel like I’m getting stronger every day and look forward to getting back to work and other activities I love,” said Magazzu, who is the Office and Development Coordinator for Outreach Teen and Family Services, a local non-profit organization that provides counseling and educational programs for young people and their families.

CTEPH is often difficult to diagnose because its primary symptom in the early stages, shortness of breath, can signify a variety of conditions. As the degree of the pulmonary blockage progresses, however, additional debilitating symptoms may appear due to stress placed on the right side of the heart as it struggles to push blood through the blocked area and oxygenation of the blood is diminished. Those symptoms may include: difficulty breathing, water retention in the limbs (edema) due to the heart's reduced ability to move fluid through the body's blood vessels, chest pain, light-headedness and fainting (syncope).
 

Physicians diagnose the condition using a series of imaging tools, including echocardiography (sound wave pictures of the heart) and pulmonary angiography – or X-ray imaging of the pulmonary arteries.
Dr. Benza said for those who are candidates, 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.”

Studies show that five-year survival following PTE is approximately 75% in a patient group whose life expectancy without surgery is often just a few years.

“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 West Penn Allegheny Health System Cardiovascular Institute and Director of System’s Division of Cardiovascular Medicine.

“The goal of the Cardiovascular Institute is to provide a complete spectrum of advanced surgical and medical care for complex cardiopulmonary diseases and it is extremely gratifying to add this important new surgical technique to our capabilities.”
 

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