The gift of life—times three
Last year, Michele Melvin gave birth to healthy twins. A remarkable feat, certainly—as all births are. But for Melvin, the twins represent something bigger, something she thought she would never experience. At an early age, Melvin was told she would not be able to have children.
When she was born, Melvin was diagnosed with complex congenital heart disease, a condition that included transposition of the heart’s great vessels: the position of the aorta and pulmonary artery were switched. Her heart also had narrowing of the aorta, abnormal blood flow from the aorta to the pulmonary artery, a hole in the wall that separates the heart’s two lower chambers and backflow of the tricuspid valve.
Melvin’s childhood was anything but normal. “I didn’t start walking until I was 3 because I was in and out of the hospital so much,” she says. “I could never walk a whole block without being out of breath. I couldn’t ride a roller coaster or go ice-skating. I couldn’t spend the night at friends’ houses because their parents were too worried about all the heart medications I had to take.” By the time she turned 13, she had undergone four open-heart surgeries. “It was especially hard for me when I was a teenager, because I couldn’t do so many of the things my friends were doing.”
Melvin developed heart failure when she was 21; her heart was too weak to provide enough blood flow to meet her body’s needs. By early 2009, when she was 25, she had experienced several more episodes of heart failure, and her physicians told her she would need a heart transplant to survive. In July of that year, she was placed on a transplant wait list, and by July of 2010, she was so sick that she was admitted to the intensive care unit at St. Louis Children’s Hospital.
By surviving to adulthood, Melvin had become part of a rapidly growing demographic within the U.S.: adults with congenital heart disease who survive childhood thanks to advances in medicine. Her care teams at Barnes-Jewish and St. Louis Children’s hospitals collaborated to offer Melvin the best possible care. And in 2010, they worked together to give Melvin the new heart she needed.
Melvin says that when she woke up after her transplant surgery, she could breathe well for the first time in her life. “It was amazing. But I thought my heart was beating too fast, and I kept telling the nurse there was something wrong. Actually, it was working just fine. I just didn’t know what a normal heart felt like.”
Those who undergo transplantation take immunosuppressant medications to keep their bodies from rejecting their new organs—and these powerful drugs can cause harm to a developing fetus. In Melvin’s case, her physicians were able to make some changes to her immunosuppressant regimen. And after considerable pre-conception counseling with Roxane Rampersad, MD, an obstetrician-gynecologist who specializes in maternal-fetal medicine, Melvin finally was given the OK to have children.
She became pregnant with twins, a situation that can put women at higher risk for complications. Rampersad notes that this risk combined with the special care required after heart transplantation meant that a team of maternal-fetal medicine specialists would need to closely monitor Melvin’s health during her pregnancy. When she developed hypertension, she was hospitalized on two occasions to help prevent pre-eclampsia, and she took medication to control her blood pressure. In her 34th week of pregnancy, Melvin gave birth via C-section to Emma, who weighed 4 pounds, 3 ounces; and Andrew, who weighed 4 pounds, 13 ounces.
“I still can’t believe I have them,” she says. “My whole life I wanted to have children more than anything, and now I do. I’m so happy.”
“It’s wonderful to see people thrive with their new hearts and experience life events such as having children, getting married, going to school and watching their kids or grandkids grow,” says Cindy Pasque, MSN, RN, the transplant nurse coordinator at Barnes-Jewish Hospital who has helped care for Melvin since her transplant surgery. “Our patients truly feel like family because we get to know them so well.”
Justin Vader, MD, a Washington University cardiologist at Barnes-Jewish Hospital who treats Melvin, says Melvin’s good health, and her children’s, is possible because of the efforts of an extensive team of experts. “Few places offer such a specialized group of dedicated people to care for patients with complex cardiovascular issues,” Vader says. “It really does take a village.”
Melvin says the people who make up her medical team are her “other family.” Many of them were invited to her wedding and her baby shower. And she is grateful to her donor and her donor’s family.
“If not for my donor, I wouldn’t be here today,” she says. “The heart I received made life possible not just for me, but for my babies, too. I wish more people would become donors.”