Andres Castillo Jr. was born with a hole in his heart.
At age 2, he underwent his first major heart surgery to repair the hole—an atrial septal defect. Seven years later, his first pacemaker was implanted—a box the size of an old VHS tape, visible under his shirt.
He tried to live a normal life, though his teenage years and young adulthood were marked with repeated hospital stays and countless heart procedures.
“Every year, my doctors wrote notes to the school saying I couldn’t do anything physical,” he said. “I really wanted to play dodgeball and do what the other kids did. The doctors were scared my pacemaker would get hit.”
Castillo was 35 when his tricuspid valve, the door that lets blood enter the heart from the body, narrowed. It took yet another open heart surgery for the tricuspid valve to be replaced with a bovine pericardial valve: a manufactured valve made from the sack that contains a cow heart.
It didn’t last.
By his 43rd birthday, his bovine valve was failing and creating a deadly domino effect on his other organs. With a seventh pacemaker and four decades of surgeries, his options were limited.
UT Health San Antonio doctors, including cardiologist Marc Feldman, M.D., and A.J. Carpenter, M.D., Ph.D., the cardiothoracic surgeon who had performed his valve surgery, considered what to do next. They consulted with Steven R. Bailey, M.D., interventional cardiologist.
They all agreed: He wouldn’t survive another invasive heart valve surgery.
“We knew we had to do something. If we didn’t, he would be dead within six months,” said Dr. Bailey, chief of the Janey and Dolph Briscoe Division of Cardiology at the UT Health Science Center.
Pacemakers had damaged Castillo’s tricuspid valve, he said. When the right tricuspid valve doesn’t work, the liver starts filling with blood and fluid. This condition results in cardiac cirrhosis of the liver. Once one organ shuts down, others can follow.
Castillo’s immediate future looked grim.
“He would have endured extended stays in the hospital; he would have had no quality of life,” Dr. Bailey said. “That is no way to live.”
Members of the Heart and Vascular Institute, a collaboration of cardiologists and cardiothoracic surgeons from UT Medicine and the University Health System, considered a heart transplant, “but we learned that was not an option,” Dr. Bailey said.
A heart transplant is performed when there is failure of the left ventricle. Castillo’s case was unique because the failure was on the right. This unusual condition required a novel remedy.
They turned to a relatively new device called the Edwards SAPIEN XT Transcatheter Heart Valve, first introduced in the U.S. in 2011.
The Edwards valve consists of an expandable metal mesh cage with bovine tissue within it that expands and contracts like the heart’s natural valve. It is approved by the Federal Drug Administration for aortic or left valve use, but “there are so few patients with Andres’ right valve problem that research has not been done on use of the Edwards valve on it,” Dr. Bailey said. “This is where the art of medicine can extend the science.”
Source: Edwards LifeSciences Corporation, image of Transcatheter Aortic Valve Replacement (TAVR)
It wasn’t a guaranteed fix and did include some risk. But Castillo, a single father of 11-year-old son Andres Castillo III, said he prayed about it and decided the chance to spend more time with his son was worth the risk.
“Since he was 5 years old, I have been raising him by myself,” Castillo said of his son. “I cherish every day I have with my son. He has made me a better father.”
On Jan. 8, a team of 22 health care professionals at University Hospital inserted the valve into Castillo’s existing bovine valve. The noninvasive procedure used a catheter to push the crimped valve into an expanded balloon.
“You get the equivalent of a new valve without having surgery,” Dr. Bailey said.
Dr. Bailey is cautiously optimistic about Castillo’s prognosis. Before the valve procedure, Castillo’s liver had already begun to fail and other organs were following suit. Dr. Bailey said he is hopeful that treating the right valve will improve his overall health.
“In all reality, we don’t know. In patients who have had similar problems with their tricuspid valve, this returns them to normal status. The only thing wrong with him was that right valve,” he said.
Castillo still struggles to climb the stairs to his second-floor apartment. Coughing fits interrupt his speech. A collection of prescription pill bottles lines his tabletops. This is his daily life.
Yet his body is getting stronger. Slowly. And his spirituality remains intact—evidenced by the crosses hanging on the wall in his apartment.
“I take life day by day. I take things slow,” he said.
Dr. Carpenter has helped to save Castillo’s life twice in seven years. She’s seen him fight through prolonged hospital stays and multiple health crises. She is confident that with Castillo’s right tricuspid valve repaired, he will be a candidate in the future for a heart transplant.
“Andres told me once that his dream was to see his son graduate from high school,” she said. “I would like him to think bigger than that. I think we can help him be here for even more of his son’s life.”
Castillo has struggled with heart failure his entire life. He knows the struggles aren’t over, but neither is his journey.
He has much to be thankful for, he said, including his family that continues to support him and his doctors who haven’t given up on him.
“Thanks to all of them and to God, I am doing better,” he said. “I believe God wants me to be here. I have been through so much, but, at a time when others may have said I had no options, these doctors worked together to help me. They saved my life.”
Amen Andy I will continue to pray for u and ur family…. God is Good
This is Sylvia Garcia from Torreon st …What a awesome story
Andrew , I just read this article and it made me cry , to know of the struggle that you have been thru with your illness and yet you stand tall and strong in your faith , It is an honor to know you and to be your sister in Christ . GOD is an awesome GOD , he is a loving GOD and a GOD of healing . GOD has you here for a purpose to spread his word to all people , you are a vessel of GOD
UPDATE: Andy Passed away on April 1, 2017.
I knew him since elementary his belief and faith never lacked he was a God fearing man and a great father to his son.
Rest in Peace my friend. You are now in Gods glory!
My Primo we all miss you and yes we say you passed away on April 1st 2017. even though its not an April fools joke that your gone but it is. The joke is on us as we are all here picking up the missing pieces of our heart which is you,
You are with our Dear LORD and our Loved ones that has passed away and are with them now. We have stated growing up who is my mother’s and Mammo’s favorites and we all beg to differ as I am, no its me and so forth. As you are now up there with them we are now left behind thinking hmmm… Well my mother was up there with her my mother took my sister has me wondering was she her favorite as she was the oldest and wants some alone time with her? did she take my mammo too because she missed her mommy? Did mammo take Juanbo because he was the one she babied the most? Did mammo take you because you were the next best son she got to raised as her own? not sure as its all an April’s fool joke. I know Our Dear LORD is the one that says when our time is up its time to come home, and we the living are still here in our temporary place called home. Just know you are missed and I am here trying my best to honor my word to you on helping out as much as I can with lil Drew even though he isn’t lil anymore. Your daughter Destiny is doing an amazing job in raising him and still making sure he keeps God in his life. He is an awesome kid and love talking with him when I get to pick him up to take him his appt when Destiny needs me to. But over all my primo you will never be forgotten as all the memories we created together when we were youngsters or lived together when we were in our 20’s and listening to the same music and loving it to the very last day you were still here with us when you were moving and me helping to clean your old apartment, I just wanna say I miss and love you deeply.