Doctors at St. Mary Medical Center in Long Beach say they've saved a woman's life through a rare medical procedure that involves inserting an elongated balloon into an artificial heart valve and inflating it to widen the valve and relieve an obstruction.
While the procedure, called balloon valvuloplasti, has frequently been used to clear natural heart valves, the doctors say it has been employed in only a handful of cases involving patients with artificial valves.
"We had a great deal of difficulty at first," said Dr. Richard D. Spellberg, associate director of the hospital's cardiology department, who performed the unusual procedure last week on Angela Hernandez. "A natural valve will conform somewhat to the shape of the balloon and not tear loose, but who knows what will happen to an artificial valve when you blow up a balloon in it?"
As it turned out, what happened was the relief of congestive heart failure that Spellberg believes would have otherwise killed the patient.
"I'm grateful for what he's done," said Hernandez, recovering in her hospital room two days after the procedure was performed. "I hope and pray that he can do it for others."
Hernandez was a perfect candidate for the procedure, Spellberg said, because she had no alternative.
Hernandez, 64, who was born in Mexico, suffered a bout with rheumatic fever as a child. That damaged her heart valves, resulting in a lifetime of progressive heart disease.
By 1982, Spellberg said, Hernandez's condition was so bad that doctors performed open-heart surgery to replace the two damaged valves with artificial valves made out of the lining of a calf's heart.
For a time, her condition remained stable.
Then about a year ago, Spellberg said, one of the artificial valves began narrowing due to calcification and general deterioration. As a result of the increased congestion, he said, the blood in Hernandez's heart began backing into her lungs, causing shortness of breath and swelling throughout her body.
Last week, barely able to breathe, she was admitted to the hospital. Ordinarily in such cases, Spellberg said, doctors perform open-heart surgery to replace the defective valve with yet a new one. But Hernandez's generally poor health and the deteriorated condition of the existing valves made that impossible, he said. So after searching the literature for information on the handful of similar cases since 1987, Spellberg said, he decided to try the experimental procedure.
"We had virtually nothing to lose," he said. "Without it she would have died."
Doctors inserted a long catheter about the diameter of a pencil into an artery in Hernandez's leg and pushed it up through the chambers of her heart and into the defective valve. They then inserted the small balloon, positioned it in the valve and inflated it with a saline solution.
As a result, Spellberg said, the valve was widened and the unobstructed flow of blood increased.
Because of the risk involved, he said, the procedure is appropriate only for patients with deteriorated artificial valves who, like Hernandez, are too weak for surgery. While recent technological innovations have yielded artificial valves likely to last a lifetime, Spellberg said, as many as 40,000 Americans are living with valves produced in the early 1980s that are already in a state of deterioration.
"The treatment of choice is surgery," Spellberg said, "but where surgery is not an option, this new option should be considered."
In Hernandez's case, he said, the valve in question has about a 50-50 chance of going bad again within a year. If that happens, he said, doctors may have to repeat the risky procedure.
For the time being, though, the Long Beach grandmother and her family are enjoying what can literally be described as her new room to breathe.
"It's like a miracle," said Paula E. Ayala, Hernandez's daughter. "I thank God that he gave the doctor the means to help her. Any length of time, to me, is a gift."