Patient Stories: Heart

Heart & Vascular Institute-Texas Medical Center

Ruben's Story

Ruben is no stranger to heart problems, but clogged arteries never slow him down for long. "Retirement" for the former school superintendent includes running his own silk-screening business, keeping his home in good shape and tinkering with the family's cuckoo clock collection in his garage workshop.

"I'm 73, and I do many things that many young people can't do," brags Ruben, who lives in San Benito.

Ruben's fitness, however, belies coronary problems that began more than 20 years ago. He underwent a triple bypass in the early 1980s, a quadruple bypass a decade later and a stent procedure a few years ago.

Last year, kidney stone problems sent Ruben to the hospital in Harlingen, where he experienced chest pains while in the emergency room. Concerned about his medical history, his doctor ordered X-rays and an angiogram. The cardiologist halted heart catheterization, however, because Ruben's previous surgeries made continuing too risky.

"Ruben was not considered a candidate for further surgery because his cardiac function had deteriorated to a dangerously low level," said Richard Smalling, M.D., the J. Brent Sterling Professor of Cardiovascular Medicine at the UT Medical School-Houston. Several arteries, including two that provide blood to the heart muscle itself, were either blocked or critically narrow, and his physicians told him nothing else could be done.
   

But Ruben's family doctor recommended seeking a second opinion, which is what brought him from the Rio Grande Valley to Smalling and the Memorial Hermann Heart & Vascular Institute-TMC.

"Dr. Smalling said he was going to put me on a heart pump that would take over if my heart stopped," Ruben recalled.

The pump is an innovative new tool called the TandemHeart™ pVAD , or percutaneous ventricular assist device. "The TandemHeart takes oxygenated blood from the left upper chamber of the heart and pumps it into the arterial system," Smalling said. "It bypasses the main pumping chamber – the left ventricle – so the heart doesn't have to work as hard."

Smalling began using the TandemHeart last year with patients who couldn't withstand open heart surgery or even minimally invasive angioplasty or stent procedures.

"We use it while fixing the arteries in patients who have severe heart damage and multiple, severe blockages," Smalling said. "Sending them to surgery can be very risky, and using angioplasty without support is also risky."

If the heart is functioning at a greatly diminished level, it may not be able, on its own, to support the patient during the necessary repair procedures. But using TandemHeart to support heart function, Smalling was able to repair Ruben's arteries with stent implants.

When using the TandemHeart, Smalling inserts a catheter into the large, femoral artery on one side of the groin to perform the necessary angioplasty or stent placement.

On the other side of the groin, catheters are inserted in both the femoral vein and artery. The one entering the vein is threaded into the heart's right atrium. To gain access to the left atrium, where oxygenated blood arrives from the lungs, cardiologists must puncture a thin membrane between the heart's two upper chambers. 

"This is technically very challenging and requires a good, organized team," Smalling notes. "We've been doing this for more than 25 years and have a very good success rate in doing these punctures."

Oxygen-rich blood is then pumped out of the left atrium, into the TandemHeart pump and back into the body through the arterial catheter in the groin. The patient, who remains conscious throughout the procedure, isn't affected by dips in heart function. He is then weaned off the pump before leaving the catheterization lab.

Ruben's TandemHeart-assisted stenting was so successful that he was discharged from the hospital the next day. Smalling asked him to stay in Houston one additional night and sent him immediately across the street to the Memorial Hermann Wellness Center.

There, nutritionists counseled Ruben about a heart-healthy diet, and he walked on a treadmill for 30 minutes. "They were surprised that I was able to do it," Ruben said.

Back home in San Benito, Ruben eats lots of fish and vegetables and has lost more than 25 lbs. since first visiting the Harlingen emergency room. He gets up by 5 a.m. to make corrugated plastic yard signs for real estate agents and local politicians.

"I don't stay in bed," Ruben said. "I feel strong, and I don't get tired walking."