Successful open heart surgery during pregnancy

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When 27-year-old Chantal Dueck learned she urgently needed open heart surgery to replace a congenitally abnormal aortic valve which had become infected and was destroying her heart, her first thought was not for herself. Sixteen weeks pregnant, her main concern was for her unborn child. The care team at Royal Columbian Hospital (RCH) in New Westminster, BC shared her concern, and left no stone unturned to ensure the safest possible care for Chantal and her baby.

“Concern was warranted, because cardiac surgery in this setting has varying degrees of success,” said RCH clinical nurse specialist Jocelyn Reimer-Kent. “Multiple factors associated with surgery, especially the cardiopulmonary bypass can have a profoundly negative effect on the fetus. Although maternal mortality rates are comparable to those for non-pregnant women, the same is not true for the fetus, and fetal death is almost a certainty when an infected heart valve is added to the equation.”

Step one in RCH’s determination to ensure the best outcome for mother and baby was to form a multi-disciplinary team that met over the next week to plot out the technical how-to’s. Step two was to rapidly educate the patient and family about possible options, given that Chantal’s life was in danger. She and her family had to understand that surgery was necessary immediately, and that waiting until the fetus was viable was not an option, said cardiac surgeon Dr. Tim Latham. Chantal and her family agreed.

So, how to achieve success? Latham scoured the literature and contacted colleagues across the country who might have operated in similar circumstances. Clinical pharmacist Dr. Wendy Gordon did a thorough literature review to ascertain the potential effects of blood thinning medications on pregnant women and their unborn babies. Chantal was provided with the information she needed to help her weigh the merits of a tissue valve versus a mechanical valve. (After considering the pros and cons of each type of valve, Chantal chose a tissue valve in order to put her baby and herself at the least risk, and to give her the option of having another child. The compromise: the valve would need to be replaced in 10-15 years.) Chief perfusionist Don Trostheim worked on a precise plan to support mother and fetus while on cardiopulmonary bypass, and nurses from the heart and obstetrics units met to discuss and plan the unique care requirements. Neonatologist Dr. Duncan Farquharson contacted colleagues in BC and beyond, to ensure the best way to maintain the pregnancy long enough to support the safest possible entrance into the world for this infant, so precious to her parents Chantal and Shane.

Dr. Latham said, “When it was time to go in, we had all done our homework, we had a plan and we had taken every step we could to provide the best operation and outcome for Chantal and her baby.”

“Our team took a number of steps to adapt our care to this rare circumstance,” said cardiologist Dr. Marg Blackwell. “For example, the usual practice of administering medications to stop the patient’s heart during surgery was foregone; the flow on the bypass pump was increased; and a specialized neonatal team was standing by, all for the safety of the baby. RCH is the only one in the province which can do open heart, obstetrics, and neonatal care all in one location, so it was the ideal hospital to care for Chantal.”

“Without a doubt, Chantal is one of the very bravest women I have ever met,” said RCH patient care coordinator Renee Kinnear. “We all felt privileged to help see her through this incredible journey.”Immediately after surgery, while Chantal was still under the anesthesia administered by specially trained cardiac anaesthetist Dr. Michael Law, the team gathered round her bed to do the first of many ultrasounds. Knowing that world-wide only a handful of successful cases have been reported, the team braced for the outcome.

“Seeing that the fetus was alive, and sharing this news with the waiting family and eventually with Chantal was an incredible experience,” said Reimer-Kent.

“On the day of my surgery, our whole church was praying for me,” said Chantal. “We have felt incredibly well supported by our church, our community and the physicians and nurses at RCH throughout this adventure.”

“I made it to my 38th week of pregnancy,” adds Chantal, “and our little girl Brielle is now home with us and her big brother Chase, and gaining weight every day. We are truly blessed.”