Shina Biblow always knew she would have to have open heart surgery one day, she just never thought it would be when she was four months pregnant with her second child.

鈥淗e鈥檚 here and he鈥檚 healthy and growing. It鈥檚 a miracle,鈥� said Biblow of the family鈥檚 latest addition, a healthy baby boy named Merritt, born Jan. 26.

Unlike her first textbook pregnancy a few years before with their son Morris, Shina developed health problems almost immediately that would require complex, high-risk heart surgery at St. Paul鈥檚 Hospital when she was just 15 weeks pregnant.

鈥淭here was a 40 per cent risk of losing the baby. It was very hard 鈥� (but if ) there鈥檚 no me, then there鈥檚 no baby so we had to do what we had to do.鈥�

In a sense, Biblow鈥檚 story began 32 years ago. She was born with a narrowing of her aortic valve, the main blood vessel leaving the heart. She required surgery for this as an infant.

The condition meant that when she turned 18, she became part of the Pacific Adult Congenital Heart Clinic (PACH) at St. Paul鈥檚 Hospital, a multidisciplinary team that follows adults born with heart disease.

Feeling unwell from the pregnancy鈥檚 start

Apart from being unable to do certain intense sports, Biblow led a normal life, including an uneventful first pregnancy and birth of their oldest son, Morris.

This second pregnancy was different.

From the get-go, she felt unwell. 鈥淚 was nauseous and tired, my heart was racing and I got what I call hot flashes,鈥� she says. 鈥淚 just assumed they were caused by a surge of pregnancy hormones.鈥�

She received care at Cariboo Memorial Hospital鈥檚 emergency department.

鈥淭hat鈥檚 when they discovered I was going into heart failure.鈥�

Doctors sent an urgent referral to the highly specialized Cardiac Obstetrics Clinic (COB) at St. Paul鈥檚 Hospital. She received tests that revealed episodes of sudden extremely rapid heart rhythms.

Calf cramps followed 鈥� also a pregnancy symptom, she figured. When she developed itchy red spots on her body, she became alarmed.

鈥淭hings just kept getting worse,鈥� Shina said.

Breathing was so hard she could not even care for her toddler. When she called a PACH Clinic nurse, she exploded into fits of coughing.

Dr. Marla Kiess, St. Paul鈥檚 cardiologist and COB founder, followed Biblow by Zoom to monitor the heart palpitations, shortness of breath and other symptoms.

A soaring heart rate

As they persisted, Dr. Kiess directed the local hospital to airlift her for more advanced care to Royal Inland Hospital in Kamloops on August 12. There, her heart rate soared to 190 beats/minute. A normal rate is 60 to 100.

Tests found growths on her aortic valve, suggesting a bacterial infection: serious in any patient, more so in a pregnant woman.

鈥淭he infection in the valve was totally unexpected and unpredictable,鈥� recalls Dr. Kiess.

She and her team arranged for Biblow鈥檚 transfer to St. Paul鈥檚, the only centre in British Columbia for complex cardiac-obstetrics cases like this.

Surgery poses big risk to fetus

Shortly after arriving on August 15, St. Paul鈥檚 cardiovascular surgeon Dr. Jamil Bashir told Biblow she鈥檇 need open-heart surgery to replace the infected aortic valve.

鈥淚t was scary,鈥� says Biblow. 鈥淏ut it needed to be done if we wanted to keep the baby and save my life.鈥�

Risks were high. 鈥淭hat point in gestation is a critical time in the baby鈥檚 evolution because many organs are developing,鈥� says Dr. Kiess.

A complex case requires a large care team

In surgery, Biblow would be supported by a heart-lung bypass machine, which would reduce blood flow to the fetus and risk organ malformation. Alarmingly, it would bring a 40 per cent risk of the baby dying, says Dr. Kiess.

Because of the case鈥檚 complexity, her care team began a huge amount of planning to anticipate potential responses to problems in both mom and baby. It included nurses and doctors from cardiology, anesthesia, surgery, infectious diseases, the ICU, and obstetrics. Zoom proved invaluable.

Her husband Tyson, a millwright at Gibraltar Mine, rushed to Vancouver to be with his wife, narrowly getting over the Coquihalla pass before it was closed due to last summer鈥檚 wildfires.

Delicate balance around medication

On August 18, Dr. Bashir and his team successfully implanted a mechanical aortic valve to replace the severely infected one. The good news was, a mechanical valve (unlike a cadaver valve) would never have to be replaced. The bad news was, it increased Biblow鈥檚 risk of clotting. She would need blood thinners for the rest of her life.

Those drugs brought risks to the fetus, so Dr. Anna Rahmani and Dr. Tony Wan from the St. Paul鈥檚 Thrombosis clinic were also part of her care.

St. Paul鈥檚 teams then followed her post-surgery to monitor her with the new valve and pregnancy.

The birth approaches

As the delivery date approached, her team wanted her in Vancouver near the hospital several weeks before, to tend to her cardiac and obstetrical needs. Registered nurse Karen Sandhu, complex care coordinator for maternity, and Amy Graham, COB RN, oversaw the many logistics around that chapter, as did PACH/COB social worker Kassandra Maxwell.

鈥淚 coordinated with her St. Paul鈥檚 obstetrician, Dr. Nancy Matinko and the virtual visits Shina would have with her,鈥� says Sandhu.

More planning ensued, especially around her anticoagulants. They had to stop in advance because of the risk of a severe bleed giving birth. Yet she couldn鈥檛 be off them for more than 24 hours because of clotting risks.

Amid it all, Merritt arrived on January 24 at 38 weeks鈥� gestation, weighing six pounds, four ounces. 鈥淲ith all the meds I was on, they were expecting a smaller baby,鈥� Biblow says proudly. He is healthy and well.

The family is now home on their ranch, enjoying life at Miocene.

Shina has regular virtual visits with St. Paul鈥檚 teams, including COB and the Thrombosis Clinic.

She and her husband Tyson are grateful to St. Paul鈥檚 expansive team of doctors, nurses, social workers and many others who helped her and her baby survive risky cardiac surgery and see her through delivery and post-partum care.

鈥淓ven though everything happening was very scary and we didn鈥檛 know what the outcome was going to be, our faith and prayers from our family and friends, and the care from the team at St. Paul鈥檚 is what got us through the experience.鈥�

With files from Providence Health Care

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