Woman With Heart Problem Achieves Dream of Becoming a Mother, Twice Over

Stanford hospitals collaborated closely to provide deeply specialized care to expectant mom with heart condition

Fitness enthusiast Kelly Chong always wanted to have a baby, and with successful in vitro fertilization it looked like that dream might come true. Yet she had a big hurdle to overcome: a serious heart condition—one that became more dangerous with pregnancy.

When Kelly heard the words “You are pregnant,” she was ecstatic. She and her husband, Brian, had been trying for a while without luck. She expected her heart to function as it normally did, but once pregnant, she started feeling extremely tired, dizzy, and nauseous, especially during exercise but even when she simply climbed stairs.

Kelly’s symptoms frightened her, so much so that she went to the emergency room of her local hospital in Castro Valley, California, three times. Her heart condition—mitral valve stenosis caused by rheumatic fever as a teenager—was restricting blood flow in her heart. When the mitral valve doesn’t work properly, blood doesn’t leave the heart efficiently, which can lead to heart failure and fluid in the lungs.

Since the number one cause of maternal deaths during pregnancy is heart disease, Kelly’s local cardiologist advised her to go to Stanford Health Care, the adult hospital attached to Lucile Packard Children’s Hospital Stanford, to receive specialized care for pregnant women with heart conditions. There, at Stanford Health Care, she met Abha Khandelwal, MD, an adult cardiologist and Clinical Associate Professor.

“The heart has to increase its work by almost 50% for a normal pregnancy. That’s a lot of extra strain on a heart with severe mitral valve stenosis, which can worsen with pregnancy and put a women at risk for fluid in her lungs or stroke,” Dr. Khandelwal says. “So we were worried about Kelly.”

Dr. Khandelwal, who is also the Cardiology Director of the joint Stanford Medicine Children’s Health and Stanford Health Care Maternal Heart Program, called upon her colleague, Katherine Bianco, MD, the Obstetrics Director of the Maternal Heart Program, to help provide the sophisticated, nuanced care that’s needed for women in Kelly’s situation. This close collaboration between multidisciplinary teams led by Dr. Bianco, who is a maternal-fetal medicine (high-risk obstetrics) specialist, and Dr. Khandelwal, an adult cardiologist, makes it possible to provide the highest level of care for expectant mothers with complex heart conditions and serves as a model for the nation and the world. The team called on other specialists and subspecialists in obstetric anesthesia, cardiology, and neonatology as needed to ensure the best possible outcome for Kelly and her baby.

“We had all hands on deck,” Dr. Bianco says. “It truly takes a village to care for pregnant women with heart problems.”

“Ideally when a woman has a complex heart condition, we like to see her before she gets pregnant,” says George Lui, MD, director of the joint Stanford Medicine Children’s Health and Stanford Health Care Adult Congenital Heart Program. “That way, we can predict the risks for both mom and baby. Studies show that women with heart disease who receive preconceptual counseling have better outcomes.” A recent study by Dr. Lui and colleagues shows that exercise testing prior to pregnancy is a good predictor for cardiac complications during pregnancy for certain conditions.

Since the Stanford hospitals are connected—something that’s fairly unique for children’s and adult hospitals in the United States—Kelly’s doctors were able to meet easily and regularly to discuss the best next steps for her care. Each member of the large team of experts contributed to creating an optimal care plan by looking at Kelly’s condition from every possible angle—as a pregnant woman and as a woman with a serious heart condition—and considering and preparing for every possible scenario.

“When a woman gets pregnant, her body changes to handle more blood volume, influenced by an influx of many hormones, which makes the heart work harder. Moreover, during late-stage pregnancy, the uterus can press on major blood vessels, so anyone pregnant with a heart condition is especially vulnerable,” Dr. Bianco says.

On Kelly’s delivery day, a large team of nearly 50 doctors and nurses gathered in the delivery room to support her, including obstetricians, high-risk maternal-fetal medicine specialists, an adult cardiovascular surgeon, a cardiac anesthesiologist, an obstetric anesthesiologist, neonatologists, and the ECMO (mechanical circulatory support) team in case her heart should fail during delivery.

The collective team had done its job—Kelly’s heart withstood the extra strain it needed to endure labor and delivery, and she gave birth to a healthy baby boy, Ethan.

“I was very stressed and scared, but the doctors took really good care of me,” Kelly says. “It was such a big team, but they worked together really well. They watched me very closely.”

Kelly played a major role in her good outcome. She faithfully followed her doctors’ guidelines to keep herself healthy, like staying close to home, taking slow walks, and administering blood thinners daily.

A heart surgery following a successful delivery

Kelly needed a heart surgery to repair her failing heart valve, but she couldn’t have it while pregnant. Once she regained her strength, she underwent open-heart surgery at Stanford Health Care, almost exactly a year after Ethan’s birth. Joseph Woo, MD, chair of cardiothoracic surgery, replaced her valve, and she has been feeling great ever since.

“After I recovered from surgery, I felt so much energy and I was able to do any activity I wanted, without limitations,” Kelly says. “I couldn’t believe how strong I felt!”

Baby number two, a polar opposite experience

Kelly never dreamed she would have one child, let alone two. When her Stanford doctors told her she could have as many kids as she wanted after her heart surgery, she was thrilled and decided to have another. She worked out regularly and ate well so that she could go into pregnancy feeling strong. Close to a year after her heart surgery, she and Brian celebrated the good news that she was once again pregnant, this time with a girl.

“Kelly kept a positive attitude despite her worries throughout the first pregnancy, and during the second she was nervous, but trusting and resilient,” Dr. Khandelwal says.

Kelly couldn’t believe the difference the second time around. All she heard was good news from her doctors. The Maternal Heart Program, in collaboration with the adult cardiology program, kept tabs on her health and her heart, which didn’t present any concerns. To make care convenient for Kelly and to help minimize the risk of her getting infected with the SARS-CoV-2 virus, Dr. Bianco conducted telehealth visits, and she collaborated closely with Kelly’s local doctors to ensure her good health between appointments.

Kelly was rewarded for her diligence with a healthy baby girl, Victoria, in late 2021.

“With Ethan, I was worried that I might die, but with Victoria, I had a low-risk pregnancy and birth, which was such a joy,” she says.

Baby Victoria embodies her mother’s newfound energy and appreciation for life. At close to 4 months old, she rarely cries. She’s always smiling, babbling, and laughing at the antics of her big brother, Ethan, who loves to play hide-and-seek. Kelly and Brian are extremely grateful for the exceptional care that completed their family.

“I’m like a new person! It feels absolutely amazing to have energy to care for my children, do yoga, and do cardio exercise,” Kelly says.

“Kelly is such a warrior. She was willing to do whatever it took to have a good outcome. Knowing that she and her children are thriving means everything to us,” Dr. Bianco concludes.