Sentara Norfolk General Hospitals cardiac operating room recently was the site of an unusual eventthe birth of a 7 lb. 5 oz. baby girl named Kaitlyn. In a procedure so rare that physicians here had never previously performed it either in training or in their medical practices, a multidisciplinary team including cardiothoracic surgeon, Dr. Joseph Newton; obstetrician, Dr. Stephen Davis; a neonatologist and a team of ICU nurses saved the lives of 29-year-old Amy Kipnis and her unborn child.
Kipnis, who was 37 weeks pregnant, experienced sudden, severe chest pains and sought treatment at the local Navy medical center. Diagnosed with an aortic dissection, the 29-year-old woman was rushed to Sentara Norfolk General Hospital.
Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta, the major artery from the heart to the entire body. If untreated, it may lead to a rupture of the aorta, which can be fatal in a matter of minutes. Aortic dissection occurs in roughly two out of every 10,000 people, mostly men between the ages of 40 and 70.
The challenge for the physicians lay in developing and orchestrating a complicated symphony of events. If the mothers heart were repaired first, necessitating her placement on a heart/lung bypass machine, would the baby survive? If labor were induced, would the ensuing pushing during delivery cause a fatal rupture in the mothers heart? Or, if the baby was delivered through Caesarean section, would the mothers aorta remain stable enough to complete the delivery? These were some of the many questions facing the medical team.
"This was an incredibly unusual case," said Dr. Newton, who headed the team. "It is rare that a woman this young and pregnant would need such significant surgery. The surgery to repair the aortic dissection is much more complicated than regular heart surgery," he said.
The team of physicians decided to deliver the baby first through Caesarian section and immediately follow the delivery with open heart surgery on Kipnis.
"From our standpoint, a vaginal delivery was not an option," said Dr. Davis. "The increased chest and abdominal pressure associated with labor would have ruptured her aorta," he explained.
The decision to deliver the baby first was easy for the team. An intrauterine pregnancy could not be sustained through the steps required to complete her heart surgery.
The Caesarian section was fairly straightforward allowing the team to move quickly to perform the urgent heart repair successfully.
"This was a planned, controlled process. There was never any consideration given to the notion that we would not be able to save both mother and child and it worked beautifully," Newton said.
Sentara Norfolk General Hospitals heart and cardiac surgery programs placed 23rd among the top 50 hospitals in the nation in the U.S. News & World Report annual survey released in July.