Murray, Utah (11/26/2008) – Lily Marie Barnard has a lot to be grateful for this Thanksgiving.
The two-week-old newborn and her mom, Alisa, both barely survived her entrance into the world a few weeks ago. Thanks to a dedicated team of physicians, nurses and staff at Intermountain Medical Center – along with new life-saving technology – they will enjoy the holiday season together at home.
Little Lily was not delivered in the maternity unit as most babies are at Intermountain Medical Center. She is the first baby to be delivered in the hospital’s heart catheterization lab – a move that was meant to save both her and her mom.
Alisa suffered serious and life-threatening heart failure in the final weeks of pregnancy, presenting physicians with one of the most challenging cases they’ve ever seen.
“It was frightening, it really was,” said Patrick W. Fisher, M.D., the advanced heart failure/transplant cardiologist at Intermountain Medical Center who coordinated the team of physicians that cared for Alisa after she was admitted to the hospital on Nov. 7. “That was a nail-biter of a night.”
Alisa was apparently suffering from peripartum cardiomyopathy, a relatively rare syndrome that occurs in the last weeks of pregnancy or, more commonly in the first few months after. There are many theories about what causes the syndrome, but no definite answers. In Alisa’s case, her heart problem was so severe it led to another deadly condition, pulmonary hypertension, which restricts blow flow to the lungs, increases cardiac stress, and reduces oxygen levels in the bloodstream.
“The risk of death to a pregnant woman from pulmonary hypertension is about 30 to 50 percent,” says Intermountain Medical Center cardiologist A.G. Kfoury, one of several cardiovascular specialists involved in the case. “The risk of maternal death from advanced heart failure in the third trimester is extremely high. In fact, it is so uncommon in this stage of pregnancy that few cases like Alisa’s have been reported in the medical literature.”
Dr. Fisher quickly consulted with a team of experts at the hospital – cardiologists, cardiothoracic surgeons, anesthesiologists, pulmonologists, high-risk OB-GYNs, nurses, engineers and technicians from a variety of specialties. Together, they crafted a plan to help Alisa and Lily beat the odds.
Today, Alisa has returned home to her husband, Paul, and their four children, including their happy and healthy newborn, Lily. A few weeks ago, however, things were quite different as Alisa found herself fighting for her life. She’d been having shortness of breath and was waking at night, gasping for air. Preliminary tests showed that her heart was failing.
A Life Flight helicopter rushed her from McKay-Dee Hospital in Ogden, where she was first seen, to Intermountain Medical Center, where she was examined by maternal-fetal specialist Mike Draper, M.D. He called Dr. Fisher, and together they decided to put Alisa on medication that hopefully would stabilize her while they considered their options.
There were many – and all of them were complicated.
Doctors had to decide which to do first: place a pump in her heart to take over some of the work, or deliver the baby. If they implanted the device first, they would also have to give her potent blood thinners, which raised the risk of serious bleeding during delivery. If they delivered the baby first, there was a chance her
heart would get worse due to the overwhelming strain of childbirth.
There were other considerations: How would the anesthesiologist treat her labor pains without increasing the risk of bleeding in her spine, where her epidural would be placed? What pump would a cardiologist use to help her
heart, but not require too much anticoagulation? And how would they avoid a dangerous blood clot, but also reduce the risk of blood loss?
In the end, they decided to deliver Lily first.
On Nov. 10, Alisa was wheeled into the heart cath lab – a safer place to be if her heart collapsed. Just as Intermountain Medical Center maternal-fetal medicine physician Flint Porter. M.D., was preparing to induce labor, Alisa’s heart rate plunged and then slowly rose, alarming everyone in the room and confirming that something needed to be done quickly.
After less than five hours of labor – but no pushing, since that would stress Alisa’s heart too much – Lily Marie was delivered safe and healthy. With a room full of heart specialists working side by side with maternal fetal physicians, applause and tears broke out as Lily was examined.
“I just got a quick look at the side of her before they started to work on my heart,” said Alisa, who was whisked to a nearby table where Intermountain Medical Center cardiologist James Revenaugh, M.D., quickly inserted an Abiomed Impella 2.5 heart recovery pump – the smallest heart device in the world.
The tiny pump was approved for use just last summer by the U.S. Food and Drug Administration and had been used only twice before at Intermountain Medical Center. The heart pump is a minimally invasive assist device, inserted through a vein, that is designed to recover heart muscle by actively unloading the distressed left ventricle and increasing blood and oxygen supply to the heart. The pump pulls blood from the left ventricle through an inlet area near the tip and expels blood from the catheter into the patient’s ascending aorta.
In consultation with physicians at Abiomed, Dr. Revenaugh devised a unique way to deliver smaller amounts of blood thinner at the site, rather than circulating larger amounts throughout her entire body, significantly reducing Alisa’s chances of bleeding to death.
A few days later, Alisa’s heart was stabilized and doing well enough to safely remove the device.
“She’s sailing right along,” said Dr. Revenaugh, who praised the collaborative work of the physicians – an unusual group not often thrown together. “This was an extremely complex and high-risk situation with the potential for catastrophic outcome for both Alisa and her baby. It was a great example of teamwork.”
“Of all the hospitals I’ve been, I can’t say that I’ve had an opportunity to pull together an incredible group like this in such a short period of time. It was impressive,” added Dr. Fisher. “If this had happened someplace else, I’m not sure we’d have Alisa or Lily with us today,”
“This was a terrific example of the kind of care that all of our patients receive here at Intermountain Medical Center,” said medical intensivist Brad Rasmusson, MD, who cared for Alisa in the ICU.
Doctors don’t know what permanent damage, if any, Alisa’s heart has suffered, but they are hopeful that she will continue a normal life. They’ve implanted a defibrillator in Alisa’s chest to protect her if her heart develops a sudden and lethal rhythm problem. Another pregnancy will likely be too risky.