News Story - Idaho State Journal

jbulger@journalnet.com

POCATELLO � On Monday morning, Cara Jockumsen sat up, looking as healthy as a normal 29-year-old might. Only the peek of the midline incision of a recent open heart surgery gave hint to the rare condition that nearly took her life.

Jockumsen, 29, gave birth to a healthy 9-pound boy on Sept. 4. She was home when the first chest pains struck her on Sept. 6. She went to Portneuf Medical Center, where a CT scan found no irregularities.

Four days later, while feeding her infant son, Drew Michael, the pains returned with a vengeance.

“I put him down and called 911 and then I called my husband,” she said.

She was transported by ambulance to PMC. This time, tests indicated serious problems. She was whisked to the cardiac center, where a catheter procedure found Jockumsen had a dissection, or tear, in two of her coronary arteries.

PMC chief cardiologist Jacob DeLaRosa said Jockumsen’s heart was barely moving.

“There was no blood getting to the heart,” he said. “She lost about 90 percent of her heart (function) during that time frame.”

Jockumsen’s condition, known as post-partum spontaneous coronary artery dissection, is extremely rare. Rarer still are those who suffer the event and live to tell about it.

“Few patients get to their doctor in time,” said interventional cardiologist Fernando Grigera. “Most of them will die with the first chest pain.”

The cause of the disease is unknown, although the hormonal changes that occur during pregnancy and the stress of delivery are implicated.

“Why doesn’t it happen during the delivery itself? Nobody knows,” Grigera said.

Despite being gravely ill, Jockumsen was conscious and aware of what was going on before her surgery.

“They just told me I’d have to fight really hard,” she said. “It was pretty scary.”

Before he opened up Jockumsen’s chest, DeLaRosa spoke with her family. His words were not reassuring. He told the family that Jockumsen’s chances of survival were slim, and that her heart might be irreversibly damaged due to the sustained lack of blood.

“We were prepared to put her on a mechanical heart and send her for transplantation,” he said.

DeLaRosa and his team put Jockumsen on a heart bypass machine while they harvested venous grafts from her legs to repair the two tears in her coronary arteries. After that, all they could do was wait and see how her heart would react to the restoration of blood flow.

“We were able to look at real-time echogram of her heart and watched it improve after the procedure,” DeLaRosa said.

DeLaRosa showed a video of a relatively healthy heart beating. The monochrome, ghost-like image shows blood flowing and the heart constricting like a clenched fist. Then he showed Jockumsen’s heart before the procedure. The pale outline of the organ was mostly inert.

Now five days after the operation, Jockumsen is ready to go home to her newborn, her 6-year-old son, Dylan, and husband Jared. She is sore from the invasive procedure, but looks remarkably sound. Reflecting on the surgery, she is surprised at all that has transpired.

“I thought the worst thing it could be was blood clots,” she said. “I never imagined ... I’d be undergoing open heart surgery.”

She is grateful for the doctors who saved her and for her new lease on life.

“They told me it’s a miracle that I’ve recovered so quickly.”

Jockumsen’s prognosis is good. DeLaRosa said he expects she will recover fully in six to eight weeks. She is advised not to undergo pregnancy again, however.

“They usually call it a miracle baby, but she’s a miracle mom,” he said.

By John Bulger

This document was originally published online on Tuesday, September 16, 2008

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