What began as a routine checkup with her family doctor ended with a COVID-19 diagnosis, three hospital transfers, the discovery of heart failure, emergency surgery and the birth of a baby named in honor of Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health.
Michelle Baldemor, a 30-year-old from the Philippines, was pregnant with her second child. During a routine doctor visit to monitor her pregnancy, she reported experiencing a dry cough and difficulty breathing that progressed into a high fever. After ruling out other causes, she tested positive for COVID-19.
Concerned she might experience complications due to being 26 weeks pregnant, her doctor referred her to a local maternity hospital for observation. Her condition continued to worsen, and her oxygen requirements kept increasing, requiring her to be placed on a mechanical ventilator to support her lungs. In addition to severe COVID-19 Pneumonia, her chest x-ray revealed an enlarged heart.
Michelle was transferred to another hospital in the area – the second in just 24 hours – for further management and evaluation. There, an echocardiogram revealed she was suffering from heart failure due to significant tightening of her mitral valve. Blood and fluid were collecting in her lungs and the right side of her heart was failing, preventing her lungs from getting enough oxygen to her blood, something that was made even more serious by her COVID-19 pneumonia. A decision was made to transfer her to Cleveland Clinic Abu Dhabi.
“When Michelle arrived at Cleveland Clinic Abu Dhabi that evening, she was in a critical condition. Our team worked on her all night to stabilize her and remove as much of the fluid build-up in her body as possible and stabilize her blood pressure and oxygen levels. We had a surgical team from a nearby maternity hospital on standby in case we had to deliver her baby urgently. Happily, we got her stable enough that it wasn’t needed at that stage,” says Dr. Vivek Kakar, Director of the Cardiac Critical Care and ECMO Program at Cleveland Clinic Abu Dhabi.
The following day, Michelle’s case was discussed at length in a large multidisciplinary meeting that included representation from critical care, cardiology, cardiac surgery, anesthesiology, and the local maternity hospital. As traditional surgery was not an option, the team decided to attempt to open her heart valve using a balloon. It was hoped that this would stabilize her condition and allow her to carry her baby to full term before undergoing surgery to fully repair or replace the valve.
“If Michelle hadn’t been pregnant, she would have been scheduled for heart surgery right away. It wasn’t possible to do surgery without jeopardizing the baby and we know that operating on COVID-19 patients within the first 4-6 weeks leads to much worse outcomes. As a result, we looked at other options to open the valve and decided that using a balloon placed percutaneously was the only one available to us if we were to protect both her and the baby,” continues Dr. Kakar.
Understanding it was a high-risk operation, Michelle’s care team gathered in the operating room to attempt to open her heart valve. They were joined by a surgical team from a local maternity hospital who were ready to perform an emergency cesarian section to deliver the baby if her condition worsened. Doctors advanced the balloon through a vein in Michelle’s leg, a minimally invasive approach dictated by her condition. The balloon was then used to open the tight mitral valve. However, once in place, doctors found that Michelle was now experiencing mitral valve regurgitation, causing some blood to flow backwards through her valve. It was decided that an emergency delivery was now the only way to protect Michelle and her baby.
Caleb Angelo Cleveland Baldemor was born on Monday, March 8 at just 27 weeks. The first baby to be born at the hospital since it opened in 2015, he was placed on a ventilator to support his breathing and transferred to the NICU at a local maternity hospital. Following the birth, Michelle still had severe COVID-19 pneumonia to deal with but with continued efforts, her condition improved significantly, and she was able to continue her recovery at Cleveland Clinic Abu Dhabi.
“The problem with heart failure and pregnancy is that pregnancy exacerbates the heart failure by causing even more water retention. Delivering the baby definitely helped the mother’s condition. After the birth, we were able to focus the treatment on the COVID pneumonia and as her condition improved, we were able to take her off the ventilator while her baby continued to do well too. To see both mother and baby doing so well after such an ordeal is immensely gratifying and really quite special,” concludes Dr. Kakar.
When Michelle awoke, she found herself recovering at Cleveland Clinic Abu Dhabi where her nurse informed her that she had given birth and that her son was doing well.
“I remember waking up and the nurse told me congratulations. She told me my son had been born and was doing well and handed me a photo of him. I was so shocked because I had been unconscious for the last couple of weeks, I didn’t know what had been happening. That we are both here and doing well is truly a miracle. I am so grateful to all the doctors who looked after us both so well,” says Michelle.
After recovering from her COVID, Michelle focused on rebuilding her strength and caring for her newborn son. In September 2021, Michelle underwent a successful surgery to replace her mitral valve at Cleveland Clinic Abu Dhabi. She was discharged within two weeks of her surgery and continues to do well.
“I really feel that I have been given a second life, If I had not tested positive for COVID, who knows if I would have found out about my heart until it was too late. We named my son Caleb, meaning brave, because he has already faced so much. His middle name is Cleveland to commemorate everything the team did to support us both as he came into the world,” concludes Michelle.
Cleveland Clinic Abu Dhabi’s Critical Care Institute consists of a state-of-the-art 72-bed intensive care unit, staffed 24 hours a day by intensivists with diverse clinical backgrounds. Specialized units including neurologic, medical and cardiothoracic critical care provide patients with individualized care and monitor all post-transplant patients as well as those with advanced cardiac disease or on ECMO.
