Fixing a broken heart with lifesaving medical technology

“I had been on holiday and when I came back, my legs were swollen,” Josephine tells MedTech Views. “After two weeks, I was very out of breath and my legs were still swollen, so I went to the doctor, who sent me to A&E.”

A computerised tomography (CT) scan, which showed doctors detailed 3D x-ray images of Josephine’s heart and arteries, revealed that she had a damaged aortic valve, but also a blood clot. The aortic valve controls the flow of oxygen-rich blood from your heart to the rest of your body and keeps the blood flowing in one direction.

“The doctors said that I needed a new valve, but because of the clot, the risk of stroke was too high to do the usual valve replacement,” says Josephine. “I was kept in hospital for observation and given medication that would hopefully shrink the clot enough to do the operation.”

In patients who don’t have a stroke risk, doctors can perform a transcatheter aortic valve replacement (TAVI), which is a straightforward, minimally invasive procedure. It involves threading a new valve to the heart via a catheter (tube) inserted in the upper leg. However, for people like Josephine who have a high risk of stroke, it can cause fragments of the clot to break off, potentially blocking blood flow to the brain and triggering a stroke.

About a month into her hospital stay, Josephine had a stroke. “My arms and legs were fine but the stroke caused me to lose my speech. I also couldn’t eat or drink, so I had a feeding tube,” she explains. “I had daily rehab until I could finally speak, eat and drink again.”

Meanwhile, Josephine’s cardiovascular specialist said that her much-needed heart valve replacement was still too risky. But he explained that he had an idea. “There was a device in Italy that could possibly be used to carry out the procedure without the risk,” Josephine says. “It took a long time to arrive. I could have given up and decided not to go through with it, but I resigned myself to staying in hospital and waiting.”

The medical technology that would allow Josephine to safely have the valve replacement was a flower-shaped device containing a fine mesh basket that expanded within the aorta to catch any tiny fragments of the clot that could break loose during the procedure. She would be the first patient in the UK to undergo this procedure.

“They inserted a catheter into each side of my groin. One had the valve and the other had the clot catcher,” Josephine notes. “They gave me an epidural, and I was awake the whole time. I was watching it on screen while the doctors explained everything they were doing.”

After spending six months in hospital, Josephine was finally free to go home. “I felt completely different straight away and was sent home the same day,” she comments. “I had no pain or breathlessness. For just having had a heart procedure, you wouldn’t know I’d had anything done.”

Josephine feels grateful for having access to this innovative, life-saving medical technology and hopes that it can help others who, like her, couldn’t have the TAVI procedure before. She’s now looking forward to enjoying her retirement with a healthy heart.