Avoiding Open Surgery to Replace a Failing Heart Valve: Bob's Story

Bob Foley is an active 61-year-old who enjoys cycling, swimming, coaching lacrosse, and boating. You would never guess he was born with a sick heart.

The human heart includes four chambers. The two lower chambers are ventricles. The right ventricle pumps blood out to the lungs. The left ventricle pumps blood out to the rest of the body. Bob was born with a rare congenital heart condition in which the right ventricle is where the left one should be—and vice versa.

People with transposed ventricles may develop leaky heart valves and cardiomyopathy (weakening of the heart muscle). Although Bob was a healthy, sports-loving child, it was only a matter of time before heart problems would emerge.

At age 42, Bob was found to have tricuspid valve regurgitation, a condition caused when the heart's tricuspid valve doesn't close properly and leaks. He had the valve surgically replaced at a children's hospital where he had been followed since being diagnosed with congenital heart disease (CHD) around age 6.

That prosthetic valve lasted nearly two decades. Then, when Bob was 61, it began to fail. As a result, his heart went into cardiogenic shock. This is a potentially life-threatening condition in which the heart cannot pump enough blood to support the needs of the body's organs.

"Since Bob's heart has never been normal, even a small change, like a new valve problem, can cause the right ventricle to struggle and lead to a rapid decline," said Mass General Brigham cardiologist Doreen DeFaria Yeh, MD. "And that's what happened with him."

At risk of having a cardiac arrest

Five years ago, Bob decided to transition his CHD care to an adult hospital. After reading positive online reviews, he reached out to Dr. DeFaria at Mass General Brigham Heart and Vascular Institute. Dr. DeFaria specializes in caring for adult patients with CHD. Bob has since been under the care of Dr. DeFaria and her colleague, Christopher Newton-Cheh, MD, MPH, an advanced heart failure specialist.

One morning, while off from his job as director of post-secondary education at a vocational high school, Bob started having difficulty breathing. He told his wife, Cathy, he would head to urgent care to make sure nothing was wrong.

By the time he arrived, he was still struggling to breathe and also felt a tightness in his chest. "I walked in and asked them to call an ambulance," he said.

The ambulance took Bob to a local community hospital. At first, his doctors thought he had pneumonia. Then they changed the diagnosis to pulmonary edema (buildup of fluid in the lungs). He was placed in the cardiac critical care unit that evening.

Upon his request, Bob was transferred to Massachusetts General Hospital several days later. By then, his condition had gotten much worse. Recognizing that he was seriously ill, Dr. DeFaria immediately called in adult CHD sonographers to conduct imaging tests and find out more precisely what was going on.

"It was clear that his tricuspid valve was not working and he needed an intervention," Dr. DeFaria said. "We rallied a multidisciplinary team—our doctors who do congenital valve procedures, our advanced heart failure doctors, our cardiac critical care doctors—and prepared to do an emergency procedure. If we didn't act quickly, he could have had a cardiac arrest within 24 hours."

About a week and a half after the procedure, Bob was discharged and returned to his home in Kingston, Massachusetts. At first, he moved slowly with short walks and careful pacing, but he could manage the stairs to his bedroom. His strength and stamina quickly came back. Within a few weeks, he and Cathy were completing three-mile walks at a steady pace while vacationing in Florida.

Bob had high praise for his care team at Mass General Brigham, especially Dr. DeFaria.

"I haven't had a better physician than her. There was a sense of caring that I hadn't experienced before," he said. "And she never dictated what I had to do. Instead, she explained what I needed to change and what the result would be. It's kind of like how I approach coaching lacrosse players."

Less than six months after the procedure, Bob is nearly as active as ever. In addition to regular bike rides together, he and Cathy head out on their 32-foot Sea Ray boat most every weekend. Life is good again.

"I'm eternally grateful to Dr. DeFaria, Dr. Newton-Cheh, Dr. Inglessis-Azuaje, and all the other people who have taken care of me at Mass General Brigham," Bob said. "I can't say enough positive things about them. I mean, I owe them my life."