Spend some time with Mary Ellen Thein and you quickly notice that she’s friendly, caring, and easygoing.
When she started gaining weight between her semiannual doctor check-ups in 2012, however, she clearly wasn’t herself and it wasn’t just a little weight. Mary Ellen had gained 60 pounds in six months, yet she figured her body would “take care of itself,” she says.
Mary Ellen didn’t want medical attention, but Jim, her husband of 56 years, felt otherwise. He set up an “intervention” involving the Theins’ friends and immediate family.
Mary Ellen normally wouldn’t have been so resistant, but “it changed my personality when I felt so miserable,” she says. “I wasn’t myself. I was getting so sick. And as bad as it sounds, I just didn’t care anymore.”
She reconsidered when her 19-year-old grandson, with tears in his eyes, begged her to see a doctor. Mary Ellen’s family drove her to the emergency room in nearby Oelwein, where she was told she’d have been dead in two days if she hadn’t come for help. She was transferred to Covenant Medical Center in Waterloo, Iowa, under the care of cardiologist Richard Valente, MD.
“They had to take 60 pounds of fluid out of my body,” Mary Ellen says. “I was in the hospital for several weeks.”
Mary Ellen’s fluid build-up, or edema, was caused by narrowing and calcification in her aortic valve, which reduces the heart’s ability to pump blood to the rest of the body. As blood flow out of the heart is hindered and slows, blood returning to the heart backs up, causing fluid build-up in the tissues. Mary Ellen also had narrowing in the coronary arteries, which supply the heart muscle with blood.
Valente relieved the heart artery narrowings with stents. He then enlarged the narrowed aortic valve using a balloon catheter. Since the balloon treatment provides only temporary improvement, Valente referred Mary Ellen to University of Iowa Heart and Vascular Center.
Mary Ellen needed an aortic valve replacement, but traditional open-heart surgery was not an option, given her age and condition. At the heart and vascular center she met cardiothoracic and transplant surgeon Michael Bates, MD, and interventional cardiologist James Rossen, MD, and learned about transcatheter aortic valve replacement (TAVR), a new, minimally invasive procedure for patients who would have been considered untreatable in the past.
TAVR uses an artificial valve that is compressed onto a balloon, inserted via a catheter into the femoral artery in a patient’s thigh and delivered to the heart. Once in place, the valve is expanded with the balloon, making it immediately functional.
UI Heart and Vascular Center has the most experienced TAVR program in Iowa, and for patients who are good candidates for the procedure, the results are remarkable. With this minimally invasive approach, patients typically go home after a few days—often with little or no pain—making it a much-preferred alternative to traditional open-heart surgery.
Unfortunately for Mary Ellen, traditional TAVR was not an option. She also had peripheral vascular disease that had caused hardening and narrowing of the arteries in her legs. This meant that doctors could not use the femoral artery in her leg.
The Theins’ hopes rested on an even newer procedure, called transapical TAVR, or TA-TAVR, in which the replacement valve is placed via catheter through a small incision on the lower left side of the chest, under the rib cage.
The transapical approach “extends the access for heart valve replacement to a wider group of patients who are too high risk for traditional surgery and in whom vascular disease prevents the placement of the TAVR from the leg,” Rossen says.
TA-TAVR results from national clinical trials were good, but the procedure still needed U.S. Food and Drug Administration approval before Mary Ellen could receive her new aortic valve. This meant several weeks of waiting for Mary Ellen and her family.
In mid-November 2012, less than a month after TA-TAVR received FDA approval, Mary Ellen returned to UI Heart and Vascular Center for her new valve. In fact, she was the second patient—and the first woman—in Iowa to undergo TA-TAVR. Hers was among only a handful of TA-TAVR procedures that had been performed nationwide since the FDA go-ahead.
In a sense, Mary Ellen was an “ideal” patient for TA-TAVR.
“She is a strong woman who responded well and was discharged home three days post-operation in excellent condition with no complications,” Bates says. “She continues to make good progress.”
Mary Ellen experienced mild pain at the incision site in the days following the surgery, but she shrugs it off, emphasizing that TA-TAVR “was definitely worth the wait.” She praises Bates and the entire TAVR team for her recovery.
“I think the reason I got to come home so fast is because of the care I had,” Mary Ellen says. “I had such confidence in all my doctors. They impressed me so much.”
Mary Ellen continues to take a blood pressure pill and participates in cardiac rehab therapy in Oelwein, but she no longer needs oxygen or heart medications like she did before her TA-TAVR. She “feels great” and is back to her normal routines. She loves to garden—something she couldn’t do in 2012—and she can’t wait for spring. She also enjoys spending time with her family, which includes seven grandchildren.
As Mary Ellen says, “I’ve got plenty of things I can still do.”
That includes sharing her story with others.
“If I can help somebody else by telling my story, I’ll be a happy camper,” she says.