Mother and Baby Survive a Heart Defect
at Newark Beth Israel Medical Center

With the help of more than a dozen medical and surgical specialists, Cecilia was ready to deliver her first child at Newark Beth Israel Medical Center, an RWJBarnabas Health facility, earlier this year. Throughout the previous six months, this team helped her maintain the pregnancy despite her severe heart valve disease and they were determined to sustain the delicate balance that kept both mother and infant alive through the birth and beyond.

After Cecilia’s open heart surgery to replace her heart valve, she and her infant daughter, Regina, continued to bond in the Neonatal Intensive Care Unit at Children’s Hospital of New Jersey at Newark Beth Israel Medical Center.

Cecilia, a resident of Elizabeth, NJ, had a mechanical heart valve implanted fifteen years ago and was aware that her heart condition could complicate a pregnancy. Last year, when she learned that she was pregnant at age 37, Cecilia was feeling well and was hoping for the best. One August morning, she suddenly had difficulty breathing and took herself to the local Emergency Department where they found that her lungs were filled with fluid. Further testing showed that her mechanical heart valve was narrowed, preventing her heart from pumping enough blood to meet her body’s needs.

Doctors immediately referred her to Newark Beth Israel Medical Center where a team of high-risk obstetricians, cardiologists, cardiac surgeons, hematologists and neonatologists could manage her care. Joseph Ivan, MD, Chairman, Department of OB/GYN, and Karen Koscica, MD, maternal fetal medicine physician, became Cecilia’s high-risk obstetricians. Marc Cohen, MD, Director, Division of Cardiology, became her cardiologist.

“After her first visit to my office I began planning strategies together with Dr. Koscica and Dr. Ivan about what we would need to do as Cecilia’s pregnancy progressed,” recalled Dr. Cohen, “There was a tremendous amount of multidisciplinary collaboration as her case unfolded.”

Cecilia started feeling better after taking medication that lowered her heart rate. She visited Newark Beth Israel regularly for tests — an ultrasound to check on the baby’s development and a transesophageal echocardiogram to monitor the condition of her heart valve.

“Cecilia did really well until about November,” said Dr. Koscica. “At that point, her valve was failing, becoming more stenotic (tighter), so we began monitoring her more and more closely.” She and Dr. Ivan also consulted Craig Saunders, MD, Chairman of Cardiothoracic Surgery, who proposed a meeting, where they and all of the subspecialists overseeing Cecilia’s care could combine their expertise for this unique and delicate case.

The team planned to admit Cecilia to the hospital’s Cardiac Care Unit at 30 weeks of her pregnancy. “With the mechanical valve, it was necessary that the patient take blood thinners,” stated Dr. Saunders. “But of course that could also cause uncontrolled bleeding during delivery.” She remained on anticoagulation medications throughout the pregnancy.

Dr. Cohen compared the balancing of this aspect of her care to a tight rope: “If she veered to the left and her blood was too thin, that could potentially result in hemorrhage and bleeding that could affect the baby and the mother. A little bit too far to the right and you risk the cardiac valve becoming even more dysfunctional because the blood clotted.” He added, “We planned her admission to the hospital because we could no longer leave her on the oral blood thinner that had too long-acting an effect. We prepared to switch her in a very calm and gentle manner to the intravenous medication so that if she started contracting, she would be on a short-acting blood thinner that we could stop right away.”

Keeping with the plan, Cecilia was admitted on January 12. Doctors monitored her heart around the clock and weaned her off Coumadin. Generally, it takes up to two weeks to remove the medication from the body’s system so the team hoped they could stretch her pregnancy to at least 32 weeks.

“All the people around me were recovering from heart surgery and I thought, ‘What am I doing here?’” Cecilia remembered. “Little did I know how sick I was.”

The team had successfully brought her and the baby to 32 weeks, but her heart valve was under so much stress that she was in danger of heart failure. They recommended delivering the baby as soon as possible.

Dr. Koscica reflected, “Even though this case was very complex, it made it much easier having so many experienced specialists on-site. On the day of the delivery, within about 15 minutes, all of the subspecialists connected to the case were assembled in the delivery room ready to pitch in and do whatever had to be done as Dr. Ivan and I performed a C-section.”

Newark Beth Israel Medical Center subspecialists in attendance:

Alice Cohen, MD – Director, Frederick B. Cohen Comprehensive Cancer & Blood Disorders Center; Director, Comprehensive Hemophilia Services & Thrombosis Center;

Marc Cohen, MD – Director, Division of Cardiology

Morris Cohen, MD – Director, Neonatal Intensive Care Unit, Children’s Hospital of New Jersey at Newark Beth Israel Medical Center

Chunguang Chen, MD – Director, Non-invasive Cardiac Laboratory

Joseph Ivan, MD – Chairman, OB/GYN

Margaret Kee-Forte, RN – Perinatal Coordinator

Karen Koscica, MD – Maternal Fetal Medicine Physician

Onofrio Patafio, MD – Chairman, Anesthesiology

Craig Saunders, MD– Chairman, Cardiovascular Surgery

Born on January 23 weighing 3 lbs. 14 oz., Regina spent her first few weeks in the Neonatal Intensive Care Unit at Children’s Hospital of New Jersey at Newark Beth Israel Medical Center. While little Regina thrived, Cecilia’s heart function continued to decline. Two weeks after the baby was born, Dr. Saunders performed open-heart surgery to replace Cecilia’s failed mitral valve.

Today, mother and baby are home and doing well, surrounded by their supportive family and many caring friends. Dr. Cohen states that Cecilia’s cardiovascular status is excellent.

Reflecting upon this case, Dr. Ivan said, “Complex cases such as this one often have unforeseen complications. This is an extraordinary example of a woman of advanced maternal age with a serious cardiac lesion who gave birth pre-term to her first and only child. She and the baby did well because of the collaborative effort of many highly skilled physicians and nurses.”

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