Medical Miracle #7
Problem: Thirty-six-year-old female, pregnant with first child. Sudden signs of heart failure at six months. Mother—and child—face life-threatening surgery.
Doctor: David Adams
Patient: Liana Pai
In the winter of 2003, it looked as if Liana Pai might be getting her big break. After years of establishing herself as an actress—taking roles in commercials, independent films, episodes of Law & Order, and onstage—Pai landed a part as a district attorney in the pilot of a promising NBC crime show. “It was huge for me,” says Pai, now 38. What’s more, before leaving her Brooklyn home for a month of filming in Toronto, Pai learned she was pregnant with her first child. Everything seemed to be falling into place for her. “The creators of the show assured me that if the pilot were picked up, they’d write my pregnancy into the script.”
When Pai returned to New York, though, it was as if she were living the part of a patient in a gaudy medical drama. She began to grow terribly short of breath. A painful sciatic-nerve condition made it difficult to walk. Her ankles swelled to the thickness of her thighs. “I looked like something out of Lord of the Rings,” she says. She attributed her ailments to being pregnant, and at the time her obstetrician, who was waiting for the results of blood tests, had no reason to disagree. Pai told her husband, Geoffrey Quelle, the technical director of Blue Man Group, “If this is what pregnancy is like, I don’t think I can do it again.”
On a Friday afternoon in mid-June, a week before Pai was to have been a bridesmaid at her brother’s wedding, she met her mother in Manhattan to go shopping. She was six months pregnant and walking with a cane. Her skin was ashen, and her fingernails were purplish-gray. She had red lesions on her legs. The symptoms had come on over the course of just a few weeks. “My mother took one look at me and got on the phone to a family friend who’s a doctor,” Pai says. “He told us to go to the hospital. He said it sounded like heart failure.”
Pai was admitted to Mount Sinai Medical Center. She already knew she had a condition called mitral-valve prolapse, in which the valve between two chambers of the heart fails to close properly, allowing blood to leak from the heart. The disorder is typically harmless; indeed, an echocardiogram early in Pai’s pregnancy had shown her heart to be healthy. At Sinai, Pai had another EKG. This time, the results were grim: Pai’s mitral valve was being destroyed by an aggressive bacterial infection. Without immediate surgery, she and her child would die.
Pai’s heart valve was so badly damaged that rebuilding it would take hours. Adams knew he didn’t have that kind of time.
David Adams, chair of cardiothoracic surgery at Mount Sinai hospital, performs hundreds of valve surgeries each year. In almost every instance, he is able to reconstruct a healthy valve from the patient’s own tissue. This wouldn’t be possible in Pai’s case. Pai’s valve was so badly damaged that an attempt at reconstruction would take hours, during which Pai’s heart would be arrested and her vital functions assumed by a heart-lung machine. Adams knew he didn’t have that kind of time. Relying on artificial means of circulation for a prolonged period would dramatically increase the risk to Pai’s fetus—the major reason why valve surgeries are almost never performed on pregnant women. “I hate the word ‘pressure,’ ” Adams says, “but we had to have a very efficient and smooth operation. You definitely feel a responsibility to both the baby and the mother.”
Adams made an incision across Pai’s breast bone, then drained blood from the upper chambers of her heart into a reservoir, where it would be oxygenated and returned to her aorta in a continuous circuit. Adams then proceeded to cut into Pai’s left atrium and to expose her mitral valve. He was now working inside Pai’s heart. He excised the infected valve, then threaded a series of sutures into her heart, into which he attached a crucial addition: a half-dollar-size disc, fabricated from the cardiac tissue of a cow. Pai now had a new mitral valve—one whose organic composition meant that Pai would not be dependent on a lifelong, pregnancy-prohibiting regime of anti-clotting drugs. Adams was keeping a close eye on the vital signs of both Pai and the fetus. Everything was stable, and Adams was ready to complete the operation. Then he noticed that bacteria had begun to do substantial damage to Pai’s aortic valve. He swiftly replaced that valve, too.
When Pai awoke in the intensive-care unit, the first sounds she heard were those of her baby’s heartbeat, registered by a fetal-heart monitor. “I was glad to be alive, of course, but until my baby was born, I wouldn’t believe everything was okay.” Pai would get her satisfaction ten weeks later. “Ima came out perfect and healthy. She’s healthy, headstrong, independent. Dr. Adams saved two lives at once.”