Yvonne Crandall

“A lot of people checked to see how I was doing. A doctor said a prayer with me, and a housekeeper gave me little angel pin. I just appreciated this so much — they made me feel special.”

Serving Up Another Option for Heart Patients — Valve-in-valve TAVR

Yvonne Crandall’s heart valve was failing and she knew she would soon need a new one. Her greatest fear was that she would be a burden to others, regardless if she had it repaired or not. Yvonne had spent her entire life serving others, as a mother of six children and the owner of a family business, Crandall’s Café & Catering in Wheaton.

“When you own a restaurant for 38 years, you’re used to hard work and it’s hard to see yourself slow down,” she said.

Now she found herself constantly fatigued. She dreaded her nightly shower because the steam would leave her short of breath. Afterward she would need to sit down for 20 minutes before she could get dressed.

Yvonne eventually went to the CentraCare Heart & Vascular Center to see Cardiologist Thom Dahle, MD, an expert in transcatheter heart valve replacements (TAVR). TAVR is a procedure for people who suffer from severe symptomatic aortic stenosis, a common condition caused by the build-up of calcium on the aortic valve’s leaflets.

During the procedure, a new heart valve is delivered to the heart through a catheter inserted into the groin. The faulty heart valve is then opened and pushed against the heart wall and the new valve takes its place.

Dr. Dahle discovered Yvonne had a defective heart valve from a previous heart surgery. Due to her age and health history, Yvonne’s options were limited, but one possibility was a type of TAVR called valve-in-valve. This procedure would place a new valve within the valve Yvonne received at the time of her previous heart surgery. To do so, the “old” surgically placed valve would need to be fractured.

“While fracturing a valve may sound scary, patients should know it’s being done in a controlled environment with a special balloon to fit this type of procedure. This means we are not destroying the prior surgical valve, but simply using a balloon to expand the internal ring of the surgical valve to a point where the ring can fracture. Doing so allows us to fully expand the new valve within it. The prior surgical valve remains in place and intact with the heart wall,” Dr. Dahle said.

Yvonne said the valve team did a great job explaining everything to her.

“According to Dr. Dahle, I would be the first valve fracture patient at St. Cloud Hospital. The procedure could be complex, so I made sure my affairs were in order. I didn’t know if I was going to wake up to see angels or my two daughters.”

“While all heart valve procedures have potential to be complicated and challenging, before any valve fracturing procedures, we extensively plan to make sure we understand everything about the prior surgical valve and the anatomy that surrounds it. This lets us identify and avoid potential issues in the procedure and makes doing the actual procedure seem routine,” noted Interventional Cardiologist Brian Stegman, MD, who assisted with Yvonne’s case.

The evening before the procedure, Yvonne received encouragement from hospital staff. “A lot of people checked to see how I was doing. A doctor said a prayer with me, and a housekeeper gave me little angel pin. I just appreciated this so much — they made me feel special.”

One aspect of the procedure that weighed heavily on Yvonne’s mind was any potential recovery time. So, she was surprised she was able to go home just a couple days after her procedure and get back to her normal routine with minimal soreness.

“I just didn’t relish the thought of my daughter having to take care of me, so I was glad to be up and around right away.”

Since Yvonne’s procedure in 2018, valve fractures have become a standard TAVR option for patients who meet certain criteria. And Yvonne has gone back to doing what she does best — staying busy and making the most of every day.

“I’m thankful that at age 86 I have a lifestyle where I can help my daughter with light household chores, especially cooking,” she said. “From back in the days of our family business, I know good food is always appreciated and I like to give it as a gift. I try to do one good deed for someone every day and I know food is one way of pleasing people.”