The heart to carry on

May 8, 2018 JoAnn Hoven

Brandon Rowland’s move to Montana opened new possibilities to repair his faulty tricuspid valve.

Plans include marrying his fiancee, Kayla Rocker, and starting a family.

Growing up in southwestern Pennsylvania, 34-year-old Brandon Rowland always knew he had a heart murmur, a relatively common condition. A heart murmur can be congenital (present since birth) or develop later in life and isn’t necessarily serious, although it might need to be treated in the future.

Brandon didn’t have any problems with his heart until he was 25 years old. He had gotten very ill with what he thought was the stomach flu, but after days of not getting better, he sought help from his physicians. His physicians say that Brandon had an infection that attached itself to his tricuspid heart valve, damaging it. That’s when he had an open-heart valve replacement.

Brandon had severe liver disease, however, and, ultimately, his previously replaced tricuspid valve began to fail. He needed to have a heart valve replacement, but with his liver and heart not working well, care providers believed a surgical procedure was too risky for him. He was in a lot of pain, tired all of the time and unable to work.

Coming to the right place

After he moved to Montana in April 2017 to be near family, Brandon sought out the care of the physicians at the International Heart Institute (IHI) at Providence St. Patrick Hospital in Missoula. The providers there thought there was a way to help him.

The IHI team has been performing percutaneous (through the skin, versus more invasive surgical methods) valve replacements for more than four years and has replaced nearly 400 aortic valves through the groin with a procedure called transcatheter aortic valve replacement, or TAVR.

The IHI teams have also been experts in repairing the mitral valve in almost 100 patients by accessing the valve through the groin with a mitral clip, a small kind of “clothespin” that clips on the valve to help it function.

Improving on the standard

The gold standard for tricuspid valve replacement is open-heart surgery. That typically requires an incision in the chest, a one-week stay in the hospital and several weeks of recovery. Some people aren’t candidates because of medical problems or age.

Instead, there is a new procedure for these people: a transcatheter tricuspid valve replacement within a failing surgical tricuspid valve prosthesis, which entails making a puncture in the femoral vein in the groin and then crossing over from the right side of the heart to the left side. A prosthetic valve is implanted inside the old surgical valve, pushing it aside.

A team effort

“Brandon came to us, and as a team, we discussed the risks and possible outcomes of his treatment options,” says Michael C. Reed, MD, an interventional cardiologist at IHI. “This would be the first transcatheter tricuspid valve replacement we performed, and it was the first in Montana. We performed the procedure Nov. 14, 2017, and Brandon’s procedure was a total success."

“It’s important to emphasize,” Dr. Reed adds, “that this procedure is not something that’s done by a single physician working in a vacuum. It’s performed by a large group of physicians including radiologists, anesthesiologists, surgeons, imaging cardiologists and interventional cardiologists. It really is a team effort.”

“I have my life back”

With minimally invasive procedures, some people notice an immediate difference, because the recovery is usually so swift. Patients can be walking the halls that day. They typically don’t have any blood loss, and their symptoms can improve immediately.

Brandon says he now is much better. “After feeling terrible for so long, I forgot what normal felt like,” he says. “I’m not in pain, and I’m not always tired. I feel like I have my life back.”

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