A medical team in Hong Kong have successfully saved a pregnant woman with twins suffering from an “extremely rare” and potentially fatal heart condition – the city’s first such case in more than 20 years.
The challenging surgery on the pregnant patient, who was diagnosed with aortic dissection, was performed in June last year.
The medical team completed the operation in under five hours to minimise risk for the patient, significantly shorter than the usual eight to 10 hours, according to doctors from the Chinese University of Hong Kong and Prince of Wales Hospital on Wednesday.
Tiffany Chen, who was 25 weeks pregnant, was admitted to hospital after experiencing chest pain and difficulty breathing.
She was diagnosed with aortic dissection, a fatal condition described by gynaecologist Liona Poon Chiu-yee as a “ticking time bomb” inside the body, which can rapidly deteriorate in minutes or even seconds.
Poon said that aortic dissection was a rare but life-threatening heart condition where a tear occurred in the aorta’s inner layer, allowing blood to flood the tear and potentially cause it to rupture.
She added that the condition occurred in about 5.5 of every million pregnancies, as expectant mothers experienced increased blood volume and cardiovascular strain.
“Only 20 per cent of the patients survived after the surgery, while 40 per cent would die even before admission,” she said.
“In the past 20 years, only 29 reports of aortic dissection in pregnant mothers have been recorded globally.
“At 25 weeks, the survival rate of the twins is low, and they will not survive if we remove them from the mother’s body before the surgery.”
Saving three lives with one surgery
Anaesthetist Dr Lai Man-ling said the team was determined to save both the mother and the children despite the complex circumstances.
Chen said she felt helpless upon receiving the diagnosis and learning of the poor survival chances, but decided to trust the medical team.
Doctors managed to save the mother and children swiftly, completing the surgery in less than nine hours after she was diagnosed with the condition.
“My biggest wish was for the twins to be safe. It was a huge relief when I woke up after surgery and the first thing the doctor told me was that we were all safe,” Chen said.
She left the intensive care unit four days after surgery and was discharged after two weeks. Chen then successfully delivered the twins at 31 weeks.
Randolph Wong Hung-leung, head of cardiothoracic surgery at the hospital, said he believed it would have been “impossible” for the patient to survive without the aortic root operation.
Due to the rarity of the case, the team could not find any reports of an expectant mother with twins facing the condition while preparing for surgery.
Wong said he felt immense pressure during the operation, noting that the last time a similar case occurred in Hong Kong was more than twenty years ago, in which the mother died.
“It is extremely rare that we have to save three lives in one single surgery,” he said.
“The complexity of both the operation and the anaesthesia demanded a highly experienced multidisciplinary team.”
Importance of cooperation
Wong said the seamless cooperation of more than 15 staff members in the operating room – including cardiac surgeons, obstetricians, anaesthetists and intensivists – enabled them to reduce the surgery time to under five hours, thereby reducing the risks for both the mother and children.
“Cardiopulmonary bypass is used to temporarily replace the patient’s own heart and lung function during a Bentall procedure,” he said.
He added that although the patient’s body temperature was usually lowered during cardiac surgery, this could be life-threatening to the fetus, which risked hypothermia and cardiac arrest from inadequate blood flow.
Anaesthesiologists monitored the mother’s heart condition and precisely managed medication to maintain her blood pressure and control coagulation without affecting the fetuses.
The team completed the operation while maintaining the mother’s body temperature, conducting fetal echocardiograms and working swiftly to minimise the duration of cardiopulmonary bypass.
“This was a highly successful procedure that shows the importance of quickly assembling a multidisciplinary team when dealing with a highly complex surgery,” he said.
A report on the operation was published in an international medical journal of cardiothoracic surgery in June.
