Groundbreaking Heart Surgery Helps Pregnant
Woman
Penn Cardiac Care surgeons have always been recognized
as leaders in treating patients with the most complex
conditions of heart disease, particularly of the aorta,
the largest artery of the heart.
No one knows this better than Amy Maile*, a 34-year-old
woman, who in her fifth month of pregnancy, was referred
by her obstetrician to Penn Cardiac Care at Pennsylvania
Hospital, one of the area's leading cardiac care programs.
Amy’s case was unique and proved to be another
medical historical first at Penn.
Having experienced recurring fever, chills and
shortness of breath for nearly a month, Amy was
referred by her obstetrician to Kar-Lai
Wong, MD, a cardiologist at Penn Cardiac Care
at Pennsylvania Hospital. According to Dr. Wong,
“Amy’s symptoms indicated her heart
wasn't pumping as efficiently as it should, but
even more worrisome were her complaints of repeated
episodes of a distorted right lower field of vision.”
Further examination discovered a heart murmur
and all blood cultures showed signs of a bacterial
infection. An echocardiogram, a routine test,
which shows blood flow through the heart, revealed
that an infection was located on the heart’s
aortic valve and in the aortic wall. Charles
R. Bridges, Jr., MD, Chief of the Division
of Cardiothoracic Surgery at Penn Cardiac Care
at Pennsylvania Hospital and a nationally renowned
leader in cardiothoracic surgery states, “Although
the patient's condition was serious in itself,
the fact that she was in her second trimester
complicated the situation. We were caring for
the health of two patients, and standard surgical
procedures could have threatened the life of the
baby."
After discussion with Joseph
E. Bavaria, MD, Director of Thoracic Aortic
Surgery at Penn Cardiac Care at the University
of Pennsylvania Medical Center, Dr. Bridges recommended
surgery to replace Amy’s aortic valve. Although
delaying cardiopulmonary bypass surgery until
the 28th week of gestation would have presented
the least risk to the mother and enabled the baby
to be delivered via Caesarian section, the severity
of this case required that action be taken immediately.
After careful consideration of the risks involved
to herself and her baby, Amy decided to have the
operation.
During many cardiac valve operations, a patient's body
temperature is lowered, because the body requires less
oxygen at cooler temperatures. “With a pregnant
patient however, a lower body temperature may not provide
enough oxygen for the baby. For this reason, we decided
not to cool Amy’s body temperature, but rather
let it adjust itself to the temperature in the operating
room,” Dr. Bavaria explains.
Both mother and child were closely monitored during
the procedure. “Fetal echocardiography was used
during surgery, which enabled our team to make any necessary
adjustments to ensure the health of both patients,"
Dr. Bridges notes. "We learned that this procedure
can be done successfully."
The aortic root was measured and successfully replaced
with a valve taken from a human donor, called a homograft.
Drs. Bridges and Bavaria chose the homograft, because
of its durability, low risk of infection and better
survival rates than mechanical valves or animal grafts.
It also eliminated the need for blood thinners that
could have complicated Amy’s pregnancy and future
pregnancies. Dr. Bavaria explains, "In a sense,
this operation was really a transplant and to our knowledge,
the first reported case of a homograft aortic root replacement
during pregnancy."
Amy recovered from the surgery without complications
and was discharged from the hospital after just five
days. Twenty-one weeks later, Amy gave birth to a healthy
baby girl and today both mother and daughter are doing
well.
* Patient's name has been changed to protect her privacy.
|
