Steven Filby, M.D.
PINEHURST – Mary Hale has been the assistant manager at a Laurinburg fitness center for 11 years, but had never exercised there until a procedure at FirstHealth Moore Regional Hospital corrected a heart defect she had had since birth but didn’t know about until recently.
The minimally invasive patent ductus arteriosus (PDA) closure performed by Steven Filby, M.D., an interventional cardiologist with Pinehurst Medical Clinic, was a first for Moore Regional and it left Hale feeling better than she had in years.
“I feel like a totally different person,” she says. “I haven’t felt like this in a long time.”
Dr. Filby calls Hale “a poster child” for PDA because her condition had existed from birth but didn’t cause any symptoms until she reached middle age. “Patients may go into their fourth or fifth decade of life before developing symptoms,” he says. “This was a typical presentation.”
A heart problem that involves an abnormal blood flow between two of the major arteries connected to the heart, a PDA is usually diagnosed in infants. Before birth, the aorta and the pulmonary artery are connected by a blood vessel (the ductus arteriosus) that is an essential part of fetal blood circulation.
Usually, as part of the normal changes that occur in infant circulation, the vessel will close within minutes or a few days of birth. In some babies, however, it remains open (or patent), allowing oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery and straining the heart and increasing blood pressure in the arteries in the lungs.
Small PDAs sometimes close without treatment, but treatment is required if a PDA is large or causes health problems. Because most of these defects are diagnosed in newborns, treatment (medicine, catheter-based procedures or surgery) usually occurs shortly after birth. Occasionally, however, in about one in 2,000 cases and more often in females, the condition will go undetected until the patient becomes an adult and develops shortness of breath, pain or arrhythmia.
Long-term PDA can put pressure on the right side of the heart, leading to congestive heart failure or pulmonary hypertension (abnormally high blood pressure in the arteries in the lungs).
Hale, who is now 54, had been having chest pain and shortness of breath for about five years and had gone to a couple of different doctors about her problem. “They just kept telling me they couldn’t find anything,” she says.
A visit to Laurinburg cardiologist John Brooks, M.D., changed all that. When a CT scan revealed the PDA, Dr. Brooks sent Hale to Dr. Filby. He evaluated her condition and told her that her options for closing the hole included open-heart surgery and the minimally invasive closure procedure.
She chose the minimally invasive option.
“Dr. Filby said, ‘There’s open-heart surgery, and there’s this, and the risk is 1 percent,’” Hale says. “I said, ‘We’re going with the 1 percent.’”
During a procedure that began very much like a typical heart catheterization, Dr. Filby placed a catheter in Hale’s groin and carefully moved a special wire across the defect in her heart. After using a very small ultrasound probe called intravascular ultrasound to size the opening of the defect, he pulled a mushroom-shaped nitinol occluder (closure device) through the hole, tested it to make sure it fit snugly and then released it to plug the hole.
According to Dr. Filby, the device will eventually be incorporated into the tissue of Hale’s heart.
“It’s quite remarkable, and the complication risk is extremely low,” Dr. Filby says about the procedure.
The entire procedure, which was done in an outpatient setting, took about two hours. Hale was given antibiotics afterward and went home the next day. She will take aspirin and Plavix, a medication that prevents clot formation, for six months and follow up with Dr. Filby at one, three and six months and then annually.
Although PDAs are usually diagnosed in infants and closed by pediatric cardiologists, Dr. Filby expects that improved diagnostics will detect the problem in more and more adults.
“Our diagnostic tools are so much better,” he says. “People are being increasingly diagnosed because of better diagnostic tools.”
Hale, who says she feels like a totally different person, now walks on her treadmill and works in her garden without the chest pain and shortness of breath she had experienced before the closure procedure.
“I have been the assistant manager at a fitness center since 1999, but I never exercised there until after my surgery,” she says. “I went in and walked for 40 minutes. It was the first time I’d ever exercised there.”