A Hong Kong medical team successfully saved a pregnant woman expecting twins who was suffering from a rare and potentially fatal heart condition – the city’s first such case in more than 20 years, reports the South China Morning Post.
In the past two decades, said the doctors, only 29 such cases in pregnant women have been reported globally.
To minimise risk for the patient – who was diagnosed with aortic dissection – the specialists completed the operation in under five hours, significantly shorter than the usual eight to 10 hours, reported the team from the Chinese University of Hong Kong and Prince of Wales Hospital.
Tiffany Chen, who was 25 weeks pregnant, had been admitted to hospital with chest pain and difficulty in breathing.
She was diagnosed with aortic dissection, a fatal condition described by gynaecologist Liona Poon Chiu-yee as a “ticking time bomb” inside the body, which can rapidly deteriorate in minutes or even seconds.
Poon said that aortic dissection was a rare but life-threatening heart condition where a tear occurred in the aorta’s inner layer, allowing blood to flood the tear and potentially cause it to rupture.
She added that the condition occurred in about 5.5 of every million pregnancies, as expectant mothers experienced increased blood volume and cardiovascular strain.
“Only 20% of the patients survive after the surgery, while 40% would die even before admission,” she said.
“In the past 20 years, only 29 reports of aortic dissection in pregnant mothers have been recorded globally.
“At 25 weeks, the survival rate of the twins is low, and they will not survive if we remove them from the mother’s body before the surgery.”
Anaesthetist Dr Lai Man-ling said the team was determined to save both the mother and the children, despite the complex circumstances.
The patient left ICU four days after surgery and was discharged after two weeks. Chen then successfully delivered the twins at 31 weeks.
Rarity
Randolph Wong Hung-leung, head of Cardiothoracic Surgery at the hospital, said he believed it would have been “impossible” for the patient to survive without the aortic root operation.
Due to the rarity of the case, the team could not find any reports of an expectant mother with twins facing the condition while preparing for surgery, and Wong said he felt immense pressure during the operation, noting that the last time a similar case occurred in Hong Kong was more than 20 years ago, in which the mother died.
“It is extremely rare that we have to save three lives in one single surgery,” he added.
“The complexity of both the operation and the anaesthesia demanded a highly experienced multi-disciplinary team.”
Wong said the seamless co-operation of more than 15 staff in the operating room – including cardiac surgeons, obstetricians, anaesthetists and intensivists – enabled them to reduce the surgery time to under five hours, thereby reducing the risks for both the mother and children.
“Cardiopulmonary bypass is used to temporarily replace the patient’s own heart and lung function during a Bentall procedure,” he said.
Although the patient’s body temperature was usually lowered during cardiac surgery, this could be life-threatening to the foetus, which risked hypothermia and cardiac arrest from inadequate blood flow.
Anaesthesiologists monitored the mother’s heart condition and precisely managed medication to maintain her blood pressure and control coagulation without affecting the foetuses.
A report on the operation was published in Annals of Thoracic Surgery.
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