Shin Kong Wu Ho-Su Memorial Hospital
Last Update:2026-10-01
Twenty-year-old Palauan pregnant woman Vianna was diagnosed with severe rheumatic heart disease complicated by multiple valvular lesions and heart failure. Her condition deteriorated rapidly during the third trimester, prompting an international medical referral to Shin Kong Wu Ho-Su Memorial Hospital in Taipei.
As the patient was at risk of cardiopulmonary failure at any time, the medical team prepared extracorporeal membrane oxygenation (ECMO) equipment and kept it on standby throughout the delivery process. Vianna eventually underwent a successful cesarean delivery at 34 weeks of gestation and gave birth to a baby boy weighing 2,245 grams, averting the potentially fatal risk to both mother and child.
Vianna's mother accompanied her daughter at today's press conference. She shared that this was the second time her daughter had received life-saving treatment from the Shin Kong medical team following her previous heart surgery. She expressed her heartfelt gratitude to the medical team for their care and support.
Dr. Wei-Chun Lee, attending physician in the Department of Obstetrics and Gynecology at Shin Kong Hospital, said that the hospital mobilized a multidisciplinary team from Obstetrics and Gynecology, Cardiology, Cardiovascular Surgery, Anesthesiology, and Pediatrics to care for Vianna.
To prevent labor and delivery from triggering cardiovascular decompensation, the cardiovascular surgery team inserted bilateral femoral arterial and venous catheters before the cesarean section. This enabled the team to rapidly initiate ECMO and provide extracorporeal circulatory support if necessary.
The patient subsequently underwent a successful lower-segment transverse cesarean section and recovered well after surgery. She is expected to return to Palau soon, where her ongoing care will be continued by a physician from Shin Kong Hospital stationed locally.
This was Vianna's first pregnancy. During pregnancy, she developed severe shortness of breath, fever, coughing, and other symptoms indicating impending heart failure. After evaluation by local physicians in Palau, concerns were raised that local medical resources might not be sufficient to safely manage her high-risk condition, and she was therefore referred to Shin Kong Hospital for further treatment.
Dr. Lee explained that the severe valvular stenosis from which the patient suffered is classified by the World Health Organization (WHO) as a condition in which pregnancy is contraindicated. The risk of fetal death is extremely high. This was not simply a high-risk pregnancy, but an extreme clinical challenge involving the risk of imminent cardiac decompensation.
The medical team had to carefully balance the mother's cardiac workload with the time needed for fetal development in order to determine the optimal timing for delivery. Ultimately, 34 weeks of gestation was selected as the appropriate timing for the cesarean section.
Dr. Lee further explained that during delivery, a large volume of blood returns to the heart, potentially causing acute pulmonary edema and even circulatory collapse. For patients with severe underlying heart disease, this makes delivery particularly challenging.
On the day of the cesarean section, approximately 30 to 40 medical personnel were assembled and placed on standby. Staff from the Pediatric Intensive Care Unit also waited outside the delivery room, prepared to receive the newborn and transfer him to the intensive care unit for respiratory support and temperature management.
Fortunately, the mother recovered well after surgery. Her left ventricular ejection fraction (LVEF), which had been critically reduced to 43% before surgery, subsequently improved to 52.3%.
Cardiovascular disease is a major cause of maternal mortality. Dr. Lee reminds women with a known history of rheumatic heart disease or valvular disease to undergo a comprehensive cardiac ultrasound evaluation before becoming pregnant.
According to the WHO classification referenced by Dr. Lee, women with mild valvular prolapse are considered to have a relatively low risk and may receive routine prenatal care and delivery at a general hospital. Pregnant women with moderate mitral stenosis or mechanical heart valves are considered high-risk and should receive prenatal care and delivery at a medical center with cardiac specialty services, with follow-up approximately every two months.
For women with severe mitral stenosis similar to the patient in this case, pregnancy is strongly discouraged due to the extremely high risk. Such patients require close monitoring and intervention by a multidisciplinary medical team on a monthly basis.