The Naggy family at home in Collegeville
Heart palpitations would have many people dialing 911. But Mary Naggy had palpitations for years, and doctors told her they were normal. They even dismissed the heart murmur that was detected when Naggy was 2 years old.
By the time she was 34, Naggy considered the palpitations more of an annoyance than a cause for concern. But because she was four months pregnant with her second child and wanted to be extra careful, she mentioned the palpitations to her general practitioner, Dr. Jason Conwell of Main Line HealthCare Family Medicine at Exton Square. Conwell ordered an echocardiogram, an ultrasound of the heart. The results were shocking.
Naggy had an atrial septal defect, a hole in the wall that separates the heart’s upper chambers. Some ASD holes are small, but Naggy’s was large, causing Naggy’s palpitations and murmur.
The majority of ASD cases are diagnosed in childhood and repaired through relatively standard surgery—also the solution for Naggy’s condition. If left untreated, the hole expands, enlarging the heart to unsafe proportions.
Naggy’s pregnancy was putting extra strain on her heart. Blood volume increases, making the heart work harder. That’s why many pregnant women have palpitations. But the situation was more serious for Naggy, and she became a high-risk pregnancy. “What hit me hardest was that this had been in my body all along,” she says. “What if Dr. Conwell hadn’t ordered that echocardiogram?”
The gravity of Naggy’s medical situation was evidenced by the specialists to whom she was referred: Dr. Andrew Gerson, chief of maternal and fetal medicine at Lankenau Medical Center, and Dr. Konstadinos Plestis, system chief of cardiothoracic and vascular surgery at the Lankenau Heart Institute. “Mother and the child became our patients, and we had to do what was best for both of them,” Plestis says. “We assembled a specialized team and decided that, with close observation, it would be safe for her and the baby to continue with the pregnancy. She needed surgery to repair the hole in her heart, but it could wait until she gave birth.”
On June 16, 2015, Naggy gave had her son, Reid. Eight months later, she went back to Lankenau for surgery. Although she’d consulted with a Penn Medicine specialist, Naggy decided to stay with Plestis because, unlike the other doctor, he could repair her heart with a minimally invasive procedure. “The less we invade the heart, the quicker it heals,” says Plestis. “We specialize in minimally invasive procedures because, when medically appropriate, they are best for the body.”
The surgery was still traumatic for Naggy’s body. “We did a one-inch incision under the breast, connected her to a heart-lung machine, stopped her heart, opened the chamber, then closed the hole with sutures,” says Plestis.
Had the hole been smaller, the surgery could’ve been done even more minimally with a catheter inserted through Naggy’s groin. But it was too late for that. “It was an unusual surgery because most are performed on children,” Plestis says. “Had it been detected then, she’d never have been at risk during her pregnancy.”
On the third night of her recovery at Lankenau, Naggy went into atrial fibrillation. Doctors assured her that, although scary, A-fib is a common reaction to the procedure. “My heart just got put back together, and it had to figure out how to pump,” she said.
The rest of her recovery was uneventful. Her mother and mother-in-law came to help with her older son, Cole, and Naggy hired a nanny as extra support for infant Reid. “The toughest part was not being able to pick up my kids for six weeks,” she says. “But I’m glad that was it, rather than face more serious health problems later in life.”
Nine months after surgery, Naggy’s life was back to normal. She was exercising four times a week and running around after her kids. She only wishes that her ASD was diagnosed and treated years ago. Plestis says Naggy is in the clear and shouldn’t have any complications from her surgery. She sees Naggy’s condition as a red flag for specialists, who should check every cardiac irregularity. “There’s so much cardiologists can do with minimally invasive procedures,” says Plestis, “but only if patients come to us before the problem is critical.”