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A lung disease thought hopeless until doctors tried this treatment

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Lakeitha Perry was discharged from a local hospital with no treatment options for her pulmonary hypertension, but innovative treatment methods transformed her prognosis and ultimately saved her life.

For nearly 11 years, Lakeitha Perry has struggled with serious health problems, including chronic pulmonary embolisms, or PE, or blood clots in her lungs.

However, thanks to advanced treatment methods and the expertise of doctors at the University of Michigan Health Frankel Cardiovascular Center, the grandmother of seven is now “living on the other side of the healing.”

How it began

Perry, 43, was diagnosed with pulmonary embolism in 2010 after experiencing shortness of breath and exhaustion. She was treated with blood thinners at her local hospital to dissolve the clots that had formed in her lungs.

“I was put on warfarin for eight months, then taken off because doctors assumed the clots had dissolved,” said the Detroit resident.

However, after her symptoms persisted, she was eventually diagnosed with chronic thromboembolic pulmonary hypertension, or CTEPH, a rare form of hypertension in the lungs’ arteries that occurs in approximately 4% of PE patients.

CTEPH is caused by pulmonary embolisms that do not dissolve despite blood thinner treatment. These embolisms can cause scarring in the lungs’ blood vessels, obstructing normal blood flow and taxing the right side of the heart.

Perry was referred to the Frankel Cardiovascular Center in 2015, where a multidisciplinary team provides advanced care to patients suffering from PE and CTEPH. She met with cardiothoracic surgeon Jonathan Haft, M.D., a specialist in pulmonary endarterectomy (PEA), a novel treatment for CTEPH.

The procedure necessitates the use of a technique called hypothermic circulatory arrest, which involves cooling the patient’s blood to slow the body’s metabolism.

“This allows brief pauses in circulation to best visualize the fragile layer between the old fibrous clot and the wall of the pulmonary artery,” said Haft. “PEA is best used for patients whose obstructions are located predominantly in the larger branches of the pulmonary arteries.”

“Lakeitha recovered and was doing well following the procedure, and returned to her local physician’s care,” said nurse practitioner Susanne McDevitt, N.P. “However, she was still experiencing pulmonary hypertension symptoms and needed to be on lifelong blood thinning medication.”

Perry was in and out of her local hospital in early 2020 due to severe pulmonary hypertension symptoms.

“She had worsening right-sided ventricular failure due to additional pulmonary embolisms and was considered to be extremely ill,” said McDevitt, adding,

“She had limitations in all activities of daily living due to shortness of breath and fatigue.”

According to Perry, she was told by her local doctors that she had no hope for further treatment.

“The doctors told me there was nothing more they could do for me and I was sent home with hospice care,” she said.

Perry returned to U-M and cardiologist Victor Moles, M.D., at the urging of her sister, who suggested she might be a candidate for balloon pulmonary angioplasty (BPA), a highly specialised procedure brought to U-M by interventional cardiologist Vikas Aggarwal, M.D., for the treatment of CTEPH.

Due to the complexity of her health, Perry was once again in the ideal location for treatment when she returned to U-M, according to Moles.

“While pulmonary endarterectomy allows us to treat blood clots in the larger branches of the pulmonary arteries, patients with blood clots in the smaller arteries are treated with balloon pulmonary angioplasty,” said Aggarwal.

“PEA and BPA are complementary procedures sometimes used in conjunction to treat patients who have blood clots in larger and smaller branches of the pulmonary arteries, respectively.

“BPA is performed in the cardiac catheterization laboratory where a balloon catheter is used to open up the smaller branches of the pulmonary arteries that often can’t be reached through a pulmonary endarterectomy,” said Aggarwal.

“For years, there wasn’t a good treatment for reaching these smaller blocked branches, but now with balloon pulmonary angioplasty, we can give our patients hope.”

BPA is usually carried out in a series of four to eight procedures. A long, thin catheter is inserted into the artery through the neck or groyne during the minimally invasive percutaneous treatment, and a second hollow tube is introduced through the catheter and passed to the diseased lung vessels. A wire is guided through the vessels using X-ray images, and a deflated balloon is directed to the site of blockage. The balloon is inflated to press the clots against the artery walls, creating a pathway and restoring blood flow. After that, the balloon is deflated and removed. Each BPA procedure involves the treatment of multiple vessels. Patients are given a light anaesthetic and are usually discharged the following day.

“At one time, balloon pulmonary angioplasty was considered very high risk, but today we have the right team and the expertise for treating patients with CTEPH. This is a new frontier in interventional cardiology,” said Aggarwal, who performed the procedures on Perry last summer.

According to Aggarwal, the majority of patients have good outcomes, including restored blood flow to the lungs, reduced shortness of breath, and increased exercise tolerance.

Perry is living proof.

“This is the best I’ve felt in 11 years,” she said, adding, “I have much clearer lungs and more energy. I no longer need a motorized cart at the grocery store and don’t use a walker.”

Best of all, Perry is keeping up with her seven grandchildren, all under the age of 4 years. “I had to get better to keep up with them,” she said. “They keep me going, especially during hardships. They are my greatest inspiration.”

Perry is looking forward to “living on the healing side of this condition. I was sick for 11 years and could have died. But now I’m in the season of living,” said the woman who wants to inspire others in some way and help them with their health journeys.

McDevitt is confident in her ability to succeed in whatever path she chooses, thanks to her improved quality of life.

“Lakeitha is absolutely strong and resilient, and now has a whole new lease on life with her speciality CTEPH interventions and therapies.”

Image Credit: Bryan McCullough, Michigan Medicine

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