Procedure at Willis-Knighton believed to be world’s first

Three doctors at Willis-Knighton joined to perform what they believe is the world’s first nonsurgical removal of a fibroelastoma attached to the aortic valve. Doctors found no reference to this type of procedure while searching options to help the patient. The lead cardiologist, Joseph L. Fredi, MD, FACC, with Pierremont Cardiology, was assisted by Boshra Louka, MD, FACC, FSCAI, of Willis-Knighton Cardiology. The two Willis-Knighton Physician Network interventional cardiologists were supported by Syed Mehmood, MD, FACS, of Red River Cardiovascular Surgeons. The minimally invasive procedure at the WK Heart & Vascular Institute hybrid suite was performed on a 77-year-old patient who was not a candidate for cardiac surgery due to multiple severe comorbid conditions.

A fibroelastoma is a non-malignant tumor primarily located on the left side of the heart. It can pose significant health threats to the patient, including stroke, heart attack, heart failure, emboli and even death. This fibroelastoma was located on the aortic valve leaflet, a thin flap of tissue that opens and closes to allow blood to leave the heart and flow outward throughout the body and supply organs with oxygen-rich blood.

“It is very rare,” Dr. Fredi said about the condition. “We really are not able to estimate the incidence in the general population as it is so rare. It is likely that less than 0.1% of patients who undergo cardiac surgery have fibroelastoma of the aortic valve.”

Typically, a fibroelastoma of the aortic valve is removed with open-heart surgery, which involves an incision through the breastbone and placing the patient on a heart/lung bypass machine. The procedure performed with the highly specialized structural heart team at Willis-Knighton required significant planning, including consultations with various cardiologists. Dr. Fredi said he first conceptualized the basic aspects of the procedure. Since the procedure had not been performed before, on the day prior to the procedure, Dr. Fredi and key support staff from the cath lab walked the team through the procedure step-bystep to assure a successful outcome. “It was a true team effort,” he affirmed.

During the three-hour procedure, catheters were placed percutaneously in the groin. Equipment to sever and remove the tumor was threaded through the catheters to the heart. Various techniques, including electrocauterization and aspiration, were used to successfully remove the fibroelastoma without damage to the aortic valve.

“The cardiac team at Willis-Knighton is committed to not only cutting-edge technology, but to the development of new procedures to advance the spectrum of patients who can receive cardiac care,” Dr. Fredi said. “We continue to push the boundaries for our patients,” Dr. Mehmood affirmed.

As the region’s high-volume heart care provider, Willis-Knighton is constantly investigating ways to enhance patient care. “As we continue to see the advances in equipment and technology, we hope that we keep offering less invasive techniques to keep our patients safe and still get efficient results,” Dr. Louka said.