Patient Leslie Echeverria, front row in hospital gown, with members of the Mount Sinai medical team who coordinated care from four specialties to ensure the safe delivery of her baby.
At around 5 pm on Wednesday, January 8, Leslie Echeverria, 24, gave birth to a healthy baby girl at The Mount Sinai Hospital—the norm at Mount Sinai under ordinary circumstances, where physicians and medical staff perform thousands of uneventful deliveries every year.
But Ms. Echeverria, born deaf and with severe congenital heart disease, was a high-risk patient. She had severe pulmonary valvular regurgitation, stenosis of the pulmonary valve, tricuspid valve regurgitation, and enlargement of the right side of her heart—both the right atrium and ventricle with right ventricular dysfunction. The delivery of her baby took place in the Hospital’s Cardiac Care Unit (CCU), a first for Mount Sinai Heart and Mount Sinai’s Department of Obstetrics, Gynecology and Reproductive Science.
The smooth birth was the result of meticulous planning and coordination among four of Mount Sinai’s medical disciplines, involving also the Department of Anesthesiology, Perioperative and Pain Medicine, the Institute for Critical Care Medicine, and the new Mount Sinai Adult Congenital Heart Disease Center.
“It was pretty unusual,” says Lauren Ferrara, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science, and a specialist in Maternal and Fetal Medicine, who managed Ms. Echeverria’s pregnancy. “The CCU certainly wasn’t used to this. But everyone loves when a baby is born.” Jill Berkin, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science, and a specialist in Maternal and Fetal Medicine, worked with Dr. Ferrara and delivered the baby, whom Ms. Echeverria named Shayla.
The makeshift delivery room in the CCU was crowded, periodically, with as many as 10 people. Dr. Berkin and her Maternal and Fetal Medicine team were accompanied closely by clinicians from Mount Sinai Heart, led by Ali N. Zaidi, MD, Associate Professor of Medicine (Cardiology), and Pediatrics, Director of the Mount Sinai Adult Congenital Heart Disease Center, and the Director of Pediatrics to Adult Transition of Care Program. Also on hand was Joshua (Zevy) Hamburger, MD, Assistant Professor of Anesthesiology, Perioperative and Pain Medicine, who managed Ms. Echeverria’s anesthesia care with Yaakov Beilin, MD, Director of Obstetric Anesthesia, and Professor of Anesthesiology, Perioperative and Pain Medicine, and Obstetrics, Gynecology and Reproductive Science. Ms. Echeverria’s mother was in the room, along with a sign-language interpreter and a critical care specialist.
“This story highlights how we take care of someone with complex congenital heart disease,” says Dr. Zaidi, who credits the entire Mount Sinai team with ensuring the safe delivery of baby Shayla. “We formulated a comprehensive plan. If Leslie or her baby ran into trouble we wanted to have all of our services there.”
Interestingly, it was not until Ms. Echeverria became pregnant that she learned about the seriousness of her heart condition. “After I got pregnant I found out so much more about my heart, because my parents didn’t really tell me, and I didn’t really know,” she says.
Infected by the rubella virus while her mother was pregnant with her in Ecuador, Ms. Echeverria had two open-heart surgeries a few years after she was born. But growing up in Queens, she played sports and did not experience pain or other symptoms. At the end of her first trimester, she came under the care of Drs. Ferrara and Zaidi, who began to carefully coordinate her delivery.
“We took a team approach that helped dispel concerns,” says Dr. Ferrara. “Even the day she was admitted to the hospital, everyone re-affirmed the plan.” Ms. Echeverria was admitted to The Mount Sinai Hospital at 35 weeks gestation and doctors induced labor at 38 weeks, with plans for the delivery to take place in the CCU.
Dr. Zaidi—trained and certified in Adult Congenital Heart Disease, and board certified in Adult Cardiology and Pediatric Cardiology—now oversees Ms. Echeverria’s cardiovascular care. He says medical advances over the past 30 years have made it possible for women with all forms of congenital heart disease to live long lives and have children of their own. But, he adds, many of these women do not receive the cardiovascular care they need as they transition from childhood to adulthood and lack the full understanding of their medical needs, which is something he would like to see changed.
Ms. Echeverria will need heart surgery in the near future. But right now, she says, “I am not worrying too much about my heart problems. I want to keep fighting for my goals and keep surviving. I just want to be successful with my baby.”