Maestro John Mauceri returns to the stage in renewed health

John Mauceri, an award-winning music conductor, author, and recording artist, is celebrating his return to the stage in better health following specialized cardiac surgery at NYU Langone Health to treat a rare and life-threatening heart condition.

Maestro Mauceri's illustrious career has taken him to the world's most prestigious opera houses, symphony halls, Broadway stages and Hollywood studios. In recent years, he has faced and overcome significant health challenges, including psoriatic arthritis, cancer, COVID-19, pneumonia, and most recently, a puzzling heart diagnosis. Now, at age 79, he is fully recovered and medication-free, and back to doing what he loves most.

He recently conducted a sold-out, live-to-picture performance of The Nightmare Before Christmas at London's Wembley Arena and a symphonic celebration of Danny Elfman's music in Paris. In April, Tokyo marked another milestone, where Mauceri conducted the Tokyo Philharmonic Orchestra on back-to-back nights, as he continues to innovate and inspire in the world of music.

"The rapid response and creativity of my multidisciplinary care team at NYU Langone is a truly uplifting example of humanity," said Mauceri. "I have been blessed with the gift of extra time."

A history of complex health challenges

A longtime NYU Langone patient, Mauceri faced health challenges that initially extended beyond his heart. In 2017, he began having trouble gripping his baton while conducting symphonies. After seeing Jonathan Samuels, MD, a rheumatologist and co-director of NYU Langone's Joint Preservation and Arthritis Center, he was diagnosed with psoriatic arthritis, an autoimmune disease that can cause inflammation in joints, tendons, and the hands and feet. With the help of immunosuppressive medication, Mauceri found significant relief from stiffness and swelling in his hands.

In May 2019, he was diagnosed with chronic lymphocytic leukemia, the most common blood cancer in adults, which affects white blood cells. Under the care of Michael L. Grossbard, MD, chief of hematology at NYU Langone's Perlmutter Cancer Center, he was treated with a targeted cancer therapy and achieved remission. Some cancer treatments can trigger secondary immune responses that may elevate the risk of heart disease. Both the arthritis and cancer added layers of complexity to Mauceri's care, requiring careful coordination across specialties.

A turning point in 2024

Mauceri's health took a sharp turn in early 2024 following a severe case of COVID-19 and pneumonia that left him with a persistent, debilitating cough. "The wheezing was so violent, it actually threw me out of bed one night," he recalled. Struggling with everyday tasks like climbing stairs, Mauceri visited the emergency department, where an X-ray revealed not only viral pneumonia but also severe underlying lung disease. Over a liter of fluid was removed from his left lung, and he spent a few weeks at NYU Langone's Kimmel Pavilion before being discharged in February as his symptoms began to improve.

But shortly after returning home, new complications emerged. It began with swelling in his left ankle, which progressively spread up both legs, into his abdomen, and eventually into his lungs. By April, Mauceri's condition had severely worsened. "I had gained over 30 pounds in two months from fluid retention, despite high doses of diuretics [water pills meant to eliminate excess fluid] and wearing compression socks," he said. "I could no longer function like myself. I felt like I was trapped in someone else's body."

He had trouble walking even short distances due to shortness of breath, and his legs and abdomen were so swollen and heavy, he struggled to put on socks and shoes."

Dr. Jonathan Samuels, MD, rheumatologist and co-director of NYU Langone's Joint Preservation and Arthritis Center

Despite seemingly normal heart function on routine cardiac ultrasounds and normal studies of Mauceri's leg vessels and lymphatic system, Dr. Samuels referred him to Adam H. Skolnick, MD, a cardiologist at NYU Langone Heart, for a more detailed evaluation of his heart as the potential underlying issue.

"When a patient presents with this kind of swelling, we start by ruling out the most common causes and then work our way to the less likely possibilities," Dr. Skolnick noted. "Could it be heart failure? Liver or kidney dysfunction? Blood clots? Or even a cancer recurrence? As the saying goes, 'When you hear hoofbeats, think horses, not zebras.' But in Mr. Mauceri's case, the diagnosis turned out to be a zebra."

