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Danbury Hospital: Minimally Invasive Procedure Heals Woman’s Heart | NEWS-Line for Healthcare Professionals

Danbury Hospital: Minimally Invasive Procedure Heals Woman’s Heart


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Joan Lipman, an 86-year old retired nurse, has dedicated her life to caring for others. So, it was unusual for Joan, who is by nature active and optimistic, to find that she was the one who needed help when aortic stenosis symptoms prevented her from even leaving her home. The good news — Joan found the care she needed from a multidisciplinary team at Western Connecticut Health Network (WCHN), and a minimally invasive heart procedure at Danbury Hospital.

What is aortic stenosis?

Joan, a Danbury, Connecticut native, had a history of aortic stenosis. Aortic stenosis is one of the most common and serious heart valve disease problems. The heart has four valves that help regulate blood flow as it is pumped by the heart. One of these valves is the aortic valve. Aortic stenosis causes narrowing of the aortic valve opening. This means the valve cannot fully open and close, which makes it harder for the heart to pump blood. Aortic stenosis can weaken the heart muscle and lead to complications including heart failure.

Joan’s primary care physician of 20 years, Svetlana Tikhomirova, MD, a board-certified internist from Danbury Medical Group, noticed Joan had a heart murmur during a routine exam. Heart murmurs are common, but given Joan’s age (81 years old at the time), she referred her to Jonathan Alexander, MD for further evaluation.

Dr. Alexander, a board-certified cardiologist with Western Connecticut Medical Group Cardiology in Danbury and Ridgefield, has also known Joan for 20 years — ever since he treated her husband for aortic stenosis. Now it was Joan’s turn to be a patient. An echocardiogram confirmed her diagnosis.

Aortic stenosis can be mild, moderate, or severe. Medications may help to manage symptoms or minimize complications from the disease, but they will not prevent the disease from progressing. This is why for someone like Joan, close monitoring by a primary care provider and cardiologist are important. Severe aortic stenosis may require heart valve replacement surgery.

At the time, Joan’s aortic stenosis was mild — she was not experiencing any symptoms — so the treatment plan was to monitor her with checkups twice a year with Dr. Alexander and also Dr. Tikhomirova.

“During Joan’s checkups, we reviewed her symptoms, if any, together. For example, was she experiencing any chest pain, fatigue, light headedness, or exercise intolerance?” explained Dr. Alexander, who is also the medical director of cardiac rehabilitation and the director of nuclear cardiology at Danbury Hospital. Joan also had regular echocardiograms to evaluate her heart and valve function.

Living with Aortic Stenosis

Joan has always had a lot of energy. She constantly evolved during her career and had many different roles as a nurse. Once she retired, she devoted her time to her community and family. She arranged local blood drives and taught classes at her synagogue. She arranged a Gift of Life event in Danbury, an organization that finds bone marrow matches for people who have blood cancer. Joan also was the sole caregiver for her ailing husband.

When Joan was caring for her husband, she had to keep sitting down to catch her breath. She attributed her labored breathing to the emotional and physical toll of being a caregiver. But when her husband recently passed away from kidney failure, she continued to have trouble breathing.

Drs. Alexander and Tikhomirova said Joan had been fairly asymptomatic since being diagnosed with aortic stenosis about five years ago. Then, her symptoms abruptly progressed over just a couple of months.

Joan loves to walk and she lives on a long street. Every day she would walk her cherished rescue dog, Baby Bucky, down to the end of the street — counting the mail boxes to mark her progress. She started to count fewer and fewer mailboxes until she could only reach the end of her driveway before stopping to gasp for air.

With her endearing sense of humor Joan said, “I took up a hobby many, many years ago, it was breathing — I happen to love breathing. When I started to fail at that hobby, my other activities got disrupted too.”

Joan missed spending time with her family and friends. She was disappointed because she couldn’t attend her nephew’s wedding. Her son had to take Baby Bucky because she couldn’t care for him anymore.

“It was very unlike me to stay inside and not do any activities. But I couldn’t breathe well, so I couldn’t move much. I also couldn’t sleep because I had so much discomfort,” said Joan. “I was becoming extremely concerned for my life.”

