Physician Cares For The Tiniest Hearts

Pregnancy is a time of joy and anticipation as women happily make plans for the new life developing inside of them. Yet those same nine months can be quite a different experience for women with congenital heart disease. “Pregnancy is a fairly stressful time for them,” said Dr. Ozzie Shuler, an associate professor in the Department of Pediatrics and a pediatric cardiologist.

Because Dr. Shuler follows patients born with complex or unusual heart diseases through their adult years, it’s a natural progression to continue caring for these patients after they conceive children. While many women with congenital heart disease can have successful pregnancies, they require closer medical supervision by their obstetrician/gynecologist and the involvement of a cardiologist to monitor their cardiac health. In addition to keeping close tabs on the added demands on the woman’s heart during pregnancy, Dr. Shuler and his colleagues typically perform a fetal echocardiogram to determine if the fetus has any cardiac abnormalities. Children of mothers with congenital heart disease have a slightly higher risk of being born with a heart defect.

Dr. Shuler encourages his patients with congenital heart disease to talk with him and/or their OB/GYN before getting pregnant. It’s important that they understand how their specific cardiac problem will impact a pregnancy. For example, women with certain heart defects are at increased risk of having a miscarriage, usually in the second trimester. Dr. Shuler noted another consideration; “Some medications that our patients take for cardiac reasons cause birth defects in a fetus. If they are planning to become pregnant, then we will stop the medications when they start trying,” he said. When a woman’s heart defect would be potentially dangerous to her and/or a fetus’ health, he recommends that these patients pursue some type of permanent birth control. “If they do not desire or are unwilling to do that, then I make sure that they understand the potential risks to themselves and the fetus if they decide to go ahead with it,” he said.

The patients that Dr. Shuler counsels on pregnancy represent a new era in medical care. Until recently, women born with such heart defects as single ventricles didn’t live long enough to have babies of their own. Modern medicine and the availability of life-extending surgery have changed all that. “This group of females is now making it to reproductive age, and we are only seeing the tip of the iceberg. The numbers are small now, but we all know that they are going to grow,” said Dr. Shuler.

Pediatric Heart Defects

Dr. Shuler and the other pediatric cardiologists in the Department of Pediatrics also provide care for infants with heart defects, following the babies’ progress even before they are born. When an obstetrician detects a potential heart problem during a routine exam, women are referred to Pediatrics for additional evaluation. Mothers who have previously given birth to a child with heart disease are also tested with a fetal echocardiogram to rule out the presence of cardiac problems. "If we do identify  something, then we can advise the mother of the significance of it and if the baby will need surgery," he said.

Detecting a heart defect in utero provides several distinct benefits for the baby. "There are certain medications we can start immediately after birth that will keep the child healthy until it is time for surgery," said Dr. Shuler, noting that surgery can take place as soon as two to three days after delivery for particular heart defects. Babies whose cardiac problems are not diagnosed until after birth can become very ill very quickly, causing a delay in surgery, more damage to the heart, and less favorable surgical outcomes.

When Dr. Shuler knows in advance that a baby will require heart surgery, he will plan for the delivery to occur at a hospital where neonatal heart surgery can be performed, in most instances the Medical University of South Carolina in Charleston. Making these preparations ahead of time will keep the mother and child from being separated if the mother is not physically able to travel and be with her child at another hospital.

Dr. Shuler has also found a major psychological advantage for his patients who learn of their child's heart defect before birth. "These mothers have already gone through the mourning stage with the anxiety and regret it produces. When it's time for the baby to be born, they have already prepared themselves for the upcoming heart surgery and can enjoy and celebrate the child's birth," he said.

Reprinted from Connections newsletter, November 2002

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