Getting to the heart of the matter

Nancy Holland was used to feeling her heart race. For years, she thought there was an issue with her heart. She experienced heart palpitations, shakiness, and fatigue. However, she was repeatedly reassured that she was fine, and symptoms were likely related to anxiety.

“Whenever I would bring it up, other providers always told me what I was feeling was the result of stress and anxiety. As I got older, they said it could be from menopause,” Holland said.

Despite interfering with her daily activities, Holland began to accept her symptoms. However, as time passed, she became more fatigued and intolerant of her usual exercise routine. Holland ultimately retired from her work early as her symptoms continued to progress. When her best friend of 40 years unexpectedly passed away from an undiagnosed heart condition, she knew she had to listen to her body and seek help.

“I just returned from my mother’s funeral in California. It had been a horrible few months between the death of my best friend and my mom. I remember feeling exhausted and I could feel and hear the whoosh of my heart beating so loudly. I told my husband to take me to the emergency room. I knew what I was feeling wasn’t due to stress,” Holland said.

Holland went to Penn Medicine Doylestown Hospital’s Emergency Department where she underwent a series of tests. An echocardiogram, which is an imaging study of the heart that looks at the heart's structure, blood flow, and function, revealed Holland had severe mitral valve regurgitation due to leaflet disease.

Mitral valve regurgitation is a common form of heart valve disease. It occurs when the mitral valve doesn’t close correctly and blood leaks backward into the left atrium of the heart. The heart works harder as a result eventually causing symptoms and heart failure in late stages. Holland had many of the common heart failure symptoms associated with mitral valve regurgitation including fatigue, heart palpitations, shortness of breath, and weight gain from fluid retention.

Although she was relieved to finally have a diagnosis, she was also apprehensive. “It was nerve-racking to finally have a diagnosis, especially after what happened to my friend so recently,” Holland said.

Holland was referred to interventional cardiologist James Hansen, MD. After an evaluation, Hansen believed that Holland would need to have a mitral valve repair by an experienced mitral valve surgeon. Surgery would give her the best odds of fixing her valve and restoring blood flow in the proper direction. Hansen referred her to his colleague, cardiothoracic surgeon Anthony Tran, MD.

Minimally invasive mitral valve repair vs traditional mitral valve repair

Holland was initially concerned when she found out she needed heart surgery. The mitral valve repair procedures she read about were all considered open-heart surgery and seemed invasive. That meant a surgeon would make a large incision in her chest and saw open her sternum, to perform the surgery, meaning her recovery could take weeks to months.

However, Doylestown Health’s Woodall Center for Heart and Vascular Care offers several minimally invasive cardiovascular procedures, including minimally invasive mitral valve repair surgery. The minimally invasive approach differs from the sternotomy surgery because of how surgeons access the heart.

“The actual valve repair is done the same way. In the right hands, a well-done valve repair can be accomplished. The difference is that in minimally invasive surgery, we maintain the integrity of the chest wall and work between the ribs with minimal spreading. No bones are broken. This leads to a quicker recovery time after surgery,” Tran said.

After a careful evaluation, Tran determined that Holland would be a good candidate for a minimally invasive mitral valve repair. “Ultimately, we want a safe, effective, and efficient operation with excellent long-lasting results. Before scheduling a minimally invasive procedure, I routinely evaluate my patient’s anatomy with CT imaging. Along with the patient’s anatomy, a number of factors play into my decision-making such as whether they had previous chest or heart surgery, if they have significant lung disease, or the acuity of their illness, etc.” Tran said.

An unexpected growth

According to Tran, Holland had severe mitral valve regurgitation with complex pathology. She had what is referred to as a Barlow valve (a form of myxomatous mitral valve degeneration), where both of her mitral leaflets are elongated and prolapsed, billowing above the normal annular plane. During the minimally invasive mitral valve repair, Tran gained access to the heart from the right side of her chest through a tiny incision. Holland’s groin vessels were used to place her on temporary heart-lung bypass, and the repair was completed with specialized instruments and materials to restore her valve.

While doing the surgery through a 4 to 5-centimeter “heart port” incision on her right chest, Dr. Tran noticed another issue—a small tumor on her heart valve he identified as a papillary fibroelastoma. Although papillary fibroelastomas are non-cancerous, Tran said they can be a source of strokes. Tran removed the tumor during Holland’s surgery.

“Thank goodness Dr. Tran performed my surgery. I had complete confidence in him anyway. I know if anyone was going to be able to handle any complications it was him,” Holland said.

A follow-up echocardiogram two years after her surgery showed that Holland’s valve repair continues to look great.

A new lease on life

Holland said her experience with everyone at Doylestown Hospital left a lasting impression. “The entire process was outstanding. I had a nurse navigator who helped me line up all of my tests and appointments. I always knew what was going on. Dr. Tran was so kind and thorough and made sure I really understood what was happening,” she said.

After a short stay in the hospital, Holland was discharged. She immediately started to work on her physical therapy and did her daily home exercises. After several weeks, she was enrolled into cardiac rehabilitation at Doylestown Health, a comprehensive program with focus not only on strength and stamina, but also on healthy cooking and lifestyle modification. During her weekly sessions, Holland worked with a physical therapist to regain strength and improve her heart health. She credits the program with helping her lose over 20 pounds.

Today, Holland says she feels a certain sense of responsibility to live a healthy lifestyle. “Dr. Tran and all of my physicians and nurses gave me a new lease on life, a second chance. I feel an obligation to take care of my body and my heart,” she said.

Holland says her one regret is not taking action sooner. “I think you need to be your own advocate. You know what goes on in your body and when something isn’t right. Had I done this sooner, maybe things wouldn’t have been so bad,” she said. “Don’t hesitate.”