David Walker faced a medical crossroads―for the third time.
He already had survived cancer and open-heart surgery, and both times had bounced back to enjoy years with his wife, kids and grandkids.
But when his artificial heart valve failed, the 57-year-old Grand Haven man again faced a third life-threatening challenge.
The malfunctioning valve left him weak and breathless. He carried an extra 100 pounds from fluid retention. He couldn’t walk to the end of his driveway.
In his fragile state, the possibility of open-heart surgery filled him with dread.
But then another solution appeared―in an unexpected place.
Through the Congenital Heart Center of Spectrum Health Helen DeVos Children’s Hospital, a clinic that helps babies (and adults) born with heart defects, he received a revolutionary new fix for his faulty valve. The new valve was implanted through a minimally invasive procedure, which allowed him to avoid open-heart surgery.
“It was great,” Walker said. “It’s 100 percent better than having your chest cracked open.”
The deft placement of a valve inside his artificial tricuspid valve―a first for the hospital―opened up new possibilities for Walker. He didn’t waste time exploring them.
Just three weeks after he got the new valve, he showed up at his checkup with one question.
“Can I go deer hunting?” he asked.
His wife, Reta, laughed and his cardiologist, Joseph Vettukattil, MD, smiled.
“Can I please go deer hunting?” Walker repeated with a grin.
Clearly, the new valve was doing its job. An echocardiogram confirmed it.
Dr. Vettukattil, MD, encouraged Walker to return to hunting and other activities after first taking time to get a little stronger.
“Just get back to your normal self, and then I don’t have a problem with it,” he said. “You should be able to do what you want to do. That’s the whole purpose of this.”
The Melody valve
It consists of a valve created from a cow’s jugular vein that is attached to a thin wire frame. A cardiologist places it on a catheter and guides it through the patient’s leg vein to the heart to place it inside the existing pulmonary valve―the one that controls the flow of blood from the heart’s right ventricle to the lungs.
The Melody valve was designed to help children and adults born with dysfunctional pulmonary valves, with the intent of delaying their next open heart surgery.
The bovine valve works especially well on the right side of the heart, because it accommodates the lower pressure of pulmonary circulation, Dr. Vettukattil said. Mechanical valves, which perform well on the left side of the heart, are more likely to become clogged when placed on the right side.
Dr. Vettukattil began placing Melody valves in patients in 2000 when he worked in England. When the device first became available in the U.S. in 2010 under a humanitarian device exemption, he began to use it in congenital heart patients at Helen DeVos Children’s Hospital.
From cancer to heart disease
However, Walker did not have a congenital heart defect. He and his doctors believe the heart problems stemmed from his bout with cancer.
In 1996, he found out he had Hodgkin’s lymphoma. He received chemotherapy and radiation therapy. After nearly a year of treatment, he returned to work and an active life, with no sign of cancer.
Four years later, however, he came home from work one day in need of a rest.
“I just pulled something in my chest and I can’t breathe,” he told his wife, Reta.
He just wanted to rest. But Reta, a neonatal intensive care nurse at Helen DeVos Children’s Hospital, insisted that a 40-year-old man with chest pains needed to see a doctor.
It took a series of tests to pinpoint the problem―calcification on the wall of his right atrium and the tricuspid valve. Not much blood could flow through the clogged valve.
It was an unusual diagnosis. Adults―at least those without congenital heart defects―typically develop problems with valves on the left side of the heart. Reta believes her husband’s tricuspid valve became damaged as he fought cancer.
Walker went to the Mayo Clinic in 2000 to undergo open-heart surgery to replace the tricuspid valve with an artificial one.
All seemed uneventful for the about 14 years. Walker continued to work―first at Hart & Cooley, a furnace pipe manufacturer, and then at Wal-Mart.
In early 2014, he developed an abnormal heart rhythm diagnosed as atrial flutter.
“Sometimes that happens years after you have heart surgery,” Reta said. “Whenever you are cutting on that heart muscle, it can cause irritability and issues.”
Despite treatments, his condition grew worse and he struggled with fluid build-up.
By the summer of 2016, he weighed 360 pounds. His doctors put him on large doses of diuretics, and he lost 93 pounds in one month.
After suffering bouts of bleeding in his gut, he stopped taking blood thinners except for an aspirin.
When Walker first came to Dr. Vetukattil’s clinic, he arrived in a wheelchair, breathless and tired. He couldn’t make the walk from the car to the office. He couldn’t even make it to the end of his driveway without stopping for breath.
A walk around the park
He suggested trying the new Melody valve, delivered through a catheter, to avoid the risks of surgery. Although the Melody valve is designed and approved to replace a pulmonary valve, which is smaller than the tricuspid valve, it has been used in the tricuspid position in some patients. The cardiologist places it inside the existing artificial valve.
Patients should be the focus. Is there anything you can do to help this particular person?
“I was all for it,” Walker said.
Reta appreciated the fact the valve would be implanted through a catheter, rather than with surgery.
“I remember after his first surgery, he said, ‘I will never do this again,’” she said.
Dr. Vettukattil, working with the cath lab team, implanted the Melody valve on Oct. 20. Walker went home the next day.
He suffered a setback a couple of weeks later―which he attributes to becoming too immersed in a project and skipping food and water for a day. But overall, Walker recovered at a steady pace.
At his follow-up appointment, he reported that walking to the mailbox no longer posed a challenge. He could stroll more than a mile through the park near his home. He planned to start cardiac rehab soon.
“So, you have significantly improved since the procedure?” Dr. Vettukattil asked.
“Oh, yeah,” Walker agreed. “Big time.”
Come back in three months, Dr. Vettukattil told him. He wanted to look for signs of narrowing or clots forming around the valve.
“This is a relatively new technique,” he said. He wanted to monitor Walker’s condition.
How medicine advances
The fix for Walker’s ailing heart shows the value of second opinions and exploring options when there is no known solution for a problem, Dr. Vettukattil said.
“Medicine advances only by people thinking tangentially,” he said. “And patients should be the focus. Is there anything you can do to help this particular person? How are we going to make this particular life better?”
Walker struggled to hold back tears as he talked about the impact that approach made on his life.
“It’s amazing,” he said simply.