The key to successful treatment of pregnant women with congestive heart failure? Team-based treatment, research finds
Every time a pregnant woman shows heart failure, there are risks for both mother and baby. What is required to protect the mother and her growing infant to achieve the best possible outcome?
According to doctors at Salt Lake City's Intermountain Health, the key to survival is a multi-disciplinary approach based on teams, including cardiovascular experts, who are usually not working together, to succeed in saving mother and baby.
In a case study presented at the American College of Cardiology of Scientific Sessions in New Orleans on March 16, doctors from the Intermountain Institute showed how multiple medical teams in a number of different disciplines saved both mother and child lives after passing a smaller hospital.
"This case represents a tremendous team effort and shows what it takes to see a critically ill patient during a unique and very challenging course of illness," said Kismet Rasmusson, DNP, FNP of the Intermountain Heart Institute.
The 36-year-old patient was 22 weeks pregnant when she arrived at Intermountain Hospital with shortness of breath but had no early history of heart disease.
When the doctors realized that her heart had failed – or from idiopathic cardiomyopathy with an unknown cause, or cardiomyopathy associated with pregnancy – she was transferred to the heart center of the Intermountain Medical Center.
Cardiomyopathy leads to heart failure – a heart muscle disease that makes it hard for the heart to pump blood to the rest of the body. About 6.2 million Americans have some kind of heart failure, including women and men. According to a recent JAMA study, maternal deaths in the United States are high, with 10% of them associated with cardiomyopathy, but 60% of them are preventable with optimal treatments and coordination of treatment, which is exactly what this team was offering this patient.
For seven weeks, the mother's treatment was administered by multiple teams, including cardiologists and heart failure with the OB team. In order to develop a complete treatment program, the rest of the staff was composed of critical care that included doctors, interventional cardiologists, cardiothoracic surgeons, specialized nurses, lab cath and surgical staff, medical center staffs of InterMountain Medical Center Medical Center of ICU and ICU, pharmacists, And cardiovascular nurses. Social workers also supported both the patient and her partner.
"We had two goals – first let the baby grow up enough for the baby to have a better outcome, and second, to maintain a stable mother with her weak heart muscle," Rasmusson said.
The baby was delivered in 29 weeks – about 11 weeks early. The team knew that shipping was dangerous and required advance planning. They held two prenatal sessions to discuss the sequence of events and roles of all members of the team, which included mechanical support at the heart of the mother during a cesarean section in a cardiac catheterization laboratory.
The complicated delivery sequence included intubation, the entry of a pulmonary artery catheter, introduction of temporary mechanical support, the birth of a cesarean section, the delivery of the baby to the intensive care unit of the father, and intensive care monitoring.
After birth, the mother's heart remained very weak, so she had an implanted left ventricular transplantation device (LVAD), which provided more durable mechanical support to her heart and served as a bridge to the heart transplant, which received eight months after birth.
The baby is now almost five years old, and both the baby and mother are doing well, Rasmusson said.
"The patient in this special case was the best result we all hoped for," she added. "Only through the experts within our various teams, that we have the depth of their skill and experience, and our commitment to provide the best care that could be possible for women as in this case for others like her."
This story was published at: 2019-03-17-17. To contact the author, please use the contact information in the article.
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