Tony Teixeira was not feeling well. He had a persistent cough and was experiencing shortness of breath. His Western Connecticut Health Network (WCHN) doctors took every precaution because of his history with cancer and their concern about his current symptoms. Routine tests revealed a surprising finding: Tony had a tumor growing in his heart.
The Diagnosis
Tony, a Danbury, Connecticut resident, doesn’t normally go to the doctor. But one doctor whose routine checkups he never missed was John F. Pezzimenti, MD, a board-certified medical hematologist/oncologist at Danbury Hospital — a.k.a. Dr. Pezz.
When Tony was 21 years old, he was diagnosed with Stage II Hodgkin’s lymphoma. At the time, Dr. Pezz recommended radiation therapy to treat the cancer. The treatment was successful and Tony has been in remission for 28 years.
More recently, Dr. Pezz helped save Tony’s life again. Tony was having shortness of breath and coughing fits for about eight months before he saw Dr. Pezz for a routine checkup. The coughing fits caused him to pass out on two separate occasions. Given Tony’s history of radiation therapy, which can affect the cardiovascular system, Dr. Pezz thought it was prudent for Tony to see a cardiologist for further examination.
Dr. Pezz referred Tony to Harvey M. Kramer, MD, FACC, FACP, a cardiologist from Western Connecticut Medical Group Southbury Cardiology. Dr. Pezz routinely referred his cancer patients to Dr. Kramer for cardiovascular care. Dr. Kramer has unique expertise as a board-certified cardiologist and internal medicine physician, and he was formerly a chief resident in internal medicine at Memorial Sloan Kettering Cancer Center in New York.
Dr. Kramer heard a heart murmur when he examined Tony with a stethoscope. Normally, Dr. Kramer would not think a heart murmur was cause for concern because they are so common. But based on Tony’s history of radiation therapy, and the symptoms he was displaying, he recommended an echocardiogram and stress test to evaluate Tony’s heart and valve function.
“Twenty-eight years ago, Tony had radiation therapy near his chest to treat the Hodgkin’s lymphoma. Radiation therapy near the chest can be associated with progressive heart valve thickening and hardening, so that’s what I expected the echocardiogram to show,” explained Dr. Kramer.
Surprisingly, the echocardiogram revealed a 1/2-inch mass on the tricuspid valve, which is on the right side of the heart.
Tony had a primary cardiac tumor — a tumor that originated within his heart. Primary cardiac tumors are very rare. About 75 percent of all primary cardiac tumors are benign and myxomas are the most common. Tony would later learn that he had a papillary fibroelastoma (PFE), which is even rarer. About 10 percent of benign primary cardiac tumors are PFEs.
Also unusual was that Tony’s tumor was on the right side of the heart. PFEs usually occur on the left side of the heart. Thankfully, a tumor on the right side is less dangerous than on the left. If a piece of the tumor broke off from the right side it would embolize and get trapped in the lung. This is likely what was causing Tony’s cough. However, if a piece had broken off from the left side and embolized, it could have gone to the brain and caused a stroke.
“I felt really nervous when Dr. Kramer called me and said he wanted to review the test results in person. I called my wife Diane and we went to Dr. Kramer’s office that same day,” said Tony. “My initial nerves turned to real fear when I learned about the tumor because I immediately thought ‘cancer’. I felt better when Dr. Kramer explained that the tumor was most likely benign.”
“At no time did I think the tumor was malignant, but I did think it needed to be removed as soon as possible. The tumor put Tony at risk of potentially life-threatening pulmonary complications, including a thrombotic embolism to lung,” said Dr. Kramer.
Robotic Cardiac Surgery at Western Connecticut Health Network
Tony did not want open heart surgery. He was only 49 years old. It was around the holidays and he wanted to be home with his family and friends. He did not want time away from his work or activities with his teenage twin daughters, and there was also no way he was missing his son’s upcoming wedding.