Transcatheter Aortic Valve Replacement at Danbury Hospital

Joan’s aortic stenosis had clearly progressed to the point where intervention was necessary. Given Joan’s age and overall health, Dr. Alexander recommended Transcatheter Aortic Valve Replacement (TAVR) as the best option for her. He contacted the structural heart team at Danbury Hospital; including, Mark Warshofsky, MD, a board-certified interventional cardiologist and the medical director of cardiovascular services for WCHN; and, Eileen Hurley, APRN and network clinical program director of the Heart Valve Center at WCHN.

WCHN’s Structural Heart Program provides patients who have vavlular and other forms of heart disease with the most advanced treatment options, including TAVR. TAVR is a minimally invasive procedure that is a safe alternative for patients who are at intermediate to high risk of complications from open heart surgery.

Traditionally, severe aortic stenosis has been treated by replacing the damaged aortic valve during an open-heart procedure. This requires opening the chest and temporarily stopping the heart. The TAVR procedure does not require an open-heart procedure. Instead the valve replacement is performed through a small entry point in the upper leg (most common), or another alternative point of entry. The interventional cardiologist guides the new valve via a catheter through the artery to the heart and replaces the damaged valve. Patients who have the TAVR procedure typically recover faster, have less pain, and go home sooner after surgery.

After meeting with Dr. Warshofsky and Eileen to discuss TAVR, Joan felt comfortable with her treatment plan.

“I wanted to be informed so I looked everything up online — I studied Dr. Warshofsky (wow!), and I studied TAVR. Eileen answered all of my questions and reassured me throughout the entire process,” said Joan. “I was determined to get better because I wanted to continue to live my life — I have so much to do! So, I decided to have the TAVR procedure.”

Joan is a primary example of the reason why WCHN has advanced treatments like TAVR available for our patients.

“Without TAVR, Joan’s options would have been much more limited because open heart surgery was not the safest option for her. Her quality of life would have continued to drastically decline due to the aortic stenosis symptoms,” explained Dr. Warshofsky. “Joan is full of life. She brings joy to everyone she meets. For folks like Joan that have so much to offer, TAVR is a great procedure that helps give them their life back.”

Dr. Alexander concurred and said that his patients who have had the TAVR procedure have had very successful outcomes.

“TAVR has taken aortic stenosis from a limiting and potentially fatal condition that required open heart surgery to treat, to a treatable condition with a minimally invasive procedure. It’s an incredible advancement in the field of cardiovascular disease, especially for our older patients,” said Dr. Alexander.

The Heart of the Matter

In October 2018, Joan had the TAVR procedure. She was home in just two days and was able to get back to the activities she loves, especially walking, soon after. Baby Bucky came home too! Joan is excited about the future. This year, she is looking forward to her birthday in April and attending her granddaughter’s wedding in June.

“Those months before the TAVR procedure, I felt like my life stopped. Everyone involved in my care at Danbury Hospital gave me my life back; and, it’s going to be beautiful because I can breathe again, walk again, and be with my family and friends again. My heart is big and full!”

Joan is thankful to her entire care team: From Drs. Alexander and Tikhomirova, who closely and carefully monitored her, to the administrative and medical staff at Danbury Hospital who coordinated all of her tests and helped her to mentally and physically prepare for surgery.

“The highly skilled and dedicated multidisciplinary team at Danbury Hospital makes it possible to provide the best, safest and most advanced heart care for patients like Joan,” said Dr. Warshofsky.

Joan was born at Danbury Hospital in 1932, when it was just a little brick building. As a lifelong Danbury resident, she has watched Danbury Hospital grow. She felt it was important to share her story so others would also know about the extraordinary care available to the community.

“I’m overwhelmed with the progress in heart care. Having worked as a nurse in an intensive care unit and coronary care, I never fathomed a procedure like TAVR would be possible. It’s remarkable that I’m here today,” said Joan.

The heart team at Danbury Hospital’s Praxair Regional Heart and Vascular Center has performed hundreds of TAVR procedures, with excellent patient outcomes. For more information about TAVR, or to schedule a consultation, please call (855) 743-2781.

Source:Western Connecticut Health Network
Photo Credit:Western Connecticut Health Network
Pictured: Joan Lipman, TAVR patient, with lead interventional cardiologist, Mark Warshofsky, MD at Danbury Hospital





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