At the Dean & St. Mary's Cardiac Center, Mary Jean McGrath meets Dr Benjamin Kleiber for the first time on January 19, 2016. Recently her fatigue and shortness of breath have increased considerably. Using her echocardiogram made six months earlier, he shows her the cause: mitral valve regurgitation. Her body isn't getting enough oxygen-rich blood.
The usual repair involves open-heart surgery. But Mary Jean is 90 years old -- probably too frail for this approach. However, a new procedure, called transcatheter mitral valve repair or TMVR, is less invasive, done through a small incision in the leg. TMVR may help Mary Jean, but Dr Kleiber will need more detailed images to know. Mary Jean decides she would like to proceed and Dr Kleiber schedules a new echocardiogram.
Eight days later, Mrs McGrath and her daughter Nancy Krumrei arrive at the hospital. A valet parking attendant helps Mary Jean into a wheelchair...
To get a more detailed picture of the heart and its mitral valve, Dr Kleiber will insert a doppler echo probe into Mrs McGrath's esophagus, much closer to her heart than would be the case with a probe on her chest. Nurse Cindie Bishop takes care of the initial checks in St. Mary's ambulatory surgery unit.
Mary Jean is moved to the fourth floor, where Nurse Larry Larson and sonographer Tosia Dennis introduce themselves and describe the procedure, called a transesophageal echocardiogram, or TEE. Mary Jean will be lightly sedated.
Larry arranges items that will be needed by Dr Kleiber. Tosia continues preparations with Mary Jean.
Teamwork: Tosia Dennis controls the recording of the echocardiogram as Dr Kleiber adjusts the position of the probe. Larry Larson keeps Mary Jean's chin positioned so she breathes easily. Detailed images of the heart appear on the monitor.
Dr Kleiber asks Tosia Dennis to switch to a 3D image. The TEE is almost done; it has taken less than fifteen minutes.
Two hours after leaving her room in the ambulatory surgery area, Mary Jean is back and awake. Dr Kleiber explains his preliminary findings to Mary Jean and her daughter Nancy: The worn leaflets of the mitral valve can't close completely. TMVR might be a solution, but he will have a better answer in about a week, after consulting with other cardiologists.
In an early morning conference, Dr John Phelan listens as Dr Kleiber describes his discussions with Abbott Vascular, manufacturer of the TMVR MitraClip device that might be used to repair the valve. Abbott's cardiologists have studied Mary Jean's images and estimate that there's a seventy percent chance the MitraClip will work.
Mary Jean's heart muscle is strong; she's a good candidate for the TMVR. It's tentatively scheduled for March 30, depending on the results of further tests. As the cardiologists' meeting ends, Dr Kleiber mentions Mary Jean's determination to attend her granddaughter's wedding, five months away.
During the next weeks Mary Jean has a chest x-ray, a pulmonary function test, and a carotid artery scan. Sonographer Kevin Iverson does the scan. The results look good: Mary Jean is still on track for a TMVR.
March 4: Dr Vijay Kantamneni, a cardiothoracic surgeon, explains TMVR’s possible complications. He needs to know what Mary Jean wants in case the doctors need to make decisions while she is sedated. It’s a sobering conversation about the risks inherent in the procedure. "I have never been a gambler," says Mrs McGrath, "but I think I want to go ahead. I like life!"
Three days later Mary Jean and her daughter see Dr Phelan, chief of cardiology. TMVR is a new technique, there are risks and Mary Jean is 90, so the cardiologists are proceeding with caution.
Dr Phelan reviews her history and finds a diagnosis of arterial blockage five years ago. Nancy, a retired nurse, describes her mother’s symptoms then. The blockage was minor and didn’t warrant treatment, but Dr Phelan is concerned that it may have worsened.
So before going ahead with the TMVR (now three weeks away), Dr Phelan wants to check the blood supply to Mary Jean’s heart muscle. He needs to know that arterial blockage won’t be a problem. Mary Jean and Nancy agree to a cardiac catheterization.
March 16: Mary Jean McGrath's youngest daughter, Barb Hixon, arrives from Atlanta to be with her mother for the cardiac catheterization. She is greeted by Nancy Krumrei. Both daughters are nurses.
March 17: in the catheterization suite, nurse Sarah Bronn introduces herself to Mrs McGrath.
Mandie Crennell "scrubs in." One of four nurses assisting at the catheterization, this makes her the only one prepared to enter the sterile field and work side by side with Dr Phelan.
Mandie readies syringes of saline solution. The blue cover on the table marks it as being within the sterile field.
Sarah Bronn asks Mary Jean if she has any questions before Dr Phelan begins..
10:50 am. Mandie Crennell and John Phelan check with each other and the cardiac catheterization begins.
Tiffany Fox monitors.
10:36: Sarah tells Mary Jean the procedure is all done. The x-ray machine is pulled back, and Mandie picks up the used towels.
Mandie Crennell applies pressure to the wound at the catheter's insertion site to help it close.
Dr Phelan tells Mary Jean's daughters that the catheterization went well and that there has been no significant blockage to her arteries in the last five years. (L-R: Kerry Wilson, Nancy Krumrei, Barb Hixon) Phelan will consult with colleagues to decide if they should go ahead with the TMVR.
March 30, 7:19 am: The big day. A week earlier, Drs. Kleiber, Phelan, and Balin decided to go ahead with the TMVR. Mary Jean is ready to go up to the operating room. Her daughter Kerry gives her a kiss.
Winfred Parker guides Mary Jean's gurney to the surgery area...
