Dubai Hospital doctors save life of pregnant woman via one-of-a-kind surgery

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In a one-of-a-kind surgery, a multidisciplinary team of doctors saved the life of a pregnant woman and her baby after she was admitted to the emergency department of the Dubai Hospital in a critical condition with a malfunctioning heart valve.
A. R. W. a 30-year-old Iraqi pregnant expatriate with a history of rheumatic heart disease was rushed to the hospital at 33 weeks of pregnancy after she complained of breathing difficulties. 
Dr Obaid Al Jassim, head of cardiothoracic surgery at Dubai Hospital said: "As soon as she was admitted in the emergency department we did an echo cardiograph and discovered that she has two mechanical heart valves and one of them was not working properly."
The patient had a history of rheumatic heart disease and her heart valves were replaced with mechanical valves when she was 16 years old. "Her condition was highly critical  and a multidisciplinary team comprising of gynaecologists, cardiologists, general anaesthesiologists, cardiac anaesthesiologists and cardiothoracic surgeons was quickly put together to decide how we could save the life of the mother and the baby." 
Dr Nawal Mahmood Hubaishi, head of gynaecology at Dubai Hospital, said: "We decided to first do a c-section immediately to save the life of the baby and after the c-section to give the mother a 48 hour break before performing an open heart surgery to replace the diseased valve." 
Dr Omaima Abdul Karim, consultant gynaecologist at Dubai Hospital added: "However, during the time her c-section was being performed, a highly specialised team of cardiac surgeons and cardiac anaesthesiologists were scrubbed and ready to perform an open heart surgery on the mother in case her condition deteriorated." 
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Dr Bassel El-Zamkan, consultant cardiothorasic surgeon said: "For the open heart surgery, the patient needs to be put on an artificial lung machine and also needs blood thinners which is very dangerous post c-section surgery due to the risk of fatal post-partum bleeding. All these factors were taken into consideration and while we were well prepared for surgery post c-section and had devised plans on to minimize post-partum bleeding we were hoping to receive a 48 hour window."
"Post C-section, the baby was taken to the NICU and the mother was kept under observation. The mother was in an ICU and her condition deteriorated after 24 hours and at 3am, the next day, we decided to do an open-heart surgery," said Dr Tarek AbdelAziz, senior specialist cardiothorasic surgeon.
"The surgery was successful and post the surgery we sent the sample of her mechanical value to the laboratory for investigation as we suspected an infection." The results showed a deep-rooted infection and the patient was put onto antibiotics and stayed in the hospital for one month. Her baby was discharged in a few days itself. Both mother and baby are fine and the mother was finally discharged from the hospital last week.
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Dr Abdelaziz highlighted that the incidence of valve thrombosis in pregnancy with mechanical valves in women receiving anticoagulants is around five per cent. The fetal mortality in such cases can range from 25 to 65 per cent, which is average is around 30 per cent and the maternal mortality is around 20 per cent. asmaalizain@khaleejtimes.com