Corewell Health cardiologist finds creative solution for Roseville woman with heart valve issue

Dearborn — As Alania Iannucci walked around Corewell Health's Dearborn Hospital Monday morning, the 32-year-old Roseville resident recalled how just over five months ago she couldn't do the same walk without feeling faint.

Iannucci's tricuspid valve, which typically opens to allow healthy blood flow through the heart, was not functioning properly because it had become abnormally narrow. While several physicians would not conduct open heart surgery due to other conditions Iannucci had at the time, one Corewell Health cardiologist, Dr. Rita Coram, found a minimally invasive workaround using catheters.

Now, Iannucci's quality of life has improved significantly since her surgery at the hospital on Oakwood Boulevard in September. She shared her experience during a media event Monday.

"As soon as I woke up (after surgery) I felt like I got a head rush from all the oxygen," said Iannucci. "Everything was so bright and I was just breathing, I was like, 'Is there something wrong or am I okay?'"

Iannucci had her first tricuspid valve replaced through open heart surgery at Corewell Health in 2016. She likened the procedure to getting hit by a train, but her natural valve had become infected prompting the surgery.

By the fall of 2023, Iannucci's replacement valve had narrowed significantly, causing fainting spells, dizziness, shortness of breath, headaches, low blood pressure, and seizures due to hypoxia, or a lack of oxygen in her tissue. Just taking a few steps caused her blood oxygen levels to drop dramatically, said Coram, one of three Corewell Health Dearborn cardiologists who also is a valve specialist.

The condition made it impossible for Iannucci to complete everyday tasks like getting out of bed, getting dressed, and cooking.

"It was getting to the point to where I started getting worried that I was going to die," Iannucci said.

For some, the standard course of treatment would be open heart surgery to replace the failing valve. But Iannucci's condition was causing other issues with her kidneys and liver, making open heart surgery too risky, Coram said.

"When patients have liver failure, they don't rebound, they don't come out of open heart surgery well," Coram said. "That could be the reason why they end up dying, even though the surgery went fine, they die because of other organ failure."

Iannucci had already seen five other physicians but kept getting turned away because none wanted to attempt open heart surgery. She returned to Corewell Health because that's where she had her open heart surgery done in 2016. Coram, along with a team of surgeons, believed that Iannucci not only had a chance at surviving but was willing to put in the work to do so.

"She's very young, and I saw that there was only one problem with her that's causing 10 problems," Coram said. "I felt if I fixed the one problem, the 10 other problems will go away."

Iannucci was particularly motivated by her 13-year-old son to fight and stay alive. She gave him up for adoption at a very young age, but "she wanted to live for him," Coram said.

Minimally invasive surgeries are common to combat aortic stenosis, or narrowing of the aortic valve, especially in elderly patients, Coram said, but it's not typically used in the tricuspid valve. Corewell Health used to only perform the procedure roughly twice a year, she added.

Coram had to use an artificial aortic heart valve to replace Iannucci's tricuspid valve and had to get special approval from the valve manufacturer for the use.

"Because the valve that we use is not designed to go into the tricuspid valve ... It's called off-label," Coram said. "It's not where it's designed to go, and we have to prove to the company so much to allow us to hand it out."

Older patients will sometimes have leaky tricuspid valves, causing tricuspid regurgitation, or when blood leaks backward in the heart's chambers, Coram said.

"Alania is young and her valve narrowed, but the majority of patients who are going to need the tricuspid valve done will have a bad leak in the valve," Coram said.

A tricuspid valve replacement system created by Edwards Lifesciences was approved by the Food and Drug Administration on Feb. 1, which Coram thinks will make a big difference for all patients who need a replacement.

Iannucci is now on blood thinning medications to prevent clots in the new valve so she won't need another replacement. She can also take antibiotics to prevent another infection. Now, Iannucci is working towards her GED and wants to apply to college in the future.

"When doctors see that, and patients look like they're really dying, many times we say there's really nothing to be done and they will die," Coram said. "But don't, please don't do that before discussing it with a heart valve specialist. ... Speak to a valve specialist because they may have tricks and options."

hmackay@detroitnews.com