Heart of a Lion
Leonila Ochangco never thought she had a heart problem until a routine annual checkup in 2002 found her with a narrowed and leaky mitral valve. While the checkup found her heart beating irregularly, she was not alarmed. She had no history of heart disease.
“Also, I was able to have children, which would have been difficult if I had heart problems,” she said. But when other lifestyle-limiting symptoms began to show that made her undergo further tests, she ended up with no choice but to have an open heart surgery. “They corrected the problem by placing an artificial valve in my heart,” she recounted.
The surgery was a success. Leonila went back to work at a local bank, without any diet restrictions nor functional limitations. However, in 2012, her health declined anew and she developed progressively severe heart failure.
“I was in and out of the hospital for various reasons,” she said. It continued in early 2013. Her legs were swelling.The doctor attributed it to poor blood circulation and water retention, she also had difficulty sleeping, lying flat in bed due to shortness of breath and had difficulty breathing even on minimal exertion. At this time she was at her weakest.
It turned out that she had another heart valve issue. The aortic valve, which was mildly diseased during her surgery in 2002, like her mitral valve, had calcified and narrowed severely, the small valve opening was causing her heart to fail.
New Procedure, New Fears
Thus, she needed another open heart surgery, but she was already in her 50s then. However, her physicians at the time thought she could not survive another open heart surgery. She was markedly frail, malnourished, with an unstable cardiac status, and a prior history of open heart surgery-—which made a contemplated valve replacement procedure extremely risky. In early 2013, she was referred to interventional cardiologist Dr. Fabio Enrique Posas of
St. Luke’s–Global City for possible transcatheter aortic valve replacement.
Knowing that Leonila was in an advanced state of deterioration, Dr. Posas suggested a transcatheter aortic valve replacement or TAVR, which is inserted via the blood vessels at the groin, instead of an open heart surgery as her best chance at surviving aortic valve replacement. Dr. Posas together with Dr. Estanislao de Castro previously led the team that pioneered the use of TAVR in the country. Given her frail state, refractory heart failure and multiple competing medical problems, TAVR (which is much less invasive) is her best treatment and lifesaving option. However, not all physicians in the St. Luke’s TAVR team of specialists were in favor of carrying out the procedure given the patient’s extremely poor overall clinical condition and low chance of survival.
“A significant number of the team members who assessed her were telling me not to do it, primarily because they thought this was the end of the line for her—that she had no chance of surviving the procedure.”
Dr. Posas stated that Leonila’s daughter, Ina, convinced him to go ahead with the procedure despite the odds. “The most important reason why I decided to do this case and take the mortality risk was this young lady,” Dr. Posas confessed. “Because her eyes…forgive me for saying this. You know how when you look at a puppy who is pleading for food? She had that pleading look in her eyes that seemed to say, ‘Please help my mom, don’t abandon her, don’t say no!’”
Because Ina wouldn’t give up on her mom,
Dr. Posas decided that he wouldn’t give up on her either. Leonila had her own risks to take. She availed herself of early retirement and went ahead with the procedure. She was also aware that, given how weak she had become, she might not make it. After the valve implantation, Leonila underwent three other procedures. They put an intra aortic balloon pump to support her blood pressure and the pumping of her heart immediately after the procedure, and a pacemaker to regulate her heartbeat. She also had to undergo surgery for a blood clot in her brain.
After a month in the hospital, Leonila was discharged, but had to learn how to walk again. Gradually, though, she progressed to eating heartily and doing things on her own. She is now back to an enjoyable and gainful life. She is back to driving her car, is able to do all her daily activities and is back working as a manager at a local bank.
Leonila’s unexpected recovery is an inspiration to many, including Dr. Posas himself. “Every time I am tempted to say no [to a patient] who is in severe trouble due to aortic valve disease, I always think of her,” Dr. Posas stressed. Leonila added that Dr. Posas takes a photo of her during checkups to show to his fellow doctors who were part of the team that took care of her. They are always delighted to see their patient’s full recovery. Her recovery is nothing short of miraculous. “I only wish patients would learn to recognize the symptoms associated with the disease and realize that there are effective, less invasive, perhaps less risky ways of treating this disease,” says Dr. Posas. Patients need to be made aware so that they are able to recognize their disease and its symptoms. Seeking care early in their disease process can save lives and improve quality of life. The mortality and morbidity associated with symptomatic aortic valve stenosis is worse than most cancers. Fortunately, the treatment of this disease is effective and does not necessarily require a big open heart procedure. Medical therapy for symptomatic aortic valve stenosis has no beneficial role in decreasing mortality and has only limited effect in managing the symptoms associated with this disease.
“If it wasn’t for their patience and support I wouldn’t have been able to extend my life. I thought I wouldn’t see my children graduate,” said Leonila, who literally lived up to her name and showed the heart of a lion.
St. Luke's Medical Center - Global City
Rizal Drive cor. 32nd St. and 5th Ave
Taguig City, Philippines