Louisville Magazine

AUG 2014

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LOUISVILLE MAGAZINE 8.14 57 Sam Pollock, 60, a physician at Baptist Cardiac Surgery, started assisting with surgeries in a hospital in Madisonville, Kentucky, while he was still in high school. He spent the summer and Saturday mornings preparing patients for surgery and handing tools to the surgeons. He graduated from the University of Kentucky College of Medicine and did his training in cardiac surgery at the University of Alabama in Birmingham. He shared a story about removing a rare type of tumor called a paraganglio- ma from the heart of his patient, a woman in her mid-20s who'd given birth to her second child days earlier. As far as he knows, it's the only case of this type of tumor that's been found in a pregnant woman. "During the last part of her pregnancy, she started having trouble with high blood pressure. But this was more than that. Her blood pressure was so high that she was so weak she couldn't even walk. She was crawling around. When she delivered her baby, her blood pressure was way high: 300 over 120. It was very difcult to control. "Afterward, she came to the emergency room having stroke-like symptoms — visual problems, bad headaches — and was admitted to the hospital. I think that's when she saw the cardiology group. In a young person you look for surgical, correctable causes of high blood pressure. Tey did an EKG and found a mass on the right side of her heart. It was a benign type of tumor called a myxoma, which you usually see in the left atrium. Tis was in the right atrium. "We thought it was possible that the tumor was obstructing infow to her heart. We thought that, even though it's 10 days postpartum, she ought to have surgery. Before she went into surgery, she knew there was a tumor there and she thought it was a benign tumor. When I saw it, the way it looked — it was really horrible looking. It was really a nasty-looking thing. We could see that this was not the usual myxoma. Tis was a tumor bigger than a golf ball. Te atrium's usually smaller than that. In a smaller person, this tumor was pretty big. But you could see it on the surface of her heart. And it was sitting right between the right atrial appendage and her right coronary artery. And you could see all these blood vessels on the surface. It looked to me like a malignant tumor. STORIES OR FROM THE When the Going Gets Tough . . . "I'd had a patient several years prior who had a sarcoma (a malignant muscle-cell tumor) in the heart. And we thought that was a myxoma, but when we operated, it was all growing into the back of the heart. She was in her 30s and died a year later. "I have a headlight camera, so the tumor is projected up on a TV screen. Everyone in the operating room could see it. I noticed it got very quiet in the room. I think some of the group had been there when I'd done the surgery on the patient who had the sarcoma. "Because of the patient's age and the baby, everybody was pretty depressed. We do an EKG before, during and after surgery. I had the patient's cardiologist come in and look at it and she cried. She's a young cardiologist, so it really hit her hard. And she'd just had a patient the week before who, after delivering her baby, developed cardiomyopathy (a weakened heart) and died at home. Tere was like a black cloud over the whole operating room. "I'm thinking, 'Oh, gosh. Here's this girl who just had a baby and her fam- ily's out there.' Her husband was so scared and nervous. And you look at this tumor and you think, 'What can we do? We have to remove it.' "What we ended up doing was dissecting it out. It actually had draped the right coronary artery, which comes of the aorta and goes down to the right side of the heart. Little feeder vessels were coming of the right coronary artery into this tumor. We were able to free it from the right coronary artery and it actually came out. Now we had to take part of the wall of the atrium with it. And when we took that out, we had to patch that with a special mate- rial that allows stem cells to grow in, so what it does is, it turns into the heart tissue. It's not like a patch that's artifcial. Your own tissue grows into it. "It was really hard to talk to her husband. But I had to tell him that I really was worried about this, that I thought it might be a cancer. I remember hold- ing his arm, and I got tears talking to him. "Tey actually sent the tumor up to the Mayo Clinic, and they thought it was a paraganglioma (a nest of neural cells that are in an abnormal place). Tey thought if it was primary (the original tumor), then everything was OK. But if it was metastatic (a secondary tumor, divided from the frst), it might be a problem. She eventually had a scan, and this was a primary tumor. It's been two years now since she had the tumor removed, and all her levels of the markers that they check have been zero. So everything is normal. "You go from thinking the worst to thinking, 'Maybe we're OK.'" W

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