Dry heat, warm hearts: News on the ticker from around the Valley.

The Heart Beat

Written by Tom Marcinko Category: Valley News Issue: April 2017
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Banner Health cardiologist Dr. Ashish Pershad
(foreground) and Dr. H. Kenith Fang, cardiothoracic
surgeon, complete a TAVR procedure.

Top Right: Normal aortic valve
Bottom Right: Aortic valve stenosis

Top: Blood flow (arrow) through a cross-section of a
normal artery
Bottom: Blood flow (arrow) through a cross-section of
an artery with an intimal tear (flap)

Why, Aorta…
A less invasive heart procedure recently approved for patients older than 60 may benefit younger patients, too. Recently, Banner Health in Phoenix got federal approval to test the cutting-edge surgery on younger, lower-risk patients (about 80 percent of them), because it’s cheaper, faster and presumably better.

Aortic stenosis is a narrowing in the valve of the aorta, the body’s major artery. The main cause is calcium buildup that comes with age, but it can also be congenital. Its main effect: an unhealthy squeezing-off of blood flow. Open-heart surgery was the usual option for 200,000 patients every year in the U.S. – until 2011, when the U.S. Food & Drug Administration approved transcatheter aortic valve replacement (TAVR), in which a surgeon pushes a catheter into the heart to replace the valve.

Banner is the only place in Arizona doing TAVR, as part of a national study to compare it with open-heart operations in low-risk patients, says cardiologist Ashish Pershad. “This study will show us through indisputable data if the less invasive approach is as safe as, or possibly better than, open-heart surgery.”

SCAD as it Looks
“The main reason she’s alive today is because she listened to her body,” says HonorHealth Deer Valley cardiologist Mayurkumar Bhakta. His patient, Ashley Wachtmann, came to the ER complaining of shoulder pain. Bhakta and his team correctly suspected she was having a rare, oft-misdiagnosed and frequently fatal kind of heart attack that strikes women who have recently given birth, as this second-time mom had a month before.

Spontaneous coronary artery dissection (SCAD) is a flow-blocking rip in the wall of that vital blood vessel (we have two, branching from the aorta). About 800 cases occur in the U.S. annually, with a fatality rate of 60 percent. The tipoffs for Bhakta, cardiologist Christian Lopez and cardio surgeon Ken Ashton were Wachtmann’s youth (she was 32) and good health coupled with her recent delivery.

Bhakta performed the delicate maneuver of sticking a catheter tube through Wachtmann’s arm and inserting a wire mesh called a stent to hold open the artery. It worked, avoiding the need for open-heart surgery to repair the artery, a fix-it job Bhakta likens to pasting together two pieces of tissue paper.

Bhakta knows two less lucky patients: One lives with chronic heart failure, the other had a heart transplant. “If you’re within a few weeks of being postpartum, you should not ignore any symptoms,” he says – even if you think it’s just heartburn.

Mayo Clinic Scottsdale cardiologist Eric Yang is seeking SCAD patients and compiling a registry for national studies. For more information, visit mayoclinic.org.

Breaking Points
A woman realizes she’s tossed her Social Security check into her dumpster. During a frantic search, she starts sweating, feels like an elephant is sitting on her chest, and calls 911. Her symptoms, and tests at the ER, point to heart attack. “But we look at the arteries and they’re squeaky clean,” without a heart attack’s telltale blockage, says Scottsdale cardiologist and PHOENIX Top Doc Christina Reuss.

Her patient had stress cardiomyopathy, aka “broken-heart syndrome,” which fans speculate may have killed actress Debbie Reynolds the day after her daughter, Carrie Fisher, died of a heart attack. Reynolds suffered a stroke, according to news reports, but two untimely passings in as many days threw a media spotlight on the syndrome.

Only about 2 percent of apparent heart attacks masquerade as “broken,” and 90 percent of those cases occur in women, Reuss says. These often strike during or after highly stressful events – the death of a child, for example – but sometimes without obvious cause. Most patients are post-menopause, which suggests age-related changes to the heart as a cause. At TGen, neuroscientist Matt Huentelman and colleagues are studying genes that could help identify people at risk.

Surprisingly, when doctors see a “broken” heart, “we get pretty excited, because we know the prognosis is pretty good,” Reuss says. “You don’t have to do much. You leave the hospital on an aspirin.”