Heather Burich remembers that Thursday in December 2022 like it was yesterday. She was 23 weeks pregnant and didn’t understand why she was struggling to breathe. The symptoms started shortly after she became pregnant at 35, and she chalked it up to normal discomfort. But her condition was serious enough that she sought an echocardiogram at Vanderbilt Health to make sure nothing was wrong with her heart.
She had just driven from her appointment at The Vanderbilt Clinic in Nashville back to her home in Clarksville, Tennessee when she got a call from Kathryn Lindley, MD, director of the Vanderbilt Women’s Heart Center, with news that her ECHO results were alarming.
“We haven’t met,” Burich recalls Lindley saying. “We’re supposed to have an appointment on Tuesday, but I don’t know how you’re managing. You need to come in, and when you do come, we’re going to have to make a plan to get you surgery.”
Burich immediately started crying.
“I knew something was wrong,” she said. “I didn’t realize it was this wrong.”
That weekend, Burich returned to Nashville to receive a Transcatheter Aortic Valve Replacement (TAVR), a common and minimally invasive procedure used to replace a narrowed or diseased aortic valve in the heart, but an unusual one for a pregnant 35-year-old woman. Three months later, she returned again for a scheduled C-section to deliver a healthy baby girl, Odessa.
Burich’s medical journey shows the need for women to be vigilant about heart health when pregnant or thinking about becoming pregnant, and it illustrates the multidisciplinary expertise of the Vanderbilt Women’s Heart Center and the Cardiac OB/High Risk Pregnancy Team, who brought Burich safely through a dangerous pregnancy.
“We are aiming to deliver comprehensive, multidisciplinary care to women with or at risk for heart disease across the lifespan,” Lindley said, “starting with adolescence into adult care all the way through life.”
Lindley advises women who have known heart conditions to come to the Women’s Heart Center if they’re pregnant or even thinking of becoming pregnant to get a risk assessment. That includes high blood pressure, high cholesterol, prior heart surgery, heart failure or a heart rhythm problem. Specialists can offer procedures or medications to lower risk before pregnancy. “It also just gives you a good road map of what you should expect for you and your baby going into pregnancy,” Lindley said.
A heart condition starting at age 5
In Burich’s case, she was diagnosed with a heart murmur at age 5. She had aortic stenosis, a condition that occurs when where the aortic valve becomes narrowed or obstructed. She was aware of the condition growing up but “never really had any kind of issues with it.”
“As I got older,” Burich said, “my mom, who was also a nurse, was always on me about checking everything. If I’m being honest, I did not take care of myself.”
Burich had her first pregnancy at age 19, and doctors checked her heart then. “Everything was fine,” she said. “In my head, I was like, well, I’ll just be fine forever.”
When she became pregnant again at 35, she began having shortness of breath. “At first I just wrote it off as I’m older and I’m pregnant,” she said. But it got worse. She couldn’t lie flat to sleep. “I wasn’t sleeping … because I couldn’t lie flat. I’m having severe indigestion. …I couldn’t walk from my car to the door of my building at work without having to sit down and rest.”
She suspected something was wrong with her heart.
“I called Vanderbilt myself,” she said, and made an appointment. Meanwhile, one morning she was having severe symptoms. She felt hot and couldn’t breathe and called her sister, who came straight to her house. “That’s the most scared I’ve been,” she said.
That episode led to the echo, and the echo led to the TAVR procedure, where doctors used a tube inserted into her left leg to place the new valve in her heart. They chose this option rather than an open-heart procedure because of how far along she was in her pregnancy.
“When Heather came to us, she was critically ill and at a time in her pregnancy when her baby would not have likely survived had she been born at that time,” Lindley said.
The procedure was successful, but her heart would soon receive another stress test – the birth of her daughter. To manage the high-risk situation, the Cardiac OB/High-Risk Pregnancy Team scheduled a C-section for March 22, 2023.
But a day before the scheduled procedure, while at her prenatal visit with Jennifer Thompson, MD, associate professor of Obstetrics & Gynecology, a maternal-fetal medicine specialist who cares for patients with cardiac disease in pregnancy, Burich began having bad pain in her back. Concerned she was in early labor and having contractions, Thompson sent her to the hospital for further evaluation.
As it turned out, Burich was in labor and by the end of the day, she had the C-section and got to meet Odessa.Burich said her labor and delivery went smoothly with no major issues, and she credited her Vanderbilt team.
“Everyone was great,” she said.
When deliveries happen in a cardiac OR
It took a multidisciplinary team to make it happen. Ashish Shah, MD, chair of Cardiac Surgery, facilitates resources including cardiac operating rooms, ECMO services and emergency cardiac surgery services on standby. On call 24/7 for cardio-OB patents are Kait Brennan, DO, MPH, assistant professor of Anesthesiology and director of Maternal Critical Care, and Susan Eagle, MD professor and executive vice chair of Anesthesiology and director of Perioperative Adult Congenital Heart Disease.
The highest-risk patients are delivered in the cardiac operating rooms. Eagle provides intraoperative invasive monitoring and transesophageal echocardiography to manage the heart failure during delivery. Brennan provides obstetric critical care expertise both in the OR and in the ICU, as heart failure typically worsens after delivery. Brennan is also on the ECMO transport team and provides cannulation services. ECMO, or extracorporeal membrane oxygenation, is a life-sustaining mechanical system that temporarily takes over for the heart and lungs of critically ill patients, allowing them to rest and recover.
“Caring for this unique and high-risk cardio-OB population takes a village of dedicated and highly specialized providers across several specialties including cardiology, obstetrics, maternal-fetal medicine, anesthesiology, cardiac surgery, perfusion/ECMO services, and critical care,” Eagle said. “VUMC is proud to be one of a handful of centers worldwide that has all the pieces in place to provide the highest level of care to our patients.”
Proactively seek care if symptoms don’t seem right
Lindley advised women who don’t know of a heart issue to seek care if they think their symptoms are out of the range of normal, such as significant swelling or significant difficulty breathing, especially when lying flat. A new cough that doesn’t seem cold- or virus-related and a racing heart are also warning signs.
Burich agreed.
“If you feel like something’s not right, go get checked out,” she said. “Don’t act like it’s nothing. I kept thinking everything was just a pregnancy symptom. It’s not always. It’s better safe than sorry. If you feel like something’s weird, just go be seen. And stay on top of your heart management. If you know you have a heart issue, please keep getting checked. Don’t wait until the last minute.”
