open-heart-surgery-pregnancy

Peaceful Christmas welcome after open heart surgery during pregnancy

David Wahlberg, Wisconsin State Journal, dwahlberg@madison.com

Three days before last Christmas, Katie Haun was sipping eggnog and unwrapping presents at her parents' house when she suddenly developed a headache, started seeing stars and lost her memory.

"Where am I? How did I get here?" she asked her husband, Nick.

He rushed her to the emergency room, where doctors said she probably had a migraine. But three weeks later, she learned she had a tumor the size of a golf ball in her heart. It was the likely cause of a series of strokes.

Haun was 28 weeks pregnant. The only way to remove the tumor was open heart surgery, which could cause premature labor and endanger the baby. After much discussion and planning, doctors performed the risky operation in Madison on Jan. 25.

Haun delivered her daughter, Rosemarie, in April, at full term. She's grateful to be having a less dramatic Christmas this year.

"I feel really relieved she's here and healthy," Haun said, holding Rosemarie at her home on Madison's West Side. "Last year was full of a lot of anxiety, a lot of fear."

Open heart surgery on pregnant women "is extremely rare," said Dr. Dinesh Shah, a maternal and fetal medicine specialist at UW Health who oversaw Haun's care.

A 2011 article in the International Journal of Cardiology said 17 cases of pregnant women with the kind of tumor Haun had have been reported worldwide since 1969. Ten of the women had open heart surgery while pregnant, six had surgery after delivery and one refused treatment.

The last open heart surgery in Madison on a woman in advanced pregnancy was more than 10 years ago, for a different condition, said Dr. Peter Pryde, anesthesiologist during Haun's surgery at Meriter Hospital. Pryde plans to submit an article about Haun's procedure to a medical journal.

Shah, Pryde and Dr. Takushi Kohmoto, Haun's heart surgeon from UW Health, debated how and when to do Haun's operation, balancing the risks to mother and baby. They decided to proceed when Haun's pregnancy was at 30 weeks. Most babies born at that stage do relatively well, though they typically require lengthy hospital stays.

"Every week you can wait is good for the baby, but it's another week of compounding risk for the mother," Pryde said.

The ordeal came as Dr. Nick Haun worked long shifts as an internal medicine resident at Meriter, UW Hospital and Madison's Veterans Hospital. He'll be chief resident next year, imparting lessons to less experienced doctors.

"I'm saving Katie as my most interesting case," he said.

He and Katie, both 29, have three other daughters: Anna, 5, Marian, 3, and Grace, 2.

Preparing for surgery

Katie Haun's first three pregnancies went smoothly. So did her fourth — until the odd symptoms started at her parents' home in Fennimore, where she grew up.

Her headache subsided and her memory returned, but a blind spot remained in her left eye.

An MRI showed signs of strokes.

Dr. Marcus Chacon, a UW Health neurologist, ordered an echocardiogram that found the noncancerous tumor, called an atrial myxoma.

The tumor was releasing substances that cause blood clots and blocking blood flow in Haun's heart, Shah and Pryde said. Haun was also found to have a genetic condition that increases the risk of blood clots, which can cause strokes.

"She had several things going against her," Pryde said. "We didn't want to wait until she was severely compromised."

But the stress of the operation, which would require Haun to go on a heart-lung bypass machine for an hour or more, could reduce blood flow to the baby and trigger contractions, Shah said.

Katie Haun wanted to act as soon as possible. "I felt like a ticking time bomb," she said. "I was sitting there with this thing that could ruin me and in turn ruin her."

Nick Haun, who grew up in Tomah, told Katie he felt trapped. "You have a baby inside of you and you have the myxoma inside of you," he said he told her. "Which one is going to come out first?"

Nearly three dozen medical staff gathered in a conference room to plan the operation. They agreed to modify a normal open heart surgery in a few ways.

They would place Haun on her side so the baby wouldn't compress key blood vessels. They wouldn't cool Haun, to protect her organs, because the low body temperature could cause the baby distress. They'd pump blood from the bypass machine in pulses, instead of a continuous flow, to get more oxygen to the baby.

They'd also monitor uterine blood flow and fetal heart rate with equipment typically not in the operating room. And they'd set up a table to resuscitate the baby if a Cesarean section was needed.

The team assembled in the operating room for a dry run, marking the floor with tape where equipment would sit and staff would stand.

Months of stress

The surgery, which took five hours, went without a hitch.

"I thought it would be complicated," Kohmoto said. But with all the preparation, it seemed routine, he said.

Haun had contractions at the end, but medications made them go away, the doctors said.

Even after Haun's tumor was gone, her blind spot and recurring headaches remained. She rested as much as a mother with three young girls could and hoped her baby wouldn't come early.

Rosemarie was born April 6, her due date, through a normal delivery at Meriter.

"It was the most emotional delivery room," Katie said.

"Four months of stress, anxiety, surgery, ICU stays and what seemed like thousands of doctor appointments were done," Nick said. "After all that, we had a healthy baby."

Katie, sitting this month near the family's Christmas tree, said she occasionally wonders what it would be like if she wasn't around this holiday season.

But with four girls seeking her attention, those thoughts don't last long.

"They keep you busy and excited and happy," she said. "They're joyfully oblivious of everything that went on."

Contact Maternal-Fetal Medicine

Angie Skaggs
Fellowship Coordinator
MFM Fellowship Program
Meriter Hospital
1010 Mound Street
McConnell Hall 4th Floor MFM
Madison WI 53715

Phone: 608-417-6099
Email: Contact Email Ann Hodges

Partnerships With

Meriter Hospital

Center for Perinatal Care

 American Diabetes Association

AIUM

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