Cleveland Clinic Cardio-Obstetrics Program

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult brought to you by the Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Dr. Joanna Ghobrial:

Hello, everyone. My name is Dr. Joanna Ghobrial. I am the Director of Adult Congenital Heart Disease. I specialize in adult congenital heart disease, as well as interventional cardiology. Dr. Singh.

Dr. Katherine Singh:

My name is Kat Singh. I am one of the maternal-fetal medicine specialists here at the Cleveland Clinic. Thank you for joining us.

Dr. Joanna Ghobrial:

So Dr. Singh and I work very, very closely together in the Cardio OB Clinic. Dr. Singh, can you tell the audience a little bit about what Cardio OB Clinic and how it's special for us?

Dr. Katherine Singh:

Our Cardio OB Clinic is something near dear to our hearts. We have the privilege of taking care of women who either were born with heart disease or have developed heart disease. And we take care of these women prior to pregnancy, throughout their pregnancy and after delivery.

Dr. Joanna Ghobrial:

And then we also tend to see very different categories of patients with heart disease. So we can see patients that were born with a heart defect with congenital heart disease, such Tetralogy of Fallot, or patients that have acquired heart disease, such as cardiomyopathy, or heart failure, or valvular heart disease, or coronary artery disease. We also see patients that have vascular disease like aortopathies, which is a dilated aorta. In addition, we do see patients that have arrhythmias, which is palpitations or abnormal heart rhythms. And to actually have the ability to care of such a big category of different patients we clearly have very different specialties of doctors that take care of these patients. So we have doctors that specialize in congenital heart disease. We also have doctors that specialize in vascular disease, doctors that specialize in acquired heart disease or heart failure and cardiomyopathy. In addition, what other doctors do we have in our clinic, Dr. Singh?

Dr. Katherine Singh:

We are lucky enough to have many other members, including genetic specialists, both providers that take care of patients in pregnancy, prenatal providers, preconception, along with a large group of cardiovascular genetic specialists. We have neonatology to take care of the earliest babies if need be. We have social work providers. We have many OB-GYN specialists that we co-manage some patients with, along with maternal-fetal medicine sub-specialists who manage a good group of our patients as well. And then we have our OB anesthesiologists who really help us get a lot of complicated patients safely through their deliveries.

Dr. Joanna Ghobrial:

And I also wanted to mention we do have pulmonary hypertension specialists, and we have cardiothoracic surgeons, which is really important, especially in the very sick patients where they do need an intervention. We also have interventional cardiology, which is a specialty that I am involved in. So if you need an intervention in the cath lab, even during pregnancy, we're able to actually do that here in this facility. And obviously, a place that will have all these different types of specialties of doctors will have to be able to take care of these very sick complex patients. And the Cleveland Clinic is a perfect place for that. Dr. Singh, Can you tell us a little bit more about how the Cleveland Clinic is a perfect institution to take care of such complex patients?

Dr. Katherine Singh:

Because of our variety of resources and our multiple providers, multiple locations, we just have a lot available to our patients. There's been some literature and support from American College of Obstetricians and Gynecologists about categorizing different places based on levels of maternal care. And essentially we have all of the subspecialty and resources here where we can provide the highest level of maternal care, level four.

Dr. Joanna Ghobrial:

And I do want to mention that at the heart of all of this is going to be the Cardio OB nurse coordinator, who actually kind of is the glue to the patient, the doctor, and this institution, because this Cardio OB nurse coordinator is the person who's going to first meet the patient, tell them which kind of subspecialty doctors that they need to meet in Cardio OB Clinic, bring them here, guide them through this big, big hospital and institution and be their main source of contact. So that is an extremely important person that we want to emphasize as the heart of Cardio OB Clinic. In addition to all of this, obviously, pregnancy in its own is very stressful to the body. Dr. Singh, can you tell us a little bit about what happens to a woman's body during pregnancy?

Dr. Katherine Singh:

Yes. Anyone who has had children before can attest to the many changes that happen to a woman's body during the pregnancy and postpartum period. So there are so many changes to the amount of blood volume that we have, to how fast our heart can beat, to how all sorts of different tissues and parts of our body stress and change. We're also are prone pregnant and postpartum to developing things like blood clots. So basically a woman's health can be very different in the setting of pregnancy than her health was before pregnancy.

