The
Cardiomyopathy
Association

A 29-year-old woman has become the first heart transplant patient in the world to give birth to healthy twins, American doctors say.

Stefania De Mayo, who had restrictive cardiomyopathy, had her identical twins Melania and Natalia six weeks prematurely and minutes apart at Newark Beth Israel Hospital just after Christmas.  She had received her donated heart just 16 months before.

Melania, who weighed  4lbs 2oz, went home two weeks later, and is now almost 7lbs,” said her proud father Rich, 35. Her sister, Natalia, who weighed 2lbs 13oz and needed bowel surgery, went home earlier this month weighing 4lbs 6oz.

Doctors at the hospital said there had been 39 reported cases of pregnancies after heart transplants, but Stefania is believed to be the first woman with a donor heart to bear twins.

Obstetricians say pregnancy is difficult for organ transplant patients because of the stress it puts on the body, and some of the drugs the patients take to prevent rejection of the organ can be harmful to foetuses.

Stefania had become seriously ill on her honeymoon and was treated for two years for lung problems. But three years ago doctors decided she had restrictive cardiomyopathy, a condition that causes stiffening of the heart muscle and leads to heart failure.

She spent six months at home on intravenous fluids and then two months in the hospital before her heart transplant in August 2008.

A transplanted heart does not have nerve connections so does not give the normal signs of hypertension or haemorrhaging, so Stefania’s blood pressure had to be monitored through chemical hormone levels, said Dr. David Baran, transplant cardiologist at Newark Beth Israel.

There is also a risk that her body would reject the donated heart, Baran said. Fortunately for her, the hospital has the only clinical trial of a single immunosuppressive drug, Prograf, which is less likely to cause birth defects, he said.

There was also an extremely rare and potentially fatal complication in the womb, not related to the transplant. Doctors discovered an unequal flow of blood and nutrients to the individual babies because their mother’s placenta had not divided in two parts. Surgeons used a laser to fix the problem in the uterus.

Dr. Munir Nazir, director of maternal and fetal medicine at Newark Beth Israel,
said was “absolutely thrilled” by the birth.

He added: “This is something, in more than 25 years of managing high-risk pregnancies, you just never will forget, especially when the outcome is so great,” he said. “This is the best any physician can dream for.”