In any emergency medical procedure, doctors are quick to make a plan and jump into action. But for the medical staff at one North Carolina hospital, a pregnant woman with a severe heart condition presented a never-before seen case.
Danielle Gaither, 31, suffers from Marfan Syndrome, an inherited connective tissue disorder that can cause heart conditions. On February 21, Gaither was rushed to Carolinas Medical Center, a level one trauma center, with a severe tear in her aorta and her body was shutting down.
"She was sick and dying, almost beyond repair"
"As soon as we got the call that she was a code dissection, meaning her aorta had split into two which deprives oxygen from the blood and all the main organs, it was an instantaneous decision to get her in the operating room," Dr. Joseph McGinn, chair of Cardiovascular and Thoracic Surgery at Sanger Heart and Vascular Institute told ABC News. "Time was really of the essence and she was near term pregnant so that threw a monkey wrench in the plans. "
"Gaither was sick and dying almost to the point of irreversibility, so we knew we had to assemble quite a few people," McGinn said. "We got four separate teams all with their own lead surgeon working to save two lives. "
Dr. Jeko Madjarov, the lead thoracic surgeon, said he has performed hundreds of aortic dissection heart surgeries. Though each case is very difficult in its own respect, he'd never dealt with anything this severe in his more than 13 years at Sanger Heart and Vascular Institute. "This is one of the highest levels of emergency in cardio thoracic care, there's always a curve-ball scenario because their not all the same, but this one was different to the Nth degree."
"When I saw her, her body was literally shutting down. We had to move even faster because, with her circulation shutting down, we knew it was even worse for the baby," Dr. Madjraov explained. He made the decision to do the dual procedure because she is a young patient and the baby’s due date was close.
Coordinating a game plan, fast
"My first thought was to regroup quickly and assemble as many teams as possible. I was standing next to people I'd never worked with before from obstetrics, physicians, but we all kind of glued together quite fast. Everybody knew what we were doing," he said.
The four teams assembled in the OR included cardiac anesthesiologists, an obstetrical team to handle the cesarean section, a neonatal team to work on the baby immediately post-delivery and the cardio thoracic team.
Both Dr. Madjarov and Dr. McGinn said these surgeries can normally take anywhere from six to ten hours in a routine case, "but the technical details of the procedure was more difficult."
"The c-section literally took minutes, he had to come out real fast because the blood circulating to the placenta providing oxygen was dwindling rapidly," Dr. McGinn said. "In the back of your head you're thinking ‘Oh my God if we lose her, the baby's got no mom,’" he added.
But once the thoracic team heard from the neonatal unit nurses that the child was stable, Madjarov said the surgeons got a second wind to finish working on Gaither.
"I got this kind of good feeling because I knew that [KV] was intubated and breathing on the lung machine getting oxygen. By the time I finished I knew the kid was OK and that gave me this little boost of energy before the end, which is not the fun part,” he said. “It's when you fix things and stop all the bleeding and in this case takes the longest."
Doctors had Gaither in a medically-induced coma, heavily sedated for almost two weeks during her initial recovery. When she woke up, she met her son KV for the first time.
A moment that will be cherished forever
"He's my heart," the mother said after meeting the child. "I'm happy and I thank God that he's healthy."
The doctors were also touched by the moment.
"It was a very emotional and fulfilling moment when they brought KV to meet Danielle for the first time," McGinn said.
Dr. Madjarov said it was a privilege to be standing in the room for that moment and it's something he will cherish for the rest of his career.
"What struck me was how on an instinct level the kid recognized the mom -- I don't think I'm imagining this -- it was emotional,” Madjarov said. “Even routine deliveries are emotional, but in this particular case we weren't just bystanders, but participants and that made it incredible."
Gaither is healing normally and receiving rehab treatments. Both doctors said there should be no additional risks to Gaither from surgery at this stage.
"I'm very pleased with her recovery so far, she's already walking and I expect her discharge sometime at the end of this summer,” Madjarov said. “ But it could be sooner rather than later because she’s really firmly on the road to recovery."
Gaither has been surrounded by her family, including her husband, mother, friends and extended family, as she recovers in a Charlotte rehab facility.