Dr. Joanna Ghobrial:

And as you can imagine, for example, women that have congenital heart disease, when they go through all these stages during their pregnancy with extra volume, if they have a tight valve, they might not be able to handle this extra volume well. If they have underlying arrhythmias or abnormal heart rhythm, with increase in heart rate and all this stress, it can actually get worse and get exacerbated. Women that have aortopathies or vascular heart disease as that kind of elasticity that happens during pregnancy to your tissues overall are much more amplified in patients that have dilated aortas, where they're at more risk of having enlargement of the aorta or dissection. And you and I actually took care of a lovely, lovely patient who had a bicuspid aortic valve. So a valve that's not 100%. Normal aortic valve usually has three, she had only two and she also had a dilated aorta and she came to us in her third trimester and she was pregnant and clearly the aorta had gotten larger with her pregnancy, which is something that we do see.

Dr. Joanna Ghobrial:

And it was obviously a very scary time for her. But we were able to get her through this pregnancy very well. She was able to deliver by C-a section, a very healthy baby. And in that room, I remember clearly there was essentially, I would say at least five different disciplines of doctors in there. We had the CT surgeon, we had anesthesia, we had cardiology OB and we had genetics and we had neonatal. So we had like a big, big group of people in one room just for her. She actually, thankfully did not have any complications and she came back later to have her surgical repair and she's happily pregnant again. And this pregnancy is going to be a much, much healthier, safer pregnancy for her. Dr. Singh, remember any other patients that you want to share?

Dr. Katherine Singh:

Absolutely. We've had so many. One that comes to mind is a patient that was born with one ventricle of her heart instead of two, which can obviously complicate everything about how her body works and put her and the baby at very high risk throughout the pregnancy. She required a lot of support, a lot of sub-specialists, did require an admission prior to her having the baby to make sure she was safe and the baby was safe. And she had an uncomplicated delivery, an uncomplicated postpartum course. And now, despite having almost half a heart has a healthy baby.

Dr. Joanna Ghobrial:

That's very true. I do have one more story I want to share because Dr. Singh would not share it herself. And we did have that one very sick patient who was in heart failure and had a clotting disorder. She had a due date to deliver the baby. But she went to something called preeclampsia two days before, which is a really dangerous condition where your blood pressure goes up and it's dangerous for both mom and baby. And Dr. Singh was on vacation and she actually cut her vacation short, drove all the way to the Cleveland Clinic and delivered her patient. And I think that is the kind of dedication and passion that you want from your cardio OB doctors.

Dr. Joanna Ghobrial:

Sometimes you can have certain conditions that would make your pregnancy very, very high risk and it's going to be a very difficult discussion to make a decision, whether you would want to go with such a high-risk pregnancy where it's not just dangerous to you, but also to your unborn child, versus, you would seek other opportunities or other ways to be a mom. And that is a kind of discussion that we will have in Cardio OB Clinic. And I think we've had more than one of these together. And it's not always easy, but you do need the appropriate kind of guidance to understand the risks and to understand that we are there to support you with whatever decision you decide to make, but we will give you all the information needed and all the guidance and support needed through that.

Dr. Katherine Singh:

We've also seen cases of women who thought that they were not healthy enough to have a child and with preconceptual consultation and optimization of their health, they might be okay to move forward with pregnancy. There will be risks, as long as they know the risks ahead of time, but seeing our Cardio OB Clinic before and talking through these issues to find out what the woman is comfortable with, what can we improve on before a pregnancy, makes a lot of sense, and we've been able to get some women through a pregnancy where they were told previously it wasn't safe.

Dr. Joanna Ghobrial:

That's true. It's a common actually misconception that women with congenital heart disease are not allowed to have babies. But we see that quite often, it used to be back in the day, they were told, "If you have congenital heart disease, you can't have a baby." But now we actually take care of a lot of these patients. And a lot of them are able to have babies safely. But I think the emphasis is that preconception part. If you come to us before you get pregnant, we can actually guide you and make sure that it will be the safest pregnancy possible for both mom and baby.

Announcer:

Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/podcasts/cardiac-consult.