Happy ending for mom who had heart valve replaced while pregnant

When Elenilza Tritten underwent a cesarean section on Oct. 1, her obstetrician and anesthesiologist were not the only physicians involved in welcoming baby Denver to the world.

Also on hand at Virtua Our Lady of Lourdes Hospital in Camden: a pair of doctors who, earlier in the pregnancy, had repaired the Mount Laurel woman’s heart.

In April, the heart specialists replaced Tritten’s failing mitral valve, apparently the first such procedure undergone by a pregnant woman.

While the valve operation was a success, heart surgeon Arthur Martella and cardiologist Ibrahim Moussa were in the delivery room in October in case something went amiss with their patient’s repaired heart.

She and Denver came through just fine.

The boy weighed 7 pounds, 13 ounces, at birth, and is now up to 10 pounds, his mother said before visiting Virtua Health and Wellness Center in Cherry Hill for a follow-up heart ultrasound.

She said it was reassuring to have the heart specialists on hand for the birth.

“It felt good,” she said. “They’re a great team.”

The damage to Tritten’s heart valve occurred in childhood, the result of an untreated infection that progressed to rheumatic fever. She underwent open-heart surgery to replace the valve at age 18, but the replacement device started to fail much sooner than expected, just seven years later. The leaflets, which must open with every heartbeat to deliver oxygenated blood to the left ventricle, had become calcified and stuck together, and she was gasping for breath with the slightest exertion.

Upon learning that Tritten was pregnant, physicians determined that another open-heart surgery was too risky.

So they opted instead for a nonsurgical approach, inserting a new valve through a small opening that they cut in her rib cage. Martella said that in a search of the medical literature, he could find no other such case involving a pregnant woman.

All went well, but the valve replacement meant that the October delivery would occur by C-section. That was partly due to concerns that the pushing associated with a traditional vaginal delivery might overtax her repaired heart, said Tritten’s husband, Taylor.

A bigger reason for the C-section was simply timing, said Martella, the heart surgeon. Because the surgery could be planned for a specific time, the hospital could clear the schedules for physicians and nurses on both the obstetric and cardiology teams, he said. And the hospital also made sure a cardiac operating room and catheterization lab were open, Martella said.

“This delivery was just an example of planning for all potential scenarios and not having to really to utilize any of them,” he said. “It ended up being just a straightforward C-section.”

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