LVADS and Angels
A miraculous story of technology and faith
Harriette Feuerman, a 75-year-old resident of Chestnut Hill, has strong faith and a giving heart - in fact, her family and friends describe her as someone who's always eager to lend a hand to those in need. She spent years working for a nursing home run by
Catholic Charities while raising her family, and more recently has cared for her grandchildren while working for her local synagogue.
Several years ago, however, it was Feuerman's heart that needed help and in a very big way. Always an active, independent woman, Feuerman began experiencing shortness of breath with minimal activity.
"It got to the point where I couldn't even walk down the hallway without losing my breath," she said.
Feuerman's heart would take her on a journey to death's door and back again with the help of expert physicians, her family, advanced medical technology and her own strong spirit.
Diagnosing a rare condition
Evan Appelbaum, MD, a cardiologist at Beth Israel Deaconess Medical Center's
CardioVascular Institute (CVI), who viewed images of her heart and found that she was suffering from constrictive
pericarditis. This rare heart condition is marked by chronic inflammation of the sac-like covering of the heart (the pericardium), which causes it to become thick and rigid, making it difficult for the heart to stretch as needed to pump blood. As a result, blood backs up behind the heart, leading to swelling and other symptoms of congestive heart failure.
Appelbaum began by initially treating her symptoms with medications, including a blood thinner, or anticoagulant, and a diuretic to remove excess fluid from her body. Her symptoms continued to worsen. At this point, he consulted with
Robert C. Hagberg, MD, a cardiac surgeon and colleague at the CVI, who recommended a pericardiectomy.
"This is a challenging procedure, since it requires peeling away the heart's outer layer," explained Hagberg. "But leaving the condition unchecked was affecting the quality of Harriette's life, and it could eventually have become life threatening."
After discussing options with her family, Feuerman decided to go forward with the surgery.
Surgery succeeds, but heart needs more care
"The surgery successfully removed the hardened layer," said Hagberg, "but the right side of her heart - made up of thinner muscle that is more sensitive to manipulation - went into cardiogenic shock and stopped working. We tried to improve her heart's function with adrenalin-type medications to continue sufficient blood flow, but she went into cardiac arrest. Her heart stopped beating."
CVI staff quickly performed CPR, and Feuerman's heartbeat returned but her blood pressure remained very low. The state of cardiac shock continued. In a coma-like state, she remained connected to a breathing machine. Then she began to experience a multisystem failure of her lungs, her kidney, and her liver.
Inserting the LVAD that saved her life
Knowing that Feuerman was near death, Hagberg decided to insert a left
ventricular assist device, or LVAD (pronounced "el-vad"), a mechanical pump that helps pump blood from the lower left chamber of the heart - the left ventricle - to the rest of the body.
"In this case, we used an LVAD with a pump and power source located outside of the body to avoid the need for open-heart surgery," said Hagburg. "This type of ventricular assist device allows tubes to be inserted through a small incision in the groin. The tubes then travel through veins to connect the pump to the heart."
While Feuerman remained in a coma for more than three weeks, the LVAD supported her heart functions and a heart-lung machine kept her breathing. In the meantime, with her survival questionable, Hagberg recommended that Feuerman's children call in members of the extended family to say good-bye.
Feuerman's son flew in from California, along with her siblings from Florida and New York, while her son and daughter-in-law, Jeff and Rene Feuerman, kept vigil by her bedside and prayed. And, as Feuerman's friends, co-workers and congregants from her synagogue learned of her plight, the prayer circle widened.
"Her family and friends were all praying on her behalf," said Rene Feuerman.
"It was a difficult time, but we remained hopeful," said Jeff Feuerman. "Everyone at Beth Israel went above and beyond to support all of us through this time. Dr. Appelbaum connected with us every day and gave us his cell phone and email to enable us to reach him anytime. We had the best medical care possible."
A miraculous recovery
After three weeks on the LVAD device, Feuerman slowly began to show signs of improvement. At that point, physicians made the decision to remove the LVAD device. Surrounded by her family, Feuerman's LVAD was removed, and they watched with relief as her heart began to function normally on its own. With her heart stabilized, the breathing machine was also removed, and her lungs began to breathe on their own as well.
"The LVAD, along with spiritual and emotional support, saved her life," said Appelbaum. "She is definitely a miracle case."
After her discharge to a rehabilitation center, she continued to heal and returned home three weeks later. Feuerman has now returned to an active, healthy lifestyle, working 15 hours a week at the synagogue, taking regular walks for exercise and enjoying the company of her family.
"This case was both complex and unusual," explained Applebaum, "but Beth Israel's resources as an academic medical center - including skilled surgeons and support staff as well as advanced equipment and techniques - are geared to handle high-risk cases such as this."
"Her spirit and the prayer and support from her family and friends helped. Everyone stayed positive and delivered messages of love and healing. My hope is that this story is helpful to families who face similar circumstances. It's important not to give up, even when odds are not in a patient's favor," he added.
The experience has given Feuerman a new outlook on life.
"I have always believed in angels," she said, "and now I REALLY believe in angels! I was home by Thanksgiving last year and had so much to be thankful for. I feel wonderful and have a whole new chance to enjoy every day!"
What is a Ventricular Assist Device?
A ventricular assist device (VAD) is a machine that takes over the function of your heart. While the concept may sound scary, it's a device that, since first approved by the U.S. Food & Drug Administration in 1994, has kept numerous people alive when their hearts are too weak to function. In fact, this type of device received national attention last year, when former vice president Dick Cheney underwent surgery to implant an LVAD (left ventricular assist device) to assist his heart.
The LVAD, which helps pump blood from the lower left chamber of your heart (the left ventricle) to the rest of your body, is the most common type of VAD. A right ventricular assist device (RVAD) helps the right ventricle pump blood. If both types are required for a patient, the combination may be called a biventricular assist device (BIVAD).
The VAD has three components: a pump, an electronic controller and batteries, which all come together to function as one of the ventricles, the heart's pumping chambers.
For patients requiring permanent assistance for their heart, the pump is surgically placed in the belly. Those who need a temporary assist - during or after surgery or while awaiting a heart transplant - are connected to a pump outside of the body through tubes inserted into small incisions in the abdomen.
The pump contains tubes that connect to your heart, with one tube that draws blood into the pump and another that transports blood from the pump to your blood vessels.
The controller is like a small computer that controls how the pump works. Simply put, the pump takes on the function of a normal beating heart, and the controller becomes its brain. The controller also lets you know if the batteries are low or if the pump isn't working correctly. Batteries control the pump through a wire that connects them directly to the device. The battery and controller can be carried externally on a sling that fits over the shoulder or around the waist.
Posted October 2011