Canada: Baby delivered in cardiac room

It is being called a miracle as such a surgery hasn't been conducted in Canada. The surgery saved the life of the mother and the baby was safely delivered through the C-section.

While the mother was going through an open heart surgery, obstetricians were busy delivering the baby through the C-section.

"It's for the first time that we have delivered a baby in the cardiac room," said Dr Arvind Koshal, director of cardiac surgery at the University of Alberta Hospital in Edmonton, who's also the director of the cardio science programme there.

He himself didn't perform the surgery as he was in another operating room, but he coordinated this complicated procedure, he said.

Mother Roxanne Follett calls her baby Astra (star) as without her being in the womb maybe Roxanne wouldn't have survived.

It would have been deemed less of an emergency as Roxanne started having chest pains and difficulty in breathing.

Her blood pressure started going up, explained Koshal in a telephone interview with rediff.com on Monday.

Dr Billy Wong, who led the team of obstetricians, said Roxanne would likely not be alive today if she hadn't been pregnant because a tear in her aorta would probably not have been discovered otherwise.

Dr Road MacArthur, who led the cardiac surgeons' team for the open heart surgery on Roxanne, said within 24 to 48 hours of an aortic tear, 40 per cent of patients die without surgery.
 
"The mother was airlifted from Grand Prairie (Alberta) and sent to us for investigation," Koshal said about Roxanne.

"I credit my medical colleagues that they were able to make the diagnosis that she had a ruptured aorta that could kill her if she was not operated immediately," Koshal said.

"Her chest pains and shortness of breath were acute as we saw in the CT scan and that got picked up in the aorta (the largest blood vessel). This was actually a tear inside the aorta. When it happens the blood tracks through the tier and goes between the walls of the aorta," Koshal explained calling it "a dissection."

"This condition requires immediate surgical care," he said. "This is not the first case of the dissection, but the first case as the baby had to be delivered at the same time as we repaired the aorta."

There was a problem that the surgical team faced, explained Koshal. The surgery was actually conducted on January 24.

The problem was they had to find ways to relieve the pressure on the aorta and for that the surgeons had to find ways to lower her body temperature to 17 degrees C, a temperature that would make her heart stop, he went on to explain.

Implications: "The mother would tolerate it and we would be able to ensure that her brain and organs function normally without any adverse impact but the baby would not survive. Roxanne was pregnant 35 weeks."

"When we do dissection the blood has to be drained out of the body," Koshal went on to explain complicated medical conditions and surgeries in a very simple language.

"For a short period of time, say 30 minutes to one hour, we can support the function of the brain and everything. But it is too much time to keep low temperature as baby wouldn't survive."

That's how their cardiac team headed by Dr MacArthur, opened Roxanne's chest  cavity first to relieve the pressure. Then the obstetrics team, led by Dr Wong, quickly delivered the baby prematurely.

Finally, the cardiac surgeons completely the surgery to repair Roxanne's aorta.

In the process "we saved not one but two lives," Koshal said. "Of course, our first task was to save the mother, but we are happy we were able to save the child also."

MacArthur and Wong reportedly said that the operation was so rare that they didn't expect to do another one during their careers.

"There have been approximately 40 cases reported worldwide over the last 25 years and in only approximately half of those cases have both mother and baby survived." So, MacArthur called it 'truly an exceptional case.'

Without the mother being pregnant, a tear in her aorta would probably not been discovered, said Dr Wong.

The baby's father Doug reportedly said he feels like he's won a million dollars, "but it didn't get a million dollars. I got two lives."

Doug said they plan to donate a dollar for every day of Astra's life to the Heart and Stroke Foundation to pay back for the miracle they were given.

The baby currently weighs a little over four pounds. She needs to weigh 5.5 pounds. So the baby will be kept in neo-natal section of Grande Prairie's hospital where she will spend a couple of weeks to gain strength.

It wouldn't have been easy for them had the pregnancy been 25 weeks instead of 35 weeks as baby at that stage, outside the womb, wouldn't have survived.

"We would have had to think of some other strategy in that eventuality, but happily the mother had 35 weeks into her pregnancy," explained Koshal.

Roxanne right calls Astra a miracle baby.