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Tim Granzeau's Heart Issues and First in America Procedure



By Tim Granzeau

A year ago, I was diagnosed with Afib, which I define as the marching band with the drums, reeds playing in four four time and the brass playing in three quarter time. This not the best way to pump a heart and significantly increases the risk of strokes. The strokes are caused by a tight U-turn made by a vein in the Left Atrial Appendage (LAA). That LAA is as useful as an appendix.

Six years ago, an implant (Watchman) was approved that closes the LAA, significantly reducing the probabilility of a stroke.  I had a Watchman implanted in January, 2019. The procedure is completed by cathiterization into the heart.  In the US this has always been done with sedation. My implant procedure had no sedation.  Lidocaine was used only for the incisions. This was the first procedure in the US with no sedation.

The experience literally opened my eyes and creative mind--during the procedure. My story is below, with flourishes that reflect my humor and interests. 

Background: I have two stents placed last year during a four-hour long catheterization with minimal sedation. Dr. Baquero could not get a Catheter in my arteries.  She then placed the catheter in my left gastric artery without hesitancy.  


Watchman Implant with no Sedation – Patient’s Perspective


Dr. Baquero had been in frequent contact with my medically knowledgeable wife. This caring contact continues to this day.  Last fall Dr. Baquero spotted low sodium levels on a routine blood test.  My sodium has improved but new drugs have caused many side effects.  We are now determined to reduce my drugs. This is typical of her care of and dedication to her patients. More amazing was her research on devices to block the left atrial appendage. These devices were approved in Europe about 10 years ago and in the US in 2015.  Dr. Baquero called a cardiology mentor in Spain. They continued discussion about implant methods used in Europe.  Her objective was to implant a Watchman with lidocaine for the incision but no other sedation.  Her research continued.

In December, she explained the Watchman in great detail and provided us with a significant amount of material.  The device is a miniature folding parasol that opens up like a parachute after positioned in the left atrial appendage opening.  She proposed an implant with no sedation, common in Europe but not (actually never!) used in the US.  After some reflection we realized this was the perfect answer and we asked her to schedule a time to dance.

We were told a Boston Scientific Rep would come to assist with the implantation.  We have a son who helps in surgeries for Leica Medical and he explained the importance of a tech during some procedures.  He also endorsed the Watchman.

Dr. Baquero later told us that four Watchman Reps from three states would be in the Cath lab to assist.  Blood would be available if a heart surgeon was needed.

On the morning of the procedure, Dr. Baquero discussed risks that could lead to significant lifestyle changes.  She was sincerely thoughtful and considerate of our concerns.  We were grateful for her empathy and feelings for our family.  Fully understanding, we were excited to go ahead to surgery.  I was ready for prep.

The brand-new Cath lab was fantastic with a 72” monitor hulking over the gurney on the left side.  With my eyes popping out, I tried to banter with the crew. 
Dr. Baquero then appeared looking like an alien invader.  The whole staff met to review the complete game plan.  Dr. Baquero greeted me and explained the process.  She then played my requested Bossa Nova.  I enjoyed many Jobim classics, Brubeck’s renowned “Take five” and modern jazz standards.  My feet and hands began dancing.  My dancing continued for the whole procedure.  

Before takeoff, Dr. Baquero asked me to alert her to discomfort or pain and asked me to hold my legs still for the incision.  Looking around and talking would be acceptable if I didn’t lift my head.  The journey was about to begin.

She warned me about stinging pain when she injected lidocaine. This was only a minor discomfort.  For the rest of the procedure I never felt any pain or discomfort.  I was also told about pressure on my abdomen but this was no problem.  At one point, I was aware of minor shoulder nerve pressure.
The monitor began to show a live chest X-ray with the vein and two catheters visible.  The ICE took the vein into the heart and pierced the right atrium wall into the left atrium.  The sheath carried the device.  While the X-ray was two dimensional it did help maneuver the catheters.  The depth of the catheter required guess work and scan data experience.  Yes, the Boston Scientific crew had seasoned knowledge with countless implantations.  They were the navigators studying screens and relaying information to the Captain at the helm.

It was incredible watching the X-ray scan.  Later the large scanner was moved over my chest blocking my view.  After some time, I asked a tech to move the X-ray scanner.  Apparently, their view of the X-ray was deemed more important!

When my view returned there was a second display on the monitor. This was an echo image of the interior of the left ventricle, showing the left atrial appendage.  This echo image may be moved to get some depth information about the catheter location.  We needed catheters in position to place the device.
The procedure was the most intellectually stimulating experience in my memory.  The X-ray showed a red plume as they blew excess dye out the Cath.  The catheters wound around each other like intertwined cobras.  The techs discussed location with Dr Barquero saying: “Try a bit of clockwise, go counter clockwise.  Are you anterior?  Are you posterior?  Push now.  Can you pull?”  

They pushed their way through my visibly bulging vein into the left ventricle. They were looking for the left atrial appendage. We found the appendage bouncing up and down with every pump of my heart.  We understand how a space shuttle is maneuvered to a satellite.  Imagine if the space shuttle and the targeted space station are bouncing in shifting winds and the NASA engineers knew when to turn left or right but can only guess when to go up or down.  Like flying blind?

Yes, hitting the appendage opening is extremely challenging for the cardiologist and the whole Boston Scientific crew. Three analyzed data while one provided navigation information to Dr. Baquero.  Their ability to work together was vital.  Their teamwork was quite remarkable.  I was just mesmerized by the journey.

I know why our navigation crew became ecstatic when they thought the bullseye was hit dead center.  Soon they realized the pumping ventricle had dislodged the Sheath catheter.  It was time to reevaluate their position and move ahead….

Finally, the appendage entry opening on the echo screen looking like a white Hershey’s Kiss. They spent time studying the target location took measurements.  The pea size circumference of the device was too small by 3mm.  The sheath was removed and a larger catheter was prepared.  The added lidocaine was no problem for me.  They were finally ready to place the Watchman. 

First, they switched the echo scan to color revealing red and blue flashes. The color indicated the direction of the blood flow through the veins. After some more maneuvering they were in the optimal position.  One push and pull the ripcord! Success required some time watching to spot potential problems with the implant.  The Watchman was firmly in place and had no leaks.  It was time for Champagne.  In this case the more appropriate choice would be Cava Brut!
Recovery from this procedure took about three minutes.  I was fully charged and ready to learn more.  For the past few weeks I have been looking for answers to all of my life’s questions.  It has been invigorating and a remarkable blessing.

I have now watched a British video with little narrative but some familiar views of their implant results.  Their echo scan clearly showed a leaking device in the appendage.  My portrait had no blemishes!  Was it touched up?

This was a most astonishing medical procedure! Yes, Lidocaine is better than hypnotism and allows the patient to participate in a life-changing experience. 
During the procedure I had noticed RNs entering the lab and conferring with the Watchman crew.  At that time, I didn’t realize Shari Hill, Director, Cardiovascular Invasive Services, delivered frequent updates to my wife.  That was a Godsend for Lib and she treasures her relationship with Shari.
We send heartfelt thanks to our dear Giselle, Kimmi from Memorial’s Structural Heart Clinic, Memorial RN’s and the Boston Scientific crew. Your dedication to your patients has earned our sincere respect.  We thank you all. 

Tim Granzeau


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