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Patient Care
Case Studies 90-year-old man Over a six-month period, a 90-year-old man had become progressively breathless and fatigued while walking. The symptoms prevented him from accompanying clients to inspect construction sites, which was essential to his business. He had undergone successful bypass grafting more than 10 years before, followed by an angioplasty to relieve obstruction in a coronary artery. Aortic stenosis first became apparent five years prior to development of the symptoms. In spite of medication, the breathlessness and fatigue became progressively severe, preventing him from working. Diagnosis Howard Gilman Institute for Heart Valve Disease staff ordered an echocardiogram, which detected critically severe aortic stenosis. The diagnosis was confirmed by catheterization, at which time his bypass grafts were found to be functioning well. Treatment Surgeons at the Howard Gilman Institute for Heart Valve Disease performed a valve replacement. Outcome At 94, the patient was still running his business.
50-year-old woman An active 50-year old woman, who had contracted rheumatic fever as a child and had had mitral stenosis for years, found her exercise tolerance gradually decreasing over a year's time. Diagnosis Using a non-invasive echocardiogram, Howard Gilman Institute for Heart Valve Disease staff determined that she had a modest abnormality of pulmonary artery pressure (blood pressure in the lungs). The test indicated that the patient had complex valve anatomy, which was unsuitable for a catheterization-based balloon valvuloplasty. Treatment Howard Gilman Institute for Heart Valve Disease surgeons performed open valve repair, widening the opening through which blood flowed from the atrium to the ventricle. Outcome The patient not only recovered, but also returned to her full exercise level within three months.
31-year-old man A 31-year old asymptomatic male with severe aortic regurgitation was referred to the Howard Gilman Institute for Heart Valve Disease for evaluation by his internist, after the doctor detected a heart murmur. Diagnosis Non-invasive evaluation was performed using radioisotope imaging and an echocardiogram. Test results showed a leaking aortic valve and evidence of severe myocardial dysfunction. Even in the absence of symptoms, these results indicated relatively poor near-term survival without surgery. Treatment Surgeons at the Howard Gilman Institute for Heart Valve Disease performed a valve replacement. Heart function improved quickly and returned to normal within three years. Outcome The patient was asymptomatic and active for more than 10 years after his operation.
73-year-old woman A 73-year old active woman had recurrent irregular heartbeats but no other symptoms. Diagnosis Howard Gilman Institute for Heart Valve Disease staff diagnosed mitral regurgitation after a physical examination. The disease was confirmed as severe by echocardiogram. Radioisotope imaging during exercise indicated that the woman had right ventricular dysfunction, and there was imminent danger of her developing congestive heart failure. The echocardiogram showed that valve repair would be possible with good likelihood of success. Treatment A catheterization confirmed the patient's valvular disease and showed normal coronary arteries. Howard Gilman Institute for Heart Valve Disease surgeons performed successful valve repair. Outcome The patient returned to skiing at the age of 74.
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