Expectant mothers with extremely severe congenital heart valve disease may face a hard decision as their due date approaches: the potential need to terminate the pregnancy or risk heart failure. For 38-year-old Claire Sprouse, this seemed like the only choice—until she found a multidisciplinary team at NYU Langone Health who performed a specialized, minimally invasive procedure to replace Sprouse’s narrowing heart valve while still pregnant.
Thanks to their care, on October 3, 2022, her first child, Milo, was born—a holiday gift that months earlier seemed perhaps impossible. She and her husband, Nico Russell, are now home to celebrate Christmas with their first child at their family-owned restaurant in Brooklyn.
“As emotional as this experience has been, I felt like I was in very good hands, and I’m so relieved to have access to all of these world-class physicians in one place,” says Sprouse, referring to the team at NYU Langone that successfully executed a rare, lifesaving transcatheter aortic valve replacement (TAVR) procedure during her pregnancy. “I couldn’t have done this without them.”
Sprouse was born with a bicuspid aortic valve, in which only two—rather than the normal three—aortic leaflets keep blood flowing in the correct direction through the heart. While people can live with this defect for many years without developing symptoms, over time, they may notice chest pain, heart palpitations, shortness of breath, fatigue, and dizziness. People with this defect are more prone to develop aortic valve disease early in life.
While Sprouse was asymptomatic throughout her life, an abnormal heart often can’t keep up with the heart rate and function increases that occur during pregnancy, especially in the last three months.
“For pregnant women with valve disease, the risk is much higher,” says Sprouse’s maternal–fetal medicine specialist, Ashley S. Roman, MD, vice chair for obstetrics in the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine. “Cardiovascular diseases affect 0.2 to 4 percent of all pregnancies, and untreated cardiac disease during pregnancy accounts for 10 to 15 percent of maternal mortalities.”
Initially receiving obstetric care at another hospital, Sprouse switched to Dr. Roman who, in partnership with a multidisciplinary team including interventional cardiologists and cardiothoracic surgeons at NYU Langone, came up with a plan to save both mom and baby given Sprouse’s narrowing heart valves.
Sprouse’s cardiologist, Edward J. Bernaski, MD, part of the Leon H. Charney Division of Cardiology at NYU Grossman School of Medicine, confirmed her abnormality was leading to problems that limited the amount of blood flow from the heart out to the rest of the body, known as aortic stenosis. She would need an aortic valve replacement or risk heart failure.
“Current guidelines are specific for the treatment of valvular heart disease before pregnancy, including counseling and medical management,” says Dr. Bernaski. “However, in a pregnancy with symptomatic aortic stenosis where surgical intervention is recommended, little direction outside of monitoring and echocardiography examination requirements is provided.”
While open heart surgery during pregnancy poses a risk for the mother, surgical interventions present a much higher risk for the fetus—as high as a 20 percent chance the baby won’t survive. Dr. Bernaski referred Sprouse to interventional cardiologists Cezar S. Staniloae, MD, and Mathew R. Williams, MD, at NYU Langone’s Transcatheter Heart Valve Program, part of the Heart Valve Center, who are pioneers in nonsurgical procedures that use only a small incision in the groin to access the aortic valve and have performed more than 5,000 TAVR procedures.
“While TAVR during pregnancy has not yet been studied, we weighed the risk and benefits with mom and offered the procedure as a lower-risk option to fetus and mom compared to surgery,” says Dr. Williams, co-lead of NYU Langone Heart.
The procedure delivers a balloon-expandable aortic valve via a catheter, replacing the diseased valve while the heart continues to beat, avoiding the need to stop the patient’s heart. “With careful preprocedural planning, TAVR can be a low-risk treatment option during pregnancy and provide a reliable bridge to a healthy delivery of baby,” says Dr. Staniloae.
On May 26, 2022, Dr. Staniloae and Dr. Williams successfully performed the TAVR—with local anesthesia and minimal radiation to protect the fetus—while Sprouse was nearly 21 weeks pregnant. She was discharged the following day.
“I feel as good as new, sporting a shiny new aortic valve,” says Sprouse. “It worked out better than I thought. If I hadn’t been pregnant, I would’ve had to have open heart surgery due to the size and shape of my valve, so I feel really lucky.”
Sprouse and Russell’s son, Milo Ernesto Russell, was born 18 weeks later via a scheduled cesarean delivery performed by Dr. Roman, with a team in place monitoring and aware of Sprouse’s heart condition. Sprouse recovered well from the birth and was discharged with baby Milo without any complications.