When Sarah Rosenfeld says that NYU Langone’s doctors are “all heart,” she’s speaking from the bottom of her own.
More than 30 years ago, one of the institution’s renowned cardiac surgeons saved her son’s life with an innovative procedure performed on children born with one functioning heart ventricle. Last January, another pioneering surgeon saved Rosenfeld’s own life with a tiny clip designed to repair a leaky heart valve.
Mathew R. Williams, MD, director of NYU Langone’s Heart Valve Center, inserted the clip into Rosenfeld’s heart during a nonsurgical procedure that took about 25 minutes and required not a single stitch.
For Rosenfeld, a 78-year-old Brooklyn native with a long, complex history of heart problems, the procedure not only saved her life, but also restored much of her quality of life. A human resources executive who retired only last year, she had long commuted to Manhattan by subway. Its gauntlet of staircases and the sudden sprints to beat closing doors can be tiring for even the fittest New Yorkers, but for Rosenfeld, it began to feel dangerous.
“I’d walk 5 blocks to the station and then climb 50 steps to reach the elevated platform,” she recalls. “Sometimes, it left me in so much pain and so winded that I felt on the verge of fainting.”
By the time Rosenfeld reached her early 70s, she could no longer push through the discomfort. She consulted Adam H. Skolnick, MD, in NYU Langone’s Leon H. Charney Division of Cardiology, who ran a battery of tests that revealed intermittent atrial fibrillation, a type of arrhythmia.
The abnormality, Dr. Skolnick determined, was due to a condition known as mitral valve regurgitation, the most common form of heart valve disease, affecting an estimated 4 million Americans. It occurs when the leaflets of the mitral valve—one of the heart’s four gatekeepers—fail to close completely, allowing blood to backflow into the heart and lungs.
Although mild cases can often be controlled with medication, the only effective treatment for severe forms such as Rosenfeld’s may be to repair or replace the errant valve. However, some older people are too frail to survive the rigors of open heart surgery, while others may be unable or unwilling to endure months of painful recovery. Of the 1.7 million patients who become eligible for mitral valve surgery each year, however, only 30,000 undergo it. Without treatment, the condition can eventually lead to congestive heart failure.
By 2016, Rosenfeld was mostly homebound, struggling just to walk from one room of her apartment to another. “Everything had become so hard,” she says. Rosenfeld had consulted experts at several leading medical centers nationwide, but they all deemed her case too high-risk for the clip procedure.
“I had been to so many places,” she says, “but no one could offer solutions. One doctor advised me to exercise more. Another told me to stay home and drink tea.”
Dr. Skolnick referred Rosenfeld to the Heart Valve Center. Dr. Williams knew that because of Rosenfeld’s age, cardiac condition, and a chronic lung disease, open heart surgery was not an option. He also knew that her case would be challenging because calcium deposits had hardened the valve, offering little viable space to attach the clip. But he resolved to help, finding one small spot on her mitral valve where he thought he might be able to attach the clip successfully.
“Technically, we could do it,” he explains, “but if you fail to grasp the right amount of tissue, you can turn a leaky valve into a narrow one, making the problem worse.” Rosenfeld had become so debilitated, however, that Dr. Williams decided to move ahead. “With our vast experience,” he says, “we felt we had the best team to tackle this challenge.”
Even for less complex cases, the clip procedure demands rarified skills and a wide range of specialists. Dr. Williams—the first physician in the U.S. trained in both interventional cardiology and cardiac surgery— is a pioneer of catheter-based valve repairs, and his team is one of the most experienced in the country.
Cezar S. Staniloae, MD, an interventional cardiologist, sets the stage. Through a tiny puncture in the groin, he accesses the femoral vein, threading a catheter up into the heart. Muhamed Saric, MD, PhD, director of echocardiography and clinical director of noninvasive cardiology, is the navigator. Using live imaging, he provides millimeter-scale visual accuracy to guide Dr. Williams as he implants the device, which grips the leaflets of the valve and clips them together securely.
With the right team, Rosenfeld’s procedure went flawlessly. “Dr. Williams attached the clip on his first try,” says Rosenfeld. Like most who undergo this repair, she was home the next day. Her condition has improved markedly, and she’s grateful for the easy recovery.
“I feel the best I’ve felt in years,” Rosenfeld adds. “I have a rewarding, productive life, and I’ve regained my independence,” she says. “And that means a lot.”