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Michael Kwiatkowski was fully prepared to travel from home in Black Creek, north of Appleton, across the country for a rare and complicated pulmonary surgery performed at select medical centers in the nation. It turned out he only had to come to Froedtert & the Medical College of Wisconsin Froedtert Hospital for an exceptional surgery that would renew breath and restore energy.

Pulmonary Hypertension  

Mike, 62, needed surgery because he had high blood pressure. Not the kind that affects about one in three American adults but one much more uncommon — pulmonary hypertension.

The condition develops over time, and Mike’s began in 1999. “I was walking on a golf course and started getting short of breath,” he said. Mike wondered why that could be since he had never smoked, and, in his 30s, he did triathlons and biked 2,500 miles annually.

X-rays and a CT scan revealed blood clots in both of Mike’s lungs, and his blood tested positive for the prothrombin gene mutation, an inherited predisposition for blood clots.

“I thought I would be on blood thinners the rest of my life,” he said. “Until three years ago, I had no change whatsoever, and then all of a sudden I started experiencing atrial fibrillation.” Mike walked to work every day, about a mile uphill, as Black Creek’s utility manager, and the exertion would cause atrial fibrillation, an irregular heart rhythm.

“I would have to stop two to three times,” he said.

Advanced Treatment 

In early 2017, Mike was referred to Froedtert Hospital.

“When I first met Mike, there was a suspicion that he had pulmonary hypertension,” said David Ishizawar, MD, a Froedtert & MCW heart failure cardiologist and member of the Pulmonary Hypertension Program. “His blood clots were likely the cause. The body takes the fresh clot and replaces it with a cellular matrix. It will grow and harden. The large clot obstructs the cavity of the blood vessel, hindering blood flow and causing pulmonary hypertension.”

The condition strains the right side of the heart as it works harder and harder to pump blood through the restricted vessels in the lungs. “The heart muscles become thick and start to dilate, increasing the risk of arrhythmia, or atrial fibrillation,” Dr. Ishizawar said.

Dr. Ishizawar prescribed medication to help improve Mike’s heart function, but surgery was the definitive treatment. Mike opted for surgery performed by a team led by cardiothoracic surgeons Lyle Joyce, MD, PhD, and David Joyce, MD. Our Pulmonary Hypertension Program provides patients the full scope of treatment options, including the rare and complex surgery Mike needed — pulmonary thromboendarterectomy.

“They made me feel comfortable and confident that everything would be OK,” Mike said.

The surgery Dr. Lyle Joyce and Dr. David Joyce performed entailed opening Mike’s chest, putting him on full cardio-pulmonary bypass and cooling his body to around 64 degrees Fahrenheit to protect his brain.

“We make two incisions, one in the left and one in the right pulmonary artery, then follow them out and peel the layer of clot from the vessel wall,” Dr. Lyle Joyce said.

The surgeons followed a carefully orchestrated sequence of stopping blood circulation, operating, restarting circulation again to minimize the risk of stroke and neurological damage, and repeating. “We have about 20-25 minutes at a time without blood circulating and have to work quickly within that period,” Dr. David Joyce said. “It may take 45 minutes to do each side.”

The surgery is a painstaking, intricate process. “We peel the clot off one millimeter at a time until it is removed completely,” Dr. David Joyce said. He likened it to pulling a hand out of a glove without inverting any of the fingers. In total, Mike’s surgery took about six hours. “We were pleased to remove it completely, which is exactly what we would wish for in terms of the result,” Dr. David Joyce said.

Active Again 

For Mike, the surgery has been a breath of fresh air. “I haven’t felt this good for as long as I can remember, maybe 25 years,” he said. All of his symptoms are gone, and he returned to work in late July. “I’m not out of breath whatsoever and I can climb flights of stairs, where before I had to stop and catch my breath.”

Dr. David Joyce believes there are more patients like Mike who could benefit. “Pulmonary hypertension is probably far more prevalent than any of us imagines, and the surgery really is curative in many cases.”

Just months after the surgery, Mike was quite enthusiastic about the outcome. “I’m not recovering,” he said. “I think I’ve recovered.”

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