When Katherine and her husband Shawn learned they were pregnant with their first child, the news brought mixed emotions. Katherine had a heart valve condition called rheumatic mitral valve stenosis. It threatened both her life and the life of her unborn child during pregnancy.
“We were happy, but also worried about my health. It was kind of sad that we couldn’t be thrilled about the news because of my heart condition,” she explains.
After her previous medical team recommended she consider terminating the pregnancy for medical reasons, Katherine decided to get a second opinion. She consulted with Ignacio Inglessis-Azuaje, MD, a Mass General Brigham interventional cardiologist who cares for patients at Massachusetts General Hospital, and Nandita S. Scott, MD, a Mass General Brigham cardiologist and director of the Mass General Brigham Women’s Heart Health Program. Dr. Scott helped establish the Cardiovascular Disease and Pregnancy Program at Mass General, which provides multidisciplinary care for cardiac disease during pregnancy.
After reviewing Katherine’s case with a multidisciplinary team, Drs. Inglessis and Scott told Katherine that she qualified for a percutaneous balloon mitral valvuloplasty, which widens heart valves to improve blood flow. While the procedure had risks, the team was confident they could perform it safely — and they succeeded. Katherine was able to continue the rest of her pregnancy and gave birth to a healthy baby girl named Amari 5 months later.
“We are so grateful for these compassionate and very talented doctors and their teams. Because of them, we have our beautiful healthy baby with us right now,” says Katherine.
Originally from the Philippines, Katherine was diagnosed with rheumatic mitral stenosis after a childhood illness. Rheumatic mitral stenosis occurs after a fever from an untreated strep infection damages the heart, and is more common in developing countries.
“If you don’t have access to the right treatment for the strep infection, then you can get acute inflammation that damages the heart valves,” Dr. Scott explains.
Other causes of mitral stenosis can include:
Congenital heart defects (a heart defect you’re born with)
A buildup of calcium in the valve (more common in older adults)
Mitral stenosis narrows the heart’s mitral valve opening, which restricts the amount of oxygenated blood flowing through the heart. It can also cause fluid to build up in the lungs. Signs and symptoms of mitral stenosis can include:
Shortness of breath during activity or lying down
Swollen feet or legs
Dizziness or fainting
Racing heart rate
“As a kid, I would pass out in the middle of the day when the weather was hot,” says Katherine. “I would get sick a lot. I have shortness of breath and get tired really easily.”
Katherine was initially treated for mitral stenosis in the Philippines, and she moved to the United States as an exchange student in 2017. After meeting Shawn, she moved to Massachusetts in 2020. When she found out she was pregnant, her stenosis symptoms took a turn for the worse. “Even if I took it slow walking up the stairs, I would feel nauseated and weak,” she says.
“When you’re pregnant, your heart rate increases, and your blood volume goes up. Mitral stenosis itself is probably one of the worst valve conditions you can have when you’re pregnant,” Dr. Scott notes. “It can cause heart failure and arrhythmias like AFib,” which are serious complications during pregnancy.
Katherine was prepared to end her pregnancy, if necessary, but hoped she wouldn’t have to take that step. She says her appointments with Dr. Inglessis and Dr. Scott were a huge relief. “I told Shawn, I wanted to talk to Dr. Inglessis. If he thought doing the surgery would be too risky for me, I was ready to let go and terminate it. Dr. Inglessis gave us the first glimpse of hope since we found out I was pregnant.”
Dr. Scott says that Mass General Brigham was able to offer expanded treatment options due to their multidisciplinary expertise. “Her previous care team wasn’t necessarily wrong, because her pregnancy was certainly high risk. But the benefit of our program is, we have more than a decade of lots of provider experience, nursing excellence, and teamwork, and this is not the first time we’ve done this. We could make this happen,” she explains.
Katherine’s case was evaluated by a team of high-risk pregnancy specialists, including maternal-fetal medicine, members of the Women’s Heart Health Program team, anesthesia, nursing, and interventional cardiology. Katherine also underwent additional testing to make sure her valve was a good candidate for a procedure. “We want the ideal outcome, where the pregnancy is completed in a safe way for both the mother and baby. We really value the assessment that comes from the collaboration with our team members. That’s something that is quite unique about Mass General Brigham,” says Dr. Inglessis.
“To carry the pregnancy forward, we needed to open that valve a bit more, and improve blood flow through the valve. Dr. Inglessis was very open to the whole discussion, and he thought that doing a procedure was feasible,” Dr. Scott explains.
Ultimately, the decision was up to Katherine. “Pregnancy is such a personal thing. Whatever her decision, our job is to support her through it, and do what we think is best for mom and baby survival,” Dr. Scott says.
After speaking with Drs. Scott and Inglessis, Katherine felt comfortable opting for the procedure. “Dr. Scott was always attentive and a good listener. She made sure that I got the best team of doctors and the care that I needed once we decided to go through the pregnancy,” she says.
Dr. Inglessis performed the percutaneous balloon mitral valvuloplasty on Katherine when she was about 16 weeks pregnant. This minimally-invasive procedure uses a small balloon to increase the opening of the mitral valve. Dr. Inglessis threaded a catheter (a thin and flexible tube) up through a vein in Katherine’s leg and into her heart to perform the procedure.
Throughout the valvuloplasty, Dr. Inglessis worked closely with his cardiology and maternal-fetal medicine colleagues. “There isn’t a step in the procedure where I haven’t gotten feedback from the broader team. We used an echocardiogram, or an ultrasound of the heart, to gauge the results of the procedure as it was performed,” he says. The team also collaborated on the choice of safe medications for pregnancy, including anesthesia and blood thinners.
Dr. Inglessis normally uses fluoroscopy guidance to guide the catheters through the body, but this produces extra radiation, which should be avoided in pregnancy. For Katherine, Dr. Inglessis used additional lead aprons to shield her belly and relied on his more than 20 years of experience to guide the catheters by feel instead.
Ultimately, the procedure was successful and helped improve the function of Katherine’s heart. “The main objective was to get her through the pregnancy without burdening the heart, endangering her life and the life of her baby,” Dr. Inglessis says. “This was the highest stakes of any procedure one can have as an interventional cardiologist, and it makes it all the more gratifying to see that it’s a good outcome. It was very rewarding, and a blessing to be part of this procedure.”
“Dr. Inglessis was an amazing surgeon, and he is incredible at what he does,” says Katherine.