Surgical Technique New to Baltimore Saves Man

For immediate release: November 22, 2013

For the first time in Baltimore, vascular surgeons at the University of Maryland Medical Center have successfully removed a blockage in a patient’s pulmonary artery using a new catheter-based, minimally invasive procedure instead of the traditional surgery, which requires cracking the entire chest. The complex, percutaneous approach provides faster patient recovery than traditional open heart surgery and may be an option for patients who are too sick to undergo open surgery.

Not many minimally invasive procedures are done on the pulmonary artery because the work is technically challenging and requires great skill. The artery carries a high volume of blood (five liters per minute) over a short distance through a delicate structure. The surgery is performed while the heart is beating and blood is flowing through the artery. The vascular surgeon’s tools are snaked through the heart into the pulmonary artery.

“You have to go through the agitated heart, you have to find the pulmonary valve, and that’s chaos, essentially, and then very gently pass your wires and catheter through the pulmonary artery, without injuring it,” says Shahab Toursavadkohi, MD, assistant professor of surgery at the University of Maryland School of Medicine and a vascular surgeon at the University of Maryland Medical Center.

The first use in Baltimore of new technology to unblock a pulmonary embolism occurred in the case of a Parkville, Md., man. “The new technology we use is ultrasound enhanced. It combines a catheter that infuses an anticoagulant with ultrasound, which creates a vibration, making it possible to apply the anticoagulant deeper and deeper into the clot,” says Dr. Toursavadkohi.

To understand what’s at work, think of sugar in coffee. “If you put sugar in coffee, but don’t stir it, it won’t dissolve very quickly. If you start stirring, you add a mechanical force to the chemical reaction, and speed it up. That’s exactly what happens with the ultrasound. “You can see clot dissolution during the procedure,” says Dr. Toursavadkohi. “When the catheter contacts the first clot, you can see it fall apart.”

“The doctors and nurses at this hospital saved my life!” says Donald May, describing what happened to him at the University of Maryland R Adams Cowley Shock Trauma Center. May was transferred from another hospital to Shock Trauma for care of a difficult-to-treat leg infection.

A routine blood test found elevated levels of proteins associated with heart damage in Mr. May, prompting a nurse practitioner in Shock Trauma’s Soft Tissue Infection Service to order a computed tomography (CT) scan.

The scan showed a life-threatening blood clot that blocked 90 percent of blood flow through his pulmonary artery, the artery connecting the lungs and the right side of the heart, a critical part of the system that oxygenates blood.

An acute pulmonary embolism or blood clot can decrease blood supply to the lungs, causing lung tissue to die. Surgical intervention was needed immediately.

Mr. May opted to undergo the percutaneous procedure instead of the open-chest procedure because it would speed up his recovery. Open heart surgery typically requires four to six days in the hospital after the procedure and about two months before the patient can return to normal activities. By contrast, a typical patient who has had the minimally invasive procedure can go home the next day, assuming there are no complications.

“Without the surgery, I would not be doing so well today,” says Mr. May.