Baby Delivered at Oklahoma Heart Institute Saves Two Lives

“I thought this is serious,” says Andrea Eppley of the day she was admitted to the ICU at Oklahoma Heart Institute. She was pregnant with her second son and still five weeks before his due date. “I was really scared. What if I die?” Andrea had called her OB/Gyn Monday morning complaining of shortness of breath, inability to lay down to sleep and swelling of her legs and feet so severe she was not able to walk more than a few feet. Later that afternoon, at her appointment with her OB/Gyn, she was sent to Hillcrest Medical Center’s Peggy V. Helmerich Women’s Health Center for further observation. Andrea was admitted to Oklahoma Heart Institute’s CVICU floor on the campus of Hillcrest Medical Center.

“Her heart pumping function on the left side was failing,” says Oklahoma Heart Institute heart failure specialist Dr. Sandra Rodriguez. “Normally it would be 60 percent. In her case it was 10 to 15 percent.” Dr. Rodriguez determined Andrea was in incipient cardiogenic shock – a condition in which the heart is not able to pump enough blood to adequately meet the needs of the organs in the body. It was caused by a condition brought on by her pregnancy called peripartum cardiomyopathy. “We placed her on medications to help her heart improve temporarily to try to prevent any event from happening to her or the baby.” Medication therapy helped to relieve some of the pressure Andrea was feeling when laying down or trying to breathe, but her condition remained a risk to both her and her unborn son.

“I thought, I’ve got to fight this,” recalls Andrea.

Under the care of Dr. Rodriguez, as well as OB/GYN Dr. Monica Tschirhart, Andrea and the baby’s condition were closely monitored as she continued to receive medication and care in CVICU. It was determined delivering the baby would be best for both Andrea and the baby, however, her medical team feared she would not be able to survive a delivery. “With her function being 10 to 15 percent, she would not have been able to handle volume changes during the anesthesia given for the c-section or the vaginal delivery’s increase in pressure when she is pushing,” adds Dr. Rodriguez. “She was at risk for having ventricular tachycardia, pulmonary hemorrhage and the risk of having her oxygen levels dropping so much that her baby and herself could die during the procedure.”

Together, Dr. Rodgriguez, Dr. Tschirhart and interventional cardiologist Dr. Kamran Muhammad quickly determined the safest way to deliver the baby would be with the support of a small implantable heart pump called Impella. “The Impella is a mechanical assist device or a continuous heart assist device,” explains Dr. Muhammad. Inserted near the aorta through the arteries of the groin, the Impella helps the pumping function of the heart to ensure blood is delivered to the vital organs of the body. “It literally assists the function of the heart, which isn’t working well.”

Dr. Tschirhart agreed delivery with the support of the heart pump would not only be best for Andrea, but also for the baby. “Delivery is a time of big fluid shifts and adjustments to mom’s body,” she says. “Luckily Andrea developed peripartum cardiomyopathy in the late stages of her pregnancy. She was 35 weeks when she delivered, so we were very close to full term and babies generally do very well in that case.”

“We decided with Dr. Muhammad we would do the c-section in the safest conditions,” says Dr. Rodgriguez.

To prepare for the Impella implantation and c-section delivery, Andrea was taken to the Oklahoma Heart Institute hybrid catheritization laboratory, where patients typically undergo stent procedures and other interventional cardiac procedures. This would be the first time a patient arrived in the cath lab to deliver a baby. “It was a little different of an environment for a c-section,” adds Dr. Tshirhart.

Dr. Muhammad explains why it was necessary for Andrea to deliver her son in the hybrid cath lab, instead of a traditional operating room. “It is really only possible in centers like Oklahoma Heart Institute, where we have expert heart failure physicians, expert obstetrics physicians and the physical capabilities to do a delivery with anesthesia and a c-section in a hybrid lab environment,” says Dr. Muhammad. “We can do an operation, but have the fluoroscopic capabilities to insert the Impella device safely, because that can’t be done in a regular operating room.”

As soon as Dr. Muhammad implanted the Impella heart pump, which assisted Andrea’s heart in pumping blood, Dr. Tschirhart and her team quickly moved into place for the c-section. “Any time you are close to delivery you worry about blood loss with mode of delivery,” she adds. “We tried to be very quick with our operation to help minimize blood loss and minimize the time she had to be under sedation.”

Andrea and the baby were closely monitored during the procedure. “The Impella took at least half of the load off her failing heart muscle,” says Dr. Muhammad. “She was very stable and sailed through a very quick and expertly done procedure by Dr. Tshirthart with no signs of heart failure worsening during the delivery.”

Friday, October September 19, 2014 Dylan Dela Cruz was born healthy at 5lbs 1oz at 10:33 a.m. Meanwhile, Dr. Muhammad watched to make sure Andrea’s heart stabilized after the delivery and determined it was safe to remove the Impella.

“I’m glad I was in the right place,” Andrea says.

Andrea remained at Oklahoma Heart Institute for another week to treat her condition, while baby Dylan was transported to her daily from the nursery at the Peggy V. Helmerich Women’s Health Center. Today, she says she is taking one day at a time at home with her young family and so thankful she listened to her body and alerted her OB-Gyn in time to save both her life and the life of her son. “I did,” says Andrea in relief. “I made it through.”