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Ashley Fulmer, APR
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BIRMINGHAM, Ala. – February 2, 2016 - Despite being known for taking on difficult cases, Dr. Mustafa Ahmed – an interventional and structural heart specialist with Cardiology P.C. and medical director of Princeton Baptist Medical Center’s Structural Heart Program in Birmingham, Ala. – was skeptical of accepting Marietta, Ga. resident Jason Philpot’s heart aneurysm case when first approached in mid-2015.
“In reviewing Mr. Philpot’s situation at the onset – and seeing for myself firsthand the severity of his heart issues – I truly had major hesitance in treating him, simply because no such case had been attempted before, and everything was pointing against being able to treat him,” according to Dr. Ahmed.
He added that Philpot’s aneurysm was so large that it was difficult to even see where it started or where it finished. It seemed like a shut-door situation, medically speaking.
“But everything changed when his son walked into the room, and, for lack of better words, asked us in only the way a child can to save his dad,” said Dr. Ahmed.
It was Philpot’s two-year-old son, Grey, and his captivating personality and plea that convinced him to take a chance on a groundbreaking procedure that not only saved the patient’s life, but has pushed the boundaries of what was thought to be possible when it comes to minimally invasive heart procedures.
A History of Heart Issues
Philpot, 39 – Auburn, Ala. native and Georgia transfer for 15 years – is a devout Jehovah’s Witness, husband to wife Brandi, 37, and father to Grey and older sister Carla, 9. It was in early 2012 in an annual physical that his doctor initially discovered a heart murmur and small aortic aneurysm, both of which they decided they would monitor over time.
But only a few months later, Philpot began to have fainting spells, which was soon after attributed to a leaky aortic valve. This issue was then managed by a pacemaker, which was implanted in June 2012. Though his religious beliefs prohibited him from receiving any blood transfusions during surgery, he then underwent open-heart surgery to replace his aortic root in July 2012.
By October of 2012, however, his health still deteriorating, he not only found a new cardiac surgeon, Princeton’s Dr. Clifton Lewis, but also a new plan. His second open-heart surgery took place in Dec. 2012 to replace the aortic valve. And in April 2014, Jason had his pacemaker upgraded to an ICD pacemaker for added protection.
It was in spring 2015 that his heart issues took an unrelenting turn for the worse. His previously small heart aneurysm had grown tremendously in size. It had gotten so large that is was pressing against his rib cage and causing congestive heart failure, shortness of breath and fluid retention. Philpot’s Atlanta-based cardiologist – Dr. Michael Hardee with Wellstar Health System – once again reached out to Dr. Lewis in Birmingham for help. Based on Philpot’s advanced issues, however, Dr. Lewis referred him to Dr. Ahmed, his colleague at Princeton’s Structural Heart & Valve Center.
"This was not only the largest aneurysm I or anyone else on our team has ever seen – but it was the largest aneurysm of its kind we have ever even heard of. We couldn’t find anything like it in the medical literature. It was visibly protruding through his chest wall, and in fact, it could be seen pulsating strongly through his shirt,” said Dr. Ahmed. “These issues were also preventing oxygen from getting to his heart and body. When he walked into our practice, he was short of breath even at rest. We felt that he had a remarkably short life expectancy of maybe weeks.”
Coupled with the patient’s history of heart issues was his need, as a Jehovah’s Witness, for a bloodless (non-transfusion), minimally invasive technique. With so many obstacles, Dr. Ahmed’s initial prognosis for Philpot was bleak.
“He told me – we try or you die. It was that simple. We either opted for something that had never been done before, or I wouldn’t have any chance whatsoever,” said Philpot.
The Philpot Procedure
“We definitely pushed the boundaries of cardiac procedures with this case based on unknowns,” said Dr. Ahmed. “Every element was a gamble because many parts of this specific case were so unique. There was definitely no manual on how to even approach this case, and so we would have to come up with something new.”
Philpot had a rare form of heart aneurysm that was massive, expanding rapidly and at risk of bursting. He also had another aneurysm of his aorta that was connected to his heart – known as a fistula – that was leaking large amounts of blood backward in to the heart, ultimately causing it to fail. Both of these problems were complex and would need to be addressed if Dr. Ahmed was to help him.
