Richard Chang expected to feel better after a heart valve replacement in July 2025. Instead, the retired engineer became exhausted, lightheaded and increasingly anemic.

While his doctors in Philadelphia, near where he lives, assured him the transcatheter aortic valve replacement (TAVR) procedure had gone well, Chang’s body suggested otherwise.

Over time, the avid swimmer and walker found himself growing increasingly weaker instead of stronger, with no clear explanation why.

Blood tests a month after the TAVR showed concerning results, but questions remained about what was driving Chang’s worsening symptoms. Frustrated and searching for answers, Chang eventually sought a second opinion from Novant Health interventional cardiologist Dr. Daniel Pu in Charlotte.

What happened next would lead Chang to travel hundreds of miles for treatment and allow him to get back to the active lifestyle he feared he had lost.

Searching for answers

Chang’s journey started during a routine cardiology visit when he learned he had aortic valve stenosis. The condition narrows the heart valve and makes it harder for blood to leave the heart. His cardiologist suggested monitoring it for a year or two before having surgery to replace the valve.

But Chang, then 86, wasn’t convinced.

“I thought it would be easier if I had the procedure done earlier, while I am still young and strong,” he said.

Because open-heart surgery carries greater risks for many older patients, Chang underwent the minimally invasive option. During TAVR, doctors insert a replacement valve through a catheter instead of opening the chest. The new valve is placed inside the damaged valve to help restore blood flow.

But instead of recovering after the surgery, Chang grew much weaker. He felt no one could explain why his symptoms were getting worse.

Concerned that something had been missed, Chang’s daughter-in-law contacted her niece in Charlotte, physician assistant Chelsey Moore, who works with interventional cardiologist Dr. Daniel Pu at Novant Health Heart & Vascular Institute Elizabeth - Cardiology.

After reviewing Chang’s echocardiogram, Pu identified a paravalvular leak, or PVL. A PVL is a gap between the replacement valve and surrounding heart tissue, and can destroy red blood cells faster than they’re created.

Most leaks are mild, but Chang’s was different.

“A leak is not severe,” Pu told Chang by phone during their first conversation. “But it does not have to be severe to cause issues.”

In Chang’s case, Pu recommended a blood smear. That test, performed by a hematologist in Philadelphia, confirmed hemolysis, a condition caused by the leak. It also causes anemia and kidney damage.

Fixing the leak for better health

Finally feeling heard, Chang knew it was time for further treatment — which meant traveling to Charlotte.

In April 2026, Pu performed a balloon aortic valvuloplasty, which expanded Chang’s replacement valve to seal tightly against the surrounding tissue. The minimally invasive procedure was done using a small catheter while Chang was under light sedation. He spent one night in the hospital after the procedure for observation.

“We opened the valve just enough to seal the leak, and his hemolysis resolved,” Pu said.

Today at 87, more than a year since the original procedure, Chang’s anemia is gone. He has returned to the active lifestyle he enjoyed before surgery, and continues routine follow-up appointments with his hometown cardiologist.

A heart ultrasound performed three months after his balloon aortic valvuloplasty found no leak or hemolysis. Based on his results, Chang encourages others to seek a second opinion if they’re concerned about their health or feel they aren’t getting the answers they need.

“I hope my experience can help anybody else who gets into a situation like mine,” he said. “My decision to be under Dr. Pu’s care was one of the best decisions I’ve ever made.”