Children's Hospital Colorado

Viola: Treating Fetal Heart Block

Amy Witt was just going to go to the doctor’s office and let them tell her she was crazy. She didn’t know what it was, but something felt off. She was 29 weeks pregnant. She didn’t want to take any chances. She wanted to put her mind at ease.

Instead, she learned her baby’s heart was beating at 70 beats per minute — less than half the normal rate.

“At first they said I might need an emergency c-section that day,” Amy recalls. “Then I met with a fetal cardiologist, and he said it was a benign arrhythmia and not to worry about it.”

But 10 days later another heart monitor confirmed the worst: Not only was the arrhythmia not benign; the baby was in second-degree heart block. Amy was scared. By the time she finished some internet research on heart block, she was terrified.

The best specialist for fetal heart block

“I have a family friend in Chicago who used to work at Northwestern, and I called her up and said, ‘give me the name of the best fetal cardiologist in Chicago. I will move there,’” Amy says. “She put me in touch with someone at the children’s hospital there and they said, ‘Yeah, we’d be happy to, but the best specialist for fetal heart block is actually right there at Children’s Hospital Colorado.”

Amy found out about the heart block on a Tuesday. Wednesday, she was seeing that specialist: Bettina Cuneo, MD, Director of the Fetal Cardiology Program at Children’s Colorado’s Colorado Fetal Care Center. Dr. Cuneo recognized the signs of anti-SSA antibodies, found in only about 1% of pregnant women — only 2% of whom develop fetal heart block. Without treatment, the heart block would continue to get worse, possibly necessitating a pacemaker at birth.

Right away, Dr. Cuneo started Amy on medications that would reduce the inflammation and stop further damage.

She also set Amy up with a doppler heart monitor — the kind you can buy off a shelf — she could use to monitor her baby’s heart at home. (Dr. Cuneo asked her to monitor once a day. She did it much more than that.)

Giving birth with fetal heart block

Amy went in for visits once a week through the rest of her pregnancy. She didn’t waste them. She talked to anesthesiologists, electrophysiologists, neonatologists. She took a tour of the Cardiac Intensive Care Unit and asked every question she could think of. And when the time came for baby Viola to be born, Dr. Cuneo was there, too. (“She got there before my husband,” Amy jokes.)

“They said if she comes out crying and pink, we’re going to bring her up to you so you can see her before we do the assessment,” says Amy. “When we heard her cry — I feel really emotional right now — everybody in the room started clapping.”

A strong heartbeat after fetal heart block

Viola would still need evaluation in the Cardiac Intensive Care Unit, just a floor down from the Colorado Fetal Care Center’s Labor and Delivery Unit, for a few days. But her heartbeat was so strong she was ready to go home before even Amy was. Amy’s care team had to figure out how to make space for the baby in Amy’s room.

Five months later, Viola is in great health. The care team continues to monitor her heart, but it’s possible at this point she may not need a pacemaker until high school. That’s a best-case scenario, but thanks to fast treatment and a little luck, it’s well within the realm of possibility.

“Honestly there are a lot of days when I forget she has any sort of heart condition,” says Amy. “She’s a perfect little baby, growing and doing all the things babies do, rolling over, cooing, talking to me. She’s just fine.”

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