NMMC Heart Surgeon Performs State’s First Transcatheter Tricuspid Valve Replacement
Dena Coleman of Sturgis (center) had Mississippi’s first transcatheter tricuspid valve replacement May 17 at North Mississippi Medical Center in Tupelo. She is pictured with cardiothoracic surgeon Dr. David Talton (left), who performed the procedure, and Leanne Presley, MSN, RN, (right) who oversees the Structural Heart Program at NMMC’s Heart and Vascular Institute.
TUPELO, Mississippi—Dena Coleman is a self-proclaimed “hermit,” but recently she made big news across the state.
On May 17, cardiothoracic surgeon Dr. David Talton performed Mississippi’s first transcatheter tricuspid valve replacement on the 53-year-old Sturgis woman at North Mississippi Medical Center in Tupelo.
Coleman was born with Ebstein anomaly, a rare heart defect where the tricuspid valve is in the wrong position and the valve's flaps (leaflets) are malformed. As a result, the valve does not work properly. Blood leaks back through the valve, making the heart work less efficiently and leading to enlargement of the heart and heart failure.
Coleman was diagnosed with the heart defect at birth, and while her parents somewhat limited her activity while growing up, she didn’t really experience difficulty until her mid-20s. “I got a bacterial infection—endocarditis—in my tricuspid valve,” she says. “They had to repair the valve with open heart surgery.”
Coleman recovered well and rocked along until she had her daughter, Kaylee. “The stress of pregnancy and childbirth was hard on my heart,” she says. “I couldn’t function well enough to even do daily chores.” In April 2002, she underwent a second open heart surgery—this time her surgeon replaced her tricuspid valve with an artificial one. Unfortunately, artificial valves wear out over time.
“Around the beginning of this year, I knew something was wrong,” Coleman says. “I couldn’t do anything without giving completely out—even going to the mailbox, picking up a load of clothes to wash or walking my dog. You don’t realize how valuable that next breath is until you can’t get one.”
When she saw her doctor in March, “I admitted I wasn’t feeling like I needed to be,” she says. He ordered an echocardiogram and, based on those results, referred her to Dr. Talton to see what could be done.
“Dr. Talton told me a third open heart surgery was not a good option for me,” Coleman says, because she had such profound heart failure.
Tricuspid valve replacement surgery is quite rare—Dr. Talton has only performed one other case in his 30 years of practice, and it was an open heart surgery. This time, he proposed performing Transcatheter Aortic Valve Replacement (TAVR), a minimally-invasive procedure that has been a huge breakthrough for patients considered too high risk for open heart surgery to replace their aortic valve. Dr. Talton recently performed NMMC’s 500th TAVR procedure since it was introduced in 2012, coincidentally on a patient also from Sturgis. Dr. Talton proposed using the same technique to replace Coleman’s tricuspid valve. His partner, cardiothoracic surgeon Dr. Vishal Sachdev, assisted with the procedure.
Instead of opening up Coleman’s chest a third time, Dr. Talton went through her femoral vein, requiring only a small incision in her leg. Next, a balloon catheter was placed across the faulty valve and stretched open so he could place the new tricuspid valve. When the balloon was inflated, it pushed the new valve into position inside the old one. The balloon catheter was then removed, and the new valve started working immediately.
After an overnight hospital stay, Coleman was discharged home with only a small bandage on her leg. She says she had “virtually no downtime” and right away could tell a difference “like night and day.”
“I haven’t felt good in such a long time. It was just like my life was at a miserable standstill,” Coleman says. “I’m glad Dr. Talton is a risk-taker and was willing to do this for me, because he did not have to try it. I’d do it again in a heartbeat.”
Now, not only is she tackling daily chores with vigor, but she has energy to spare for gardening and other outdoor adventures. “It was just a blessing,” Coleman says. “My prayers were answered. I’m definitely still here for a reason.”
For more information about NMMC’s Heart and Vascular Institute, call 1-800-THE DESK (1-800-843-3375) or visit www.nmhs.net/heart-vascular.