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Woman Manages Heart Failure, Becomes Mother Through Surrogacy

For Natalie Dart, being a mother was something she always wanted. “When other moms say you know when you want to be a mom, it's true,” says Natalie. That journey became unclear when she learned her heart was failing at 22 years old.

“It was Dec. 5, 2011. I'll never forget that day. I woke up throwing up blood, and I couldn’t breathe. My roommate took me straight to the emergency department where they determined I had something very wrong with my heart,” says Natalie, who was a junior nursing student at the time.

After being hospitalized, it still wasn’t clear exactly why her heart wasn’t functioning as it should at such a young age. Natalie and her family first sought care in Illinois where she lived at the time for college. They went to a few different hospitals but weren’t getting the answers they needed. Natalie says one of the providers ultimately recommended they seek care in Cleveland, Ohio. 

“It wasn’t until I came to Cleveland Clinic I was able to get the help I needed,” says Natalie.

When Natalie was first diagnosed with heart failure, her ejection fraction was severely abnormal at 16%. A healthy percentage is 50% to 70%. Ejection fraction measures your heart’s ability to pump oxygen-rich blood out to your body. A low number means your heart has difficulty keeping up with your body’s needs.

In response to her low ejection fraction, she first underwent a procedure to put an implantable cardioverter defibrillator in place. The device monitors a person’s heart and delivers an electric shock if needed to correct life-threatening arrhythmias and prevent sudden cardiac arrest. Her care team then worked to determine what was causing her heart failure.

“She had a history of high heart rate, but it was attributed to nervousness growing up. This takes a long time to actually weaken the heart, but if you’re running a marathon every day of your life, it finally catches up to you,” says Natalie’s cardiologist Eileen Hsich, MD.

Natalie was diagnosed with nonischemic cardiomyopathy, which encompasses conditions affecting the heart muscle that occur due to reasons aside from a heart attack or coronary artery disease. From talking with Natalie about her heart rate, Dr. Hsich thought she also had a rare condition called inappropriate sinus tachycardia, which is when a person has an elevated heart rate, and it’s unclear why. Given her low blood pressure, Dr. Hsich focused her therapy on the underlying disease.

Photos featuring Natalie and her friend, who offered to carry Natalie's baby for her.
Due to concerns regarding her heart, it wasn’t recommended Natalie carry her own child. But a close friend, Kalan, ended up offering to be her surrogate. (Courtesy: Natalie Dart)

“When the blood pressure is not sufficient to give all the medications needed, you have to be thinking about the underlying condition and targeting that first. When I discovered she likely had inappropriate sinus tachycardia, I treated her with a drug specific for that and her heart normalized,” says Dr. Hsich.

Natalie’s medication regimen, which includes beta-blockers and ivabradine to control her heart rate, was adjusted throughout the years as she experienced ups and downs with new bouts of heart failure. She recalls her lowest point being around the time she first wanted to start a family. She had recently married her high school sweetheart, Lawrence, and they were ready to have their first child. However, it wasn’t recommended Natalie carry her own child because her condition put her at a high risk of mortality.

“I went through a phase of feeling like I couldn't be the woman I was supposed to be, the wife I was supposed to be or the mother I wanted to be,” says Natalie. “Then, my best friend, Kalan, who I've known since 5th grade said to me, ‘I’ll do this for you. I’ll carry your baby.’”

When Natalie began the process of gestational surrogacy, she was met with another roadblock. An echocardiogram showed she was in heart failure again. This came as a shock as she recalls not having any symptoms.

Photos of Natalie and her husband, Lawrence.
Throughout her bouts with heart failure, Natalie had a lot of support from her care team, family and high school sweetheart turned husband, Lawrence. (Courtesy: Natalie Dart)

“That dip of heart failure made me feel devastated to the point where I didn't know if I was ever going to be able to have a family,” says Natalie. “But along with the support of my husband and family, Dr. Hsich was the glimmer of light I needed to get through that. She reassured me I could get to the point where I could have a family. She restored my hope.”

After adjustments to her medication, Natalie’s heart stabilized again. She was able to move forward with her plan to have a child. While she went through the surrogacy process close to home, she continued receiving her heart care at Cleveland Clinic.

“In August 2022, we found out the transfer was successful. Kalan was pregnant with our little girl,” exclaims Natalie.

In April 2023, they welcomed baby Monroe into the world. “When Monroe was born, it felt like I finally had what I waited so long for and a new chapter was beginning. I wasn't just the girl with a heart condition. I was a mom now,” says Natalie.

Natalie and her husband with their baby, and Natalie and her friend who carried the baby.
Lawrence, Natalie and Kalan all bonded throughout the surrogacy process and welcomed baby Monroe in April 2023. (Courtesy: Natalie Dart)

Reacting to the news, Dr. Hsich says, “These are the joys of my job, working with patients to allow them to do the things they want to do in their lives. Natalie is a really amazing person and will be a great mother.”

Natalie’s heart has remained stable and is functioning at a level she says they weren’t sure would be possible at the start of her treatment. Her ejection fraction is now within a healthy range.

“Not only did Dr. Hsich figure out a life-changing medication combination for me, she also made sure my mental health was taken care of. I would not be where I am now if it wasn't for her positivity and determination,” says Natalie, who continues going to Cleveland Clinic annually for follow-up visits with Dr. Hsich and cardiologist David Martin, MD.

Natalie's baby, Monroe.
Natalie says Monroe takes after her with her sassiness and has her dad's composure. They both look forward to being able to create new memories as a family together. (Courtesy: Natalie Dart)

Natalie, who finished college amid her diagnosis and bouts of heart failure, now enjoys helping others as a pediatric nurse where she lives in Indianapolis. Natalie looks forward to watching Monroe grow up and being able to show her daughter the things her mom taught her.

“If you told me this would be my story when I was first diagnosed, I wouldn’t have believed it. I want to show people even if it seems like you’re in a dark hole, it’s possible to find your way out,” says Natalie.

Related Institutes: Heart, Vascular & Thoracic Institute (Miller Family)
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