...where she is greeted by Jennifer Schildt, a Certified Registered Nurse Anesthetist.
A nurse carefully prepares mixtures of saline solution and Heparin and labels each bag.
Dr. Teggatz, the anesthesiologist, administers the initial sedatives.
Working amidst an array of equipment -- for transesophageal echocardiogram (TEE) sonography on the left and for anesthesia on the right -- the team gets Mrs McGrath ready for the TMVR. Her legs and torso need to be positioned comfortably but precisely.
Jen Schildt monitors Mary Jean's vital signs.
The three cardiologists examine doppler images of Mary Jean's mitral valve regurgitation on the monitor. [L-R: Dr Phelan, Dr. Kleiber, Dr Vijay Kantamneni, and sonographer Stacey Ragels]
Dr Phelan eases a catheter through a small incision in Mary Jean's femoral vein. It will emerge into the right atrium of her heart.
The operating room lights are switched to green to allow a clearer view of images on the monitors. [L-R: Stacey Ragels, Dr Kleiber, Dr Phelan]
Dr Eric Teggatz
Drs Phelan and Kantamneni watch the progress of the catheter, called a Baylis, as it moves into Mary Jean's heart. Between them is Brandon Wisch, the scrub tech, and, in the background, German Granados, an advisor from Abbott Vascular, manufacturer of the MitraClip device that will be used to repair Mary Jean's mitral valve. Eric Lottes is in the monitoring room.
Drs Kantamneni and Phelan examine the catheter's progress on two different monitors: one shows an x-ray, the other an echocardiogram. The catheter follows a difficult path. The doctors, moving cautiously, decide to ask Dr Kelly McDonnell to join them. Her specialty is cardiac electrophysiology; she has lots of experence guiding probes into the heart.
Dr McDonnell has been working in another area of the hospital, but she arrives quickly. She scrubs in and is helped into her gown.
Dr McDonnell assists Dr Phelan in moving the guide wire to the exact position needed to pierce the septum between the right and left atria -- the last step on the way to the left atrium, above Mary Jean's mitral valve.
This is the delivery device for the MitraClip. Dr Phelan has carefully positioned the clip to hold the valve's leaflets together. Now the three cardiologists study the monitors showing the mitral valve in action: Is the clip in the best spot? Should it be permanently secured there, or would it be better in a different position?
The x-ray and doppler images help them decide. It is clear that the leakage has been significantly reduced. To test this, Dr. Phelan asks Jen Schildt to raise Mary Jean's blood pressure temporarily. The repair looks good even at the higher pressures. The decision is made to secure the clip.
The MitraClip is secured. The repair is successful. The lights are turned back up.
Drs Phelan and Kantamneni carefully remove the catheter from the incision in the vein...
...and Dr Kantamneni sutures the incision...
...and applies pressure to the wound to help it close. The procedure has come to a very satisfying finish.
11:08 am: Dr Phelan goes to the family waiting area to tell Mary Jean's children -- Nancy, Kevin, and Kerry -- that the operation was a success!
And in the operating room, Allie Krebs and the anesthesia team monitor Mary Jean's emergence from sedation.
Dr Teggatz and Jen Schildt move Mary Jean to the cardiac intensive care unit for recovery.
12:41: Nancy Krumrei greets her mother in the intensive care unit.
The next morning, Dr Phelan visits Mary Jean and tells her, "I can't begin to say HOW happy I am with the results!"
Dr Kleiber comes also... and strikes a victory pose! Mary Jean is feeling much better. Her energy seems to have returned overnight.
Nurse Kaylah Peschel checks an IV in Mary Jean's left hand. It is no longer needed. She removes it while nurse Abby Goff adjusts the IV in Mary Jean's right arm...
...and just then Rosa Rodriguez arrives with breakfast.
It's a new day, and Mary Jean will be home soon.
Five days later, Mary Jean is at the Dean Clinic for a checkup with her primary care physician, Dr Adam Balin. It was Dr Balin who first suggested the MitraClip procedure to Mrs McGrath. Nurse Keeley Wineka checks her in, "You're looking great!"
Dr Balin enters, "So how are you feeling now, five days after your surgery?" "Oh, I feel much better! I'm so glad you told me about it!" Nancy adds, "She has more energy, she walks farther than she could before; she gets right up out of a chair now! Before, she got up so slowly!"...
Dr Balin and Mrs McGrath talk about her medications. They decide to schedule a follow-up visit for June, sometime before the wedding of Mary Jean's granddaughter.
Two days later Mary Jean attends a birthday party for her oldest son Todd. He is 69. She plays with her great-granddaughter Nora Mae McGrath; Nora has just turned one.
Five weeks after her MitraClip was put in, Mary Jean McGrath and her daughter Nancy arrive at the clinic for tests and a visit with Dr. Kleiber. Mary Jean, no longer out-of-breath, now walks easily -- previously she had needed a wheelchair...
Sonographer Nicole Spicer administers an echocardiogram...
...and shortly afterwards Sarah Brooks administers an EKG.
The EKG and echo tests look good. Dr Kleiber listens to Mary Jean's heart. It sounds good.
...and so, in June, at the wedding of Mary Jean's graddaughter Natalie, Nancy McGrath Krumrei greets her mother. Mary Jean's other daughters, Barb and Kerry look on. Maureen Cassidy, the wedding photographer, captures the moment.
And like most weddings, this one is an occasion for reunions. Four of Mary Jean's sisters and a brother have come to Madison. (l-r: Jeff Smith, Barb Maakstead, Mary Jean McGrath, Jan Feldman, Vivian Carter, and Hattie Pyatt)
