A 23-week pregnant Nikita Jadhav had come all the way from a small village in Latur to the Sassoon hospital in Pune, when she developed difficulty in breathing. She remained in Sassoon under doctor’s observation for three months and left Pune with a smile on her face after she had a successful normal delivery in the last week of June.
Jadhav’s heart’s pumping capacity was reduced to as low as 25 per cent of the normal pumping capacity when she came to Sassoon for the first time with complaint of palpation, breathlessness and chest pain. The investigation by the doctor revealed that she suffered through severe narrowing of heart which in medical terminology is called as ‘aortic stenosis’.
Doctors not only counsel the patients relative for the surgery who were not willing because of financial constrains, but also successfully performed the critical heart surgery which lasted for three hours under general anesthesia with high risk of fetal death.
Aortic valve replacement surgery are routine heart surgeries, but performing it on pregnant woman with compromised heart functioning was not only a risky thing but also a rare incidence for the doctors. Doctors at Sassoon hospital said that continuing blood supply to the foetus during operation was a challenge for us and had it not been done we might not have been able to save the baby. Doctors performed the ‘aortic valve replacement’ surgery when she was 23-week pregnant by placing a metallic valve in her heart.
“During pregnancy when the intake of oxygen is needed more, it was very risky for the woman to remain un-operated considering she was able to pump as low as 25 per cent of the normal pumping capacity. Though the surgery was risky we had to perform it as leaving her without surgery could also have been fatal for her life,” said Dr Sanjaykumar Tambe, an obstetrician and gynecologist and professor at Sassoon hospital, who led the team for the operation.
The doctors told My Medical Mantra that the family was not ready for the surgery and doctors had to counsel them about the condition being life threatening to mother and fetus. When the doctors made the surgery available at the subsidized cost under the Rajiv Gandhi Yojana, the family agreed for the surgery.
“I suffered severe chest pain when I was five month pregnant. I had visited government hospital in Latur and the doctors there then referred me to Sassoon hospital in Pune. We have a small shop in our village and a small agricultural land. The surgery was expensive for us, but when it was made available through government scheme I was ready to undergo it. I was bored to stay in hospital in the unknown city for three months but I had no other option. My daughter and me, both are in good health now,” said Jadhav. Twenty-year-old, Jadhav hails from a small village named Hippalgao in Latur district of Maharashtra.
The patient was post operatively observed in cardiac surgery ICU for three to four days. It was essential to put patient on anti-clotting therapy (blood thinner agents) after the operation in order to avoid any blood clotting after the metallic valve was inserted. Doctors administered blood clotting therapy to her for three months.
“She would be on oral anticoagulants for her lifetime in order to avoid any blood clot. After three weeks of her delivery we discharged her,” added Tambe.
Dr Nityanand Thakur, honorary head of Cardio Vascular and Thoracic Unit in Sassoon, said, “It was a high risk surgery as we had to ensure that blood supply to the baby is not compromised. But we had a successful maternal and fetal outcome of such a rare case. In developed country, women get their heart ailment treated first and then go for pregnancy. But, in our country because of lack of awareness such complication are ignored till they become life threatening.” Dr Tejaswini Kale and Dr Avinash Londhe were also part of the team for operation.
Occurrence of aortic stenosis in pregnant women is less than one per cent. Maternal mortality rate in this kind of case is 17.4 per cent while perinatal pregnancy rate is 31.6 per cent.