Three months ago, Susan Gordon, a two-pack-a-day cigarette smoker, was given a harsh diagnosis -- lung cancer. But, last Friday, the Baltimore woman thought she was face-to-face with another villain -- heart attack.
She couldn't seem to get her breath. She gasped and struggled. The little breathing she could manage was fast and shallow.
Gordon didn't realize it at the time, but she was so sick she might have died right then and there, Dr. Andrew Ziskind, a University of Maryland Medical Center cardiologist, said yesterday.
Like many thousands across the country each year, she was experiencing a buildup of fluid in the sac that surrounds the heart. It is known as the pericardium. In her case, the life-threatening fluid was coming from nearby cancerous cells or lymph nodes, limiting the ability of the heart to pump blood.
Luckily for her, Ziskind had already successfully used an experimental, non-surgical technique to make a tiny hole in the cardiac sac on nine patients here and at the Harvard-affiliated Massachusetts General Hospital in Boston.
The tool is a balloon-tipped catheter, which is inflated over the edge of the sac to create a tiny hole, or window, for the fluid to drain out into space between the lung and chest wall where it is re-absorbed by the body.
Within a half hour after Gordon appeared at the hospital, she had become the 10th patient in the country and the fifth in Baltimore to undergo the new procedure, Ziskind said. He helped develop the technique at the Boston hospital before coming to Baltimore.
"I didn't feel a thing," Gordon, who no longer smokes, said recalling her scary episode. "I even sometimes watched on the screen as the catheter moved up into the sac. I would have watched it all, but I kept falling asleep because I had been given a local anesthetic.
"I was very happy to learn that I wasn't on the verge of a heart attack. I would be willing to do anything I can to help improve things for others with serious diseases."
Ziskind thinks this procedure can be particularly helpful to cancer patients, and especially those with lung, breast and stomach cancers.
"We want to keep them out of the hospital and we want to do things with the least pain and the least suffering for them," he said. "I think that's what this promises."
This new use for the balloon catheter, widely employed in recent years in balloon angioplasty to open arteries clogged by atherosclerotic plaque, is "part of the revolution in being able to do things with catheters to avoid surgery" and it is pushing once-lowly catheters into new prominence, according to Ziskind.
At the University of Maryland, the new procedure takes place in the cardiac catheterization laboratory where Ziskind and other doctors insert the wire catheter through the skin below the rib cage and into the sac surrounding the heart.
Then, they slide a deflated balloon over the catheter. When the balloon reaches the edge of the sac, the balloon is inflated. This creates a tiny hole, known as the pericardial window. This allows the trapped fluid to escape from the sac and drain out into the body, where it is reabsorbed.
So far, after a six-month follow-up in the early Boston cases, the catheter-created holes have held up. But, should they shut down, the procedure can be repeated, Ziskind said.
The procedure takes 20 minutes, but requires a two- or three-day hospital stay. Someday it may be done on an outpatient basis, said Ziskind. Surgery, the traditional therapy, usually calls for a three-inch incision and and a three- to five-day hospitalization.
After obtaining permission from a hospital review board, Ziskind has begun a study of the new procedure that will involve 30 patients. Ultimately, he hopes that the UM Medical Center will be authorized to coordinate multi-center trials. They would involve hundreds of patients to fully establish the efficiacy of the procedure.
In Baltimore, Ziskind has performed the procedure on five patients, three at the University of Maryland Medical Center and two at the Baltimore V.A. Medical Center.
Although the procedure is also expected to be beneficial to heart and kidney disease patients, Ziskind said he will focus on cancer patients initially. Tumors, especially of the lung, breast and stomach, he said, are a major cause of fluid accumulation around the heart.
Echocardiography, an ultrasound technology that uses sound waves to produce an image of the heart and surrounding tissues, is used in conjunction with the balloon-catheter technique. Its use also accompanies traditional surgical therapy.
"Echocardiography is an important tool to identify excess fluid buildup in the pericardium and see whether the fluid is impairing the heart," Dr. Gary D. Plotnick, professor of medicine and director of the UM echocardiography laboratory.
He said that echocardiography helps to pinpoint the best location for the hole in the pericardium, the one which permits the most effective drainage of fluid.
Besides shortness of breath, symptoms of fluid accumulation around the heart include fatigue and swelling of arms and legs.