Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Houston Methodist DeBakey Heart & Vascular Center

Patient Story: Rose Joubert

Rose Joubert

Rose Joubert loves to cook and she loves to sing, and is so good at both that those who know her may sometimes think she's doing one when she's really doing the other.

But aortic valve stenosis is a cruel disease to active people. It saps them of both stamina and strength.

"Last year I began to feel sluggish," Joubert said.

Joubert found she couldn't sustain activity for very long, making even small dishes and short ditties difficult if not impossible.

Joubert had thought her trouble might have been related to her loss of kidney function in 2004, and her subsequent three-times-a-week dialysis.

"I thought, 'maybe this is just part of what's going to happen to me,'" Joubert explained. "But I didn't want that. I told myself, 'I can't end up like this. I don't want to.' I told my daughter I just didn't have energy. But I didn't know why."

Joubert said she also suspected the problem might have something to do with her heart. Joubert's mother had needed a triple bypass operation when she was 87. Joubert is 70.

"I couldn't walk from the bedroom to the den without getting extremely tired," Joubert said. "I'd feel like I'd been running a race even when I was just walking to the car from the front door."

At her church, where she's been attending services for 62 years, Joubert said the ushers came to learn she needed assistance getting to her seat.

A Houston-area nurse, Linda James, suggested Joubert see Adnan Yousuf, M.D., a family medicine doctor affiliated with Houston Methodist Hospital. Joubert's daughter Bridgette Joubertjames went to Yousuf to explain her mother's problems. After evaluating Joubert himself, Yousuf referred her to Houston Methodist DeBakey Heart & Vascular Center cardiovascular surgeon Basel Ramlawi, M.D., who specializes in heart valve repair and replacement.

"It was the end of December (2011) when her problems started getting worse," Joubertjames said. "Dialysis wasn't going as well. By the end of January we knew something needed to be done. So we went ahead and made an appointment with Dr. Ramlawi before things got really bad."

Joubert was scheduled for her first consultation on Thursday, Feb. 9. In collaboration with interventional cardiologists Neal Kleiman, M.D., and Stephen Little, M.D., Ramlawi performed a series of tests on her to examine Joubert's heart and vacular tissue. The diagnosis was aortic valve stenosis, a narrowing of the valve that sits between the heart's left ventricle and the aorta, the body's biggest blood vessel. A relatively common problem as people age, aortic valve narrowing (stenosis) causes the heart to exert significantly more stress in order to pump blood to the rest of the body’s organs. Eventually, patients develop symptoms such as fatigue, shortness of breath, chest pain or syncope (fainting). If not treated in a timely manner, aortic valve stenosis often leads to heart failure and sudden death.

Due to multiple risk factors, open-heart surgery to repair the valve would have been too risky, her doctors explained. "I had two strikes against me. One was that I am 70, and the other is that I am on dialysis. But Dr. Ramlawi told me there might be another way."

Houston Methodist DeBakey Heart & Vascular Center (MDHVC) recently acquired a semi-synthetic valve, called the Sapien, which is put in place via a procedure called trans-catheter aortic valve replacement, or TAVR. Instead of relying on open heart surgery, doctors move the valve through a small incision near the femoral artery, up through the aorta, to the problem valve. Once in place, the valve is expanded and begins working immediately. Sapien is produced by Edwards Lifesciences LLC. Very few hospitals and clinics have access to the valve, primarily because Edwards has been selective about the hospitals it allows to purchase the devices.

"Things were not going to get better by themselves for Rose," Ramlawi said. "To see if this valve would be right for her, however, we needed to make sure it was safe for her."

Following her consultation with Ramlawi, Joubert visited MDHVC several times over the next week.

"They did lots of tests," Joubert recalls. "One thing they had to do was test the size of my arteries to see if I could get the procedure."

On Feb. 16, 2012, Joubert received the replacement valve. After a day in intensive care, Joubert already found she had the strength to sit up.

"I didn't have any pain," Joubert said of her brief time in the ICU. "Just a little discomfort."

When Joubertjames first saw her mother after the procedure, said she found Joubert in a chair — not in bed.

"I came back to the hospital and found her talking and laughing with the nurses," daughter Joubertjames recalls. "I was amazed."

Nurses worked with Joubert to get her on her feet and walking, which is now standard procedure for most cardiovascular surgery patients.

"I had some help," Joubert said. "But I was able to get up and down the hallway with a walker, which is more than I'd been able to do for two or three months."

Joubert was released from the hospital four days after the procedure (open heart patients typically remain in the hospital for 5 to 10 days), and is getting around on her own.

"I have more energy now," Joubert said. "I have more air. I'm feeling pretty good."

She said she's looking forward to cooking again — the Louisiana native makes a great creole chicken, her daughter attests, and often for her family and church friends. And at some point, Joubert said, she looks forward to singing again.

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