The care team drained nearly three liters of fluid from his lungs, which showed no signs of cancer. "When fluid builds up to that extent, your kidneys and liver can begin to shut down," Dr. Skolnick explained. "Mr. Mauceri was approaching the critical point of multi-organ failure." Working together, Dr. Skolnick, Dr. Samuels, Dr. Grossbard, and the multidisciplinary care team collaborated like medical detectives to uncover the root cause behind his rapidly worsening condition.

The diagnosis of a rare heart disease: constrictive pericarditis

In the summer of 2024, after extensive investigations, Dr. Skolnick diagnosed Mauceri with constrictive pericarditis, an exceptionally rare condition where the pericardium, the protective sac around the heart, becomes inflamed and stiff. This impairs the heart's ability to pump effectively, often mimicking symptoms of heart failure. The condition accounts for less than 2 percent of all pericardial diseases, explaining why it can often be misidentified. For Mauceri, the condition caused debilitating swelling in his lower body without any of the chest pain that is typically associated with pericarditis.

"Diagnosing this condition is difficult because its symptoms overlap with others, and early stages may not show any significant abnormalities on standard tests like an electrocardiogram," noted Dr. Skolnick. "Given Mr. Mauceri's complex health history and multiple preexisting conditions, there were several factors we considered to be contributing to the severe inflammation, making the diagnosis difficult."

A medical mystery solved; life-changing heart surgery

Recognizing the need for more advanced testing, Dr. Skolnick referred Mauceri for a cardiac catheterization, a procedure in which a thin tube is inserted into the heart through the arm to directly measure heart pressures. The results revealed equalization of pressures and other telltale signs on intracardiac pressure recordings. Complementary cardiac magnetic resonance imaging scans confirmed severe inflammation in his heart's pericardial sac, further suggesting Dr. Skolnick to suspect constrictive pericarditis.

"This was a highly atypical presentation of the condition, and the only definitive way to fully diagnose and treat Mr. Mauceri would be through surgery to open the chest, which carries significant risks not many surgeons are willing to take," said Dr. Skolnick. "I don't give up easily, and we were determined to explore every option, especially since he wasn't responding to other treatments."

Dr. Skolnick referred Mauceri to Eugene A. Grossi, MD, a cardiothoracic surgeon and leader of NYU Langone Heart's robotic surgery team. On June 5, 2024, Dr. Grossi successfully performed a total pericardiectomy, a procedure to remove the hardened pericardium. Sure enough, the diagnosis was confirmed during the operation, when the team discovered a thick, leathery substance encasing the heart.

"In this case, it's almost like the heart is a hard-boiled egg, and we're peeling off the shell, although a very thick shell," explained Dr. Grossi. "As we relieve the pressure, the heart often protrudes out of its 'shell.' The pericardium isn't essential for normal heart function, so removing it doesn't cause issues, but can provide complete relief. When the entrapment surrounding the heart is relieved, the extra fluid in the legs and abdomen improves."

Dr. Skolnick noted, "The slow buildup of low-level inflammation below the surface that encapsulated his heart in such a subtle way, without any pain, combined with a myriad of other conditions, is what made this case so challenging."

A return to the stage in better health

With the mystery solved and successful surgery behind him, Mauceri has experienced life-changing results. He no longer needs to take any of his previous medications, the inflammation has not returned, and he has lost 40 pounds. "I went from fluid overload, my heart essentially trapped in a cage, to suddenly feeling like I did back in college. The results have been tremendous, thanks to this expert team I truly can't thank enough."

On September 12, 2024, Mauceri celebrated his 79th birthday, calling it "a miracle of modern medicine."

"Mr. Mauceri went from barely being able to walk into my office in May to attending my sons' bar mitzvahs in September," said Dr. Samuels. "Last April, I had never seen him so sick. He was going through so much. To have him celebrate with my family was such a gift."

For Mauceri, returning to the stage was the ultimate triumph. He celebrated his renewed health with back-to-back performances in Europe and Japan. Now, he's embracing an active lifestyle in New York City, cherishing time with his family. His plans include a proposed return to the Hollywood Bowl in the fall, shortly after celebrating his 80th birthday.

As he continues to share his passion for music across the globe, Mauceri's story is a powerful reminder of the resilience of the human spirit and a testimony to the perseverance to pinpoint a challenging diagnosis with the right care team at NYU Langone. "I am more committed than ever to living life to the fullest, bringing the joy of music to the world, and embracing the gift of time," he said.