In planning his course of action, Dr. Ahmed consulted with Dr. Mark Law, Pediatric Cardiologist with the University of Alabama at Birmingham (UAB) Hospital, to collaborate on a potential solution. They had to account for additional variables: a requirement for a bloodless procedure, the inability to do open-heart due to two previous surgeries of that nature, a weakened body, an aneurysm that could burst at any moment and limited oxygen flow, among others. Often in these minimally invasive procedures, there is the back up of converting to open-heart surgery if required, but in this case, such a back up was not possible. There was no room for error.
During Philpot’s staged, 20-hour, two-part surgery – the first procedure in July 2015 and the second in August 2015 – Dr. Ahmed and his team found a way to reach the aneurysm by going through the blood vessels of the body and then through the heart chambers, inserting small tubes known as catheters into the aneurysm.
Through these catheters, large numbers of different kinds of wires, known as coils, were passed into the aneurysm. The coils would take up the space within the aneurysm and, over time, cause it to clot and prevent further blood flowing into it, preventing continued expansion.
Finally a vascular plug was placed into the aneurysm and fistula between the aorta and the main pumping chamber of the heart, the left ventricle, eliminating the leaking of blood.
“He asked me what the procedure was called, and I told him it was something that hadn’t been described before. As a result, one of my technicians told him that it should be called the ‘Philpot procedure,’” said Dr. Ahmed.
To ensure he was in close proximity to Dr. Ahmed throughout the process, Philpot lived with Birmingham-area family members until his two-part procedure was complete.
“Though I knew that dying at any point during the procedures was a potential, my stress level on the days of surgery were not what you might think,” said Philpot. “No matter the outcome, my faith told me I would be okay. I thought to myself, ‘This is step one. Let’s do this, and move forward after.’”
And “move forward” Jason Philpot most certainly has.
Healing and Living
It’s been four months since the last of Philpot’s two-part procedure, and he is gaining strength daily. He exercises regularly by walking, always under the supervision of Dr. Hardee.
“We are keeping an eye on my heart, consistently checking for fluid retention, but I am improving each and every day,” said Philpot. “I was able to attend an Auburn football game two months post op, and while I was winded, I was able to climb stairs and walk longer distances.”
Philpot and his family keep in regular contact with Dr. Ahmed and his team at Princeton, even stopping in for a visit while in Alabama for the fall Auburn football game.
“This is, in no other way to put it, an epic story. Faced by almost insurmountable odds, we developed a procedure to extend Jason’s life – and give him more time with his children who truly motivated us to reach further to save him. Most importantly, his follow up scans have shown that the aneurysm has been nicely occluded and shown no further growth at this time,” said Dr. Ahmed.
But what does a patient like him say to the man and his team who saved his life?
“’Thank you’ isn’t a sufficient phrase, but what I would say is just that – ‘thank you’ for not only taking my case but for taking on something new and unchartered … and ultimately succeeding at it,” answered Philpot. “And if this case and my life can be used as an example to save others, then we have truly done something epic.”
For more information on Cardiology P.C. and Princeton Baptist Medical Center’s Structural Heart Program, please visit Cardiologypc.com and BaptistHealthAlabama.org, respectively.
About Baptist Health System
Baptist Health System, a not-for-profit 501(c) (3) corporation, provides healthcare services to communities in the greater Birmingham Alabama area through its equity ownership in a joint venture with Tenet Healthcare. As part of this joint venture, Baptist Health System appoints half of the joint venture's Board of Directors. Additionally, Baptist Health System provides administrative and other support to the Baptist Health Foundation. Baptist Health System is a ministry of the churches of the Birmingham Baptist Association whose representatives elect its Board of Trustees. It was founded in 1922 by a group of local Baptist congregations.
About Brookwood Medical Center
Founded in 1973, Brookwood Medical Center is one of the largest private hospitals in Alabama, and a leading provider of advanced medical care to the Homewood community and beyond. Brookwood’s medical staff is comprised of more than 900 privately practicing physicians and its workforce includes more than 2,500 employees and volunteers. Accredited by The Joint Commission, Brookwood Medical Center is a full service acute care hospital, widely recognized for its cardiology, oncology, mental health and orthopedic program. For more information on Brookwood's services, visit bwmc.com call 205.877.8800.