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Suzanne MacWhinnie, RN, of Shapiro 7W, was part of former BWH patient Martin Dettling's interdisciplinary care team.
Twelve years ago, when New Yorker Martin Dettling was diagnosed with cardiomyopathy--a disease that weakens and enlarges the heart muscle--he had no idea his condition would one day bring him to the Brigham.
In 2001, Dettling's physicians in New York implanted a defibrillator in his chest to help manage the disease. He did well with the device, but in 2005, it was replaced as a matter of routine care. But just three years later, Dettling's physicians found that the new device had eroded, leading to an infection.
"Once there is an infection of any implantable heart device, the device and its leads-which connect the device to the heart-have to be removed," said Melanie Maytin, MD, who was part of Dettling's care team at BWH.
Though the device was removed, fragments of the leads remained, eventually resulting in fevers, discomfort, sleeping trouble and a compromised immune system. One of the leads had migrated into a branch of the pulmonary artery, and an attempt to remove it elsewhere was unsuccessful. Dettling was then referred to Laurence Epstein, MD, of BWH's Cardiology Division, an expert on this type of complicated procedure, performing 200 to 250 lead extractions per year.
"Dr. Epstein and his team handled my case in a way I had never seen before," said 45-year-old Dettling. "They always came in to discuss things with me as a team. It was clear to me that excellent patient care was a guiding principle during my entire stay."
Epstein was able to coordinate a team that included cardiac surgeon Marzia Leacche, MD; cardiac anesthesiologist Martin Zammert, MD; and an entire Operating Room team that participated in planning and performing the procedure, which removed all of Dettling's lead fragments except for a piece covered by scar tissue. Florencia Pereyra, MD, of the Infectious Disease Clinic, was also part of the case. The team had the ability to perform the procedure in the hybrid OR, which allowed them to practice a reconstructed 3-D lead removal prior to the procedure, providing more detailed data to guide the actual procedure. A new defibrillator, which does not use leads, was implanted under his skin.
Dettling has made a full recovery and is back at work leading a real estate development firm. Had he not undergone surgery to remove the lead, he would have been reliant on antibiotics to fight infection for the rest of his life.
"Everyone came together to work as a team to give Martin the best possible outcome," said Epstein, who has performed more than 1,600 lead extractions. "We discussed all of his options with him to make sure he was part of the decision process."
Added Dettling: "I'd say 99.9 percent of the time, I feel great. I exercise, eat healthy and don't drink or smoke. I've attended support groups and am in better cardiac health."