Understanding Tony’s concerns about open heart surgery, Dr. Kramer referred him to Robert C. Gallagher, MD, chief of cardiothoracic surgery for WCHN, which includes Danbury Hospital, New Milford Hospital, and Norwalk Hospital. Dr. Gallagher is the only board- certified cardiothoracic surgeon in Connecticut, and one of the only in New England, with advanced expertise in robotic cardiac surgery.
“To develop the best treatment plan for Tony, we took his entire health history into consideration, including the radiation therapy he had 28 years ago for cancer. We were especially concerned about how he would heal from an open procedure, because radiation is known to affect how someone heals. We also knew that Tony didn’t want the down time required to recover from open heart surgery. With the robotic procedure, he would be home in about 3 days after surgery, versus five to seven days with an open procedure,” explained Dr. Gallagher.
Robotic cardiac surgery requires a team of highly trained, highly specialized individuals. Dr. Gallagher controls the robot: a very sophisticated surgical tool that offers a high definition vision system, and tremendous articulation and dexterity of the instruments. Because of these advances, the surgical procedure can be done with extreme precision, even without a large open incision.
“Robotic cardiac surgery provides our patients with less invasive techniques to treat their cardiac issues. Patients like Tony who have robotic cardiac surgery experience less pain and a faster recovery than with an open procedure,” said Dr. Gallagher.
“I was excited about the possibility of a minimally-invasive surgery versus an open procedure,” said Tony. “To help me prepare, Dr. Gallagher answered all of my questions — I probably had 100! I really appreciated that. I had extensive testing before surgery, which was perfectly planned by a team at Danbury Hospital. I felt very confident going into surgery.”
Tony felt even more confident going into surgery when he learned that Dr. Gallagher, a cardiothoracic surgeon with nearly three decades of experience, has performed hundreds of robotic cardiac surgeries — all with successful patient outcomes.
Edita Cubatiuk, APRN, the dedicated cardiovascular navigator for WCHN, also helped Tony feel good about his treatment plan. Edita is the primary point of contact for WCHN cardiovascular patients undergoing procedures at Danbury Hospital. In her unique role, she communicates with a patient’s entire care team, so they are all working together to help the patient have the best possible experience and outcome. Most importantly, she communicates with patients, like Tony, so they are well-informed about their diagnosis, treatment, and discharge plan.
“Edita was one of the first people I met with after I learned that I would need heart surgery. She was my go-to. Any questions I had, I spoke with her. She always got right back to me and she put me at ease. She was great!” said Tony.
Tony had robotic cardiac surgery in January 2018. During the five-hour surgery, Dr. Gallagher made five 8mm incisions in the right side of Tony’s chest in order to access his heart. Dr. Gallagher also made small incisions in his leg (femoral) and neck (jugular) to connect a drainage tube to a heart/lung machine in order to circulate blood during the procedure. Using the robot, through the small incisions in his chest, Dr. Gallagher accessed and opened the heart with instrumentation, and then opened the right atrium. He then resected the tumor. When the tumor tissue was removed, Dr. Gallagher closed the right atrium with a robotically-assisted running stitch.
Tony’s Recovery
The first thing Tony noticed when he woke up from surgery was that his cough was gone —and the rest of his recovery was almost as quick. He had surgery on a Friday and was walking up the stairs in his home the following Monday without any shortness of breath. He was back to work four-and-half weeks after surgery; he went to his son’s wedding four months after surgery; and, he was in Costa Rica zip lining the second highest zip line in the world (72 stories high) six months after surgery.
“Today, no one would be able to tell I had heart surgery. I only have tiny marks on the right side of my chest, and they’re barely noticeable,” said Tony.
It is critical for physicians to consider a patient’s entire health history, and understand how one disease can affect the presentation and treatment of another, when diagnosing a patient. Drs. Pezz and Kramer both had a high degree of suspicion about Tony’s symptoms given his history of cancer. Dr. Gallagher presented Tony with a safe alternative to open heart surgery. Their diligence and holistic approach got Tony the right care, at the right time.
Hear more from Drs. Gallagher and Kramer, Edita, and Tony in this video.