UM Cardiac Surgeons Remove, Rebuild Heart in Unprecedented Procedure
For the past six years, Sandra Lanier had been living with the stress and strain of recurring heart tumors. Since 1997, she had already endured three open-heart operations to remove the tumors. But two years after each operation, the benign but potentially deadly tumors, called myxomas, returned like clockwork at slightly different locations. Safe removal became more of a challenge with each new operation.
So when a tumor reappeared a fourth time this summer in her left atrium, Lanier was ready to take a risk in order to prevent the seemingly endless cycle of operations.
"I just wanted to try something different because having surgery every two years is nerve-wracking," said Lanier. It's hard on the body and the mind."
To halt this cycle, the surgeons needed to remove all of the atrial cells that might evolve into a tumor. So in order to save Lanier's life and spare her future surgeries, cardiac surgeons at the University of Maryland Medical Center performed an unprecedented procedure: they completely removed both of her heart's upper chambers (the left and right atria), then reconstructed them with animal and human donor tissue.
Even though she was scared to get this radical procedure done, Lanier was determined to go ahead.
"This was my fourth open heart surgery, and I've had them every two years, like clockwork," she said. "This [new procedure] would eliminate the tumors, and with this approach chances are they wouldn't come back. The percentage would be five instead of 100 percent."
Lanier, who is from Ware, Massachusetts, came to the Medical Center because of her connection with cardiac surgeon James S. Gammie, M.D., an associate professor of surgery at the University of Maryland School of Medicine. Dr. Gammie had previously operated on Lanier in 1999 and 2001 at the University of Massachusetts Medical Center in two of the earlier procedures to remove the tumors.
Her first operation was in 1997, after she was initially diagnosed with a heart tumor (an atrial myxoma) in the upper part of her heart.
A History of Heart Troubles
When her heart tumors first started developing six years ago, Lanier suffered various symptoms. At first, she had trouble breathing and her heart would race when she exerted herself.
When the second tumor appeared, it caused Lanier to get mini-strokes. "When I would exert myself the tumor would break off in little pieces and cause little blood clots in my feet and legs," she said.
Her condition also affected her wedding plans. She met her husband Larry in 1998. Right after they were engaged she found out about the second tumor. So as she was recovering from her second heart surgery, she had her wedding shower, in 2000. Since then the couple have been through two more surgeries.
What was it like to deal with this recurring problem?
"It was very stressful. The first time I had surgery the doctors said 'it probably won't come back but there are no guarantees.' Then they test you," said Lanier. "Every six months I was going for my transesophageal echocardiography (TEE) scan. The first year I was fine. But once the second year started approaching I started really getting scared, wondering if the tumor was going to come back."
And as she feared, it had returned. That was in 1999.
So she went back to University of Massachusetts Medical Center, where Dr. Gammie had just joined the staff. "Her tumor had come back, which was a very unusual situation," said Dr. Gammie.
That's when Dr. Gammie diagnosed Lanier with a syndrome called the "Carney Complex," a hereditary disorder that is associated with recurrent heart tumors as well as deep freckles on the skin. "There are only about 350 patients in the world that have been described as having this," said Dr. Gammie. "So that gave us an explanation as to why the tumor came back. We re-operated on her in 1999 and things went well."
But in 2001, a heart tumor was discovered for the third time by a TEE scan. Fortunately, physicians caught it early, before symptoms started to develop. Dr. Gammie was notified, and he removed the tumor.
When Lanier was diagnosed with a fourth tumor this summer, Lanier's cardiologist called Dr. Gammie to let him know the tumor had returned again. As he heard the news an idea came to his mind.
"It had come to my attention several years ago that Dr. Bartley Griffith had done a fairly radical operation on a patient who had a malignant heart tumor who was told it was incurable. Dr. Griffith had operated on her to remove her tumor. I said 'Why don't we do that on this patient?'" So Dr. Gammie told Lanier about the new procedure.
Cardiac surgeons at the Medical Center operated on Lanier on August 19. Despite the complex procedure, the doctors say Lanier has had an excellent recovery.
"The animal and human tissue knitted together nicely with the remaining half of her own heart," said Bartley P. Griffith, M.D., who, along with Dr. Gammie performed the surgery on Lanier. "Her newly constructed heart functions well and her recovery has been smooth."
Dr. Griffith is the chief of Cardiac Surgery at the University of Maryland Medical Center and professor and head of the Division of Cardiac Surgery at the University of Maryland School of Medicine.
Lanier went home on September 9.
A Special Bond
This was the third open-heart procedure Dr. Gammie performed on Sandy, so he felt a special bond with her.
"As heart surgeons we usually meet people, operate on them and know them for a few weeks and that's it," said Dr. Gammie. "So we don't have the long-term continuity. Certainly knowing her for a long time was almost like seeing an old friend again, so that was really special for me."
Likewise, Lanier expressed similar sentiments about Dr. Gammie.
"I think he's a wonderful doctor," she said. "I'm blessed to have him, I really am. He makes you feel comfortable, safe and in good hands and he has a great way of making you feel that things are going to be okay."
A Promising Future
Lanier's doctors believe she will go back to a fully normal life.
"We told her that we would expect a full, functional recovery, and that she should be able to lead a normal life," said Dr. Gammie. "She works with mentally challenged children, and she enjoys her job and we fully anticipate she'll get back to work within a few months."
For her part, Lanier looks forward to returning to her everyday life.
"I'm looking forward to getting back to my normal routine - working, exercising and gardening," she said. "I love my flowers." She also enjoys knitting, embroidery and spending time with her children.
Lanier is a certified nursing assistant who works with mentally challenged adults for the Commonwealth of Massachusetts Department of Mental Retardation. She recently returned to her job and so far, has had no recurrence of her tumors.
Lanier will see her cardiologist for follow-up visits. And she will be tested every six months for the next five years until doctors are sure that the tumors aren't returning. Typically, if the tumor doesn't return within five years it is unlikely that it will return again. But Lanier is more hopeful now, because the atrial tissue that kept on developing the tumors is no longer there, having been replaced by bovine and human donor tissue.
And she is thankful that the Medical Center surgeons were able to change her life. "Thank God for my doctors, that they have the gifts to do this type of delicate procedure," said Lanier. "I thank God for all of them, every day."
By Michelle W. Murray