Danicca B Beating the Odds

A young woman with two serious medical conditions risked her life to have the family she always dreamed of.

For most expectant mothers, giving birth is a joyous occasion. But as Danicca Bolante lay on the operating room table during her C-section in August 2018, her body clenched with fear. “I kept feeling like I was fading away,” recalls the 35-year-old nurse. “I didn’t know if I’d make it through the procedure alive.”

Danicca wasn’t the only one who was worried. A team of more than 40 healthcare professionals was in the room with her at Robert Wood Johnson University Hospital (RWJUH) New Brunswick to make sure both she and her baby survived. Danicca had two potentially life-threatening conditions: severe mitral valve stenosis and severe pulmonary hypertension (PH). With mitral valve stenosis, the heart’s mitral valve doesn’t open properly, preventing blood from flowing forward into the left ventricle, the main chamber of the heart. This causes blood to back up into the lungs, raising pressure inside the arteries, which eventually leads to failure of the right side of the heart.

A Risky Pregnancy

In 2014, Danicca was diagnosed with mitral valve stenosis. The condition is often a complication of rheumatic fever, which Danicca had suffered as a child. Her cardiologist had recommended surgery, but

Danicca brushed him off. “I felt fine,” she says. “I was young and healthy and assumed I had nothing to worry about.”

When Danicca learned she was pregnant in February 2018, she was so overjoyed she didn’t think of mentioning her heart condition to her obstetrician. Her first trimester was uneventful, but in her fourth month, Danicca began experiencing trouble breathing after flying home to visit relatives in her native Philippines.

As soon as she returned home, she saw her obstetrician, who immediately referred her to Justin Brandt, MD, a high-risk obstetrician at RWJUH New Brunswick and Rutgers Robert Wood Johnson Medical School (RWJMS). Her condition deteriorated rapidly, and she was unable to work. At that point, Dr. Brandt called Deepa Iyer, MD, cardiologist and advanced heart failure specialist at RWJUH New Brunswick and Rutgers RWJMS.

After hearing that Danicca couldn’t walk across the room, Dr. Iyer advised that she be admitted to the hospital immediately. Since Danicca’s mitral stenosis was never treated, she had developed pulmonary hypertension. “During pregnancy, a woman’s blood volume increases,” says Dr. Iyer. “Danicca’s heart could not handle the extra volume due to her severe mitral stenosis, so the pressures in her lungs got higher as the pregnancy progressed. The right side of her heart was starting to fail. I knew we’d need a multidisciplinary team right away.”

Saving Two Lives

Danicca was given IV diuretics and beta blockers to slow her heart rate and improve forward blood flow. Although she felt better and was able to walk around a week later, Dr. Iyer was still concerned. Repeat echocardiograms showed that the right side of her heart was enlarging, putting her at high risk for heart failure. A meeting was called with Danicca’s new multidisciplinary healthcare team. In addition to Dr. Iyer, it included Dr. Brandt, high-risk obstetrician Todd J. Rosen, MD, Aziz Ghaly, MD, a cardiothoracic surgeon, cardiac anesthesiologists, pediatricians and nurses at RWJUH New Brunswick and Rutgers RWJMS. The team concluded Danicca, who was only 31 weeks pregnant, should have a C-section. They counseled Danicca and her husband, Joseph, that there was a chance mom and baby wouldn’t make it.

“We had a priest come to administer last rites, and after he left, I said to Danicca, ‘If something happens to you, what do you want me to tell our daughter?’” recalls Joseph. Danicca’s reply was swift: “It was worth it to die to give you life,” she says.

Two days later, RWJUH New Brunswick and Rutgers RWJMS obstetrician William MacMillan, MD, delivered Jonica (a combination of Danicca’s and Joseph’s names). After the C-section, Danicca was whisked to the intensive care unit, while Jonica was sent to the neonatal intensive care unit. As soon as Danicca was medically stable, she was brought to see her baby. “I couldn’t contain my happiness,” she recalls.

But Danicca wasn’t out of the woods just yet. It would take a few weeks to continue to monitor her closely as the amount of blood in her body returned to pre-pregnancy levels. Two weeks after her C-section, she underwent a mini mitral valve replacement surgery, in which smaller incisions are made without cutting the breastbone, causing less pain, better healing and quicker recovery.

The Road to Recovery

But survive she did, and she and Jonica were discharged at the end of August. Both parents say they’re beyond thankful to the team at RWJUH New Brunswick. “From the most senior physician to the housekeeping staff to the patient reps, they were all amazing and made us feel at home,” says Joseph.

Danicca is especially grateful to Dr. Iyer. “She was very motherly to us, and I needed that at the time because my mother is in the Philippines,” she says. As for Dr. Iyer, she says, “I have a picture of Danicca,

Joseph, Jonica and their bulldog, and it lights up my heart,” she says. “I never imagined such a beautiful outcome.”

Your heart doesn’t beat just for you. Get it checked. To learn more about the full range of cardiac services at Robert Wood Johnson University Hospital (RWJUH) New Brunswick or to schedule an appointment with one of New Jersey’s top cardiac specialists, visit www.rwjbh.org/heart.