Fixing the heart to help the lungs

When it comes to breathing problems, the lungs might be the first organ to come to mind. However, there are instances where the heart may be the one in need of rescue, as was the case with 69-year-old Pat Paluso. Pat was living with COPD (chronic obstructive pulmonary disease), a chronic lung disease that made it challenging for him to breathe and sleep, and left him with little energy.

“Because he had a hard time breathing, I think Pat felt afraid to go to sleep,” says Gloria Paluso, Pat’s wife. “We attributed it to COPD. Then his doctor suggested an echocardiogram, and it turned out his symptoms were due to a leaky heart valve.”

At the advice of his primary care doctor, Pat met with Dr. Rayan Hourani, an interventional cardiologist affiliated with Sharp Grossmont Hospital. Using a minimally invasive procedure to peer into Pat’s heart, Dr. Hourani diagnosed Pat with mitral valve regurgitation.

The mitral valve is located between the left heart chambers (left atrium and left ventricle). It consists of two flaps (leaflets) that allow blood flow from the left atrium to the left ventricle. Mitral valve regurgitation occurs when these leaflets — which act as a “gate” between the heart’s upper and lower chambers — do not completely shut. When this happens, the oxygen-rich blood that normally flows out to the body ends up flowing back into the heart. Without sufficient oxygen reaching other vital organs, a person may feel excessively tired and short of breath. In severe cases, it can eventually lead to heart failure, atrial fibrillation (AFib) or pulmonary hypertension.

Dr. Hourani reached out to Dr. Jad Omran, a complex and high-risk coronary interventional cardiologist affiliated with Sharp Grossmont Hospital, to discuss a treatment plan.

“Mitral valve regurgitation is commonly treated with open heart surgery,” says Dr. Omran. “However, for a patient who already had open heart surgery, or in Mr. Paluso’s case, is too high-risk to undergo open heart surgery, Sharp Grossmont Hospital offers transcatheter edge-to-edge repair (TEER) using a device called a MitraClip to treat such patients with great success rates.”

During the minimally invasive procedure, a cardiologist inserts a thin tube into a vein in the leg and guides it to the heart. The cardiologist then inserts the MitraClip device — which is about the size of a dime and looks like a clothespin — into the tube leading to the heart. Once the device is in the heart, the cardiologist uses it to clip the loose leaflets together to help seal the mitral valve more completely. Closing the gap prevents blood from flowing back into the heart, thereby restoring normal blood flow.

“Going into the procedure, I was scared, especially since they would be operating on my heart,” recalls Pat. “But Dr. Omran and all the nurses were fantastic. I had one nurse who put her hands on my head and said not to worry, as I was on the gurney getting ready for the procedure. ‘Everything is going to come out just fine,’ she said. That was comforting.”

The MitraClip procedure, which Sharp Grossmont Hospital’s Burr Heart & Vascular Center has offered since August 2020, takes approximately 2 to 3 hours, and patients usually go home the following day.

“The procedure was as the doctors described it,” adds Gloria. “It was a relief and it seemed to be an easy procedure to go through. Afterward, Pat said to me that he could not believe it was as easy as it was. And his recovery time was excellent. We were hesitant about it at first. But it turned out to be something not to worry about, and the end result was very successful for him.”

Nearly 6 months after the procedure, Pat no longer has symptoms. “I had no energy before the procedure, and now all the symptoms are gone and I sleep like a baby,” he says. “I had COPD, but now I can breathe much better. It has progressively gotten better as time has gone on.”

“Mr. Paluso had excellent results,” adds Dr. Omran. “His mitral valve regurgitation improved from severe to trace. He actually started noticing a difference on day two after the procedure.”

“While recovering in the hospital, I was already able to walk along the hospital hallway and go up and down the steps,” recalls Pat.

Adds Dr. Omran, “I will always remember his words, ‘I can breathe again.’” I do think he will do great in the long-term.”

Pat recalls his time at Sharp Grossmont Hospital as comfortable and effortless. “Every person I came in contact with — the doctors, nurses, anesthesiologist, everyone — was a top-notch professional,” he says.

With an improved quality of life, Pat and Gloria now look forward to enjoying life’s simple pleasures.

“My wife and I want to live a happy life together, and possibly do some traveling to see the grandkids,” says Pat. “I just look forward to relaxing and enjoying everything.”

Learn more about Sharp Grossmont Hospital’s state-of-the-art cardiovascular care.