Patient Stories

Severe Heart Failure while pregnant leads to life-saving LVAD Placement

Mar. 9, 2023

Madi Smith was told she had days to live before being transferred from another hospital to UC Medical Center – she says her UC Health doctors and nurses are the reason that she’s here today

Madi Smith was 17 years old when her whole world was turned upside down. In a matter of months, she learned she was pregnant, delivered prematurely via emergency C-section around 25 weeks and discovered that there was something severely wrong with her heart. After welcoming her daughter into the world, Madi was told she herself only had days to live.

Thanks to the quick and intuitive care by UC Health cardiologists, Madi’s life was saved by a left ventricle assistive device (LVAD), two open-heart surgeries and patient-centered care that only the region's leader in heart care for over 200 years can provide.

An Emergency C-Section and Only Days to Live

After learning that she was pregnant in October of 2022, Madi was full of emotion.

“I didn’t think that I was ready, or I’d be capable of doing it,” Madi said of the early days of her pregnancy.

To add to this emotion, it wasn’t long until it became apparent that this was not going to be an easy pregnancy. Very early on she was passing out, rapidly gaining weight and feeling sick more often than not.

“Everything was going fast—a little too fast—but you wouldn’t look at a 17-year-old and think ‘heart failure’,” Madi remembered.

The night she went into labor, she recalls feeling intense pain in her back, feet and lower stomach.

“I feel kind of weird, so I started walking around trying to make the pain go away because it would come off and on and finally, I decided I needed to get to a hospital’,” she recalled.

She was rushed to the nearest hospital in Springfield, Ohio. Looking for an explanation, her doctors considered the possibility that Madi had preeclampsia or could be farther along than they originally thought, but Madi was in labor, and they were going to admit her to try and stop it. When stopping it was not working, she was taken into an emergency c-section.

Madi gave birth to her daughter Emily at 25 weeks and 5 days.

“I woke up on the c-section table after she was born, asking ‘where’s my baby? what happened? is she okay?’, but they told me she’s fine, but they said I need to go to another hospital because there’s something wrong–I was sick,” she explained.

Frightened and uncertain about what was next, Madi was only able to spend a few moments with her newborn daughter before being swept away to another local hospital.

From there, she was in and out of the hospital for a month trying to understand what was wrong with her and why she was having these symptoms.

“I couldn’t sleep really—I remember getting up in the middle of the night screaming and having trouble breathing. I thought it was just anxiety, but it was fluid buildup in my body,” she remembered. “They diagnosed me with post-partum cardiomyopathy at first, and we tried all these different medications that did not work.”

It was her cardiologist at a Dayton Hospital who made the call to have Madi, still 17 at the time, transferred to Cincinnati Children’s Hospital with a few days left to live—information that left Madi in shock and her family devastated.

Madi spent a week at Cincinnati Children’s Hospital before she was transferred to UC Medical Center.

Arrival at UC Health: The Region’s Heart Care Program

A week after being told her time was dwindling, Madi was in the capable hands of the expert cardiologists in the UC Health Heart Program at UC Medical Center. As the region’s only adult academic health system, UC Health combines clinical expertise and compassion with research and teaching—a combination that provides specialty and subspecialty cardiovascular care unavailable elsewhere in our community—and has done so for the longest in the region.

“From emergency cardiac care and cardiovascular disease to advanced heart failure and cardiovascular surgery, UC Health’s Heart Care program is nationally known for discoveries and contributions, and for translating insights into real treatments that help patients every day,” Louis B. Louis, MD, Chief of Cardiac Surgery at UC Health said.

UC Health has been improving and delivering heart care for over 200 years in Cincinnati by translating the latest science and research into personalized treatments and caring for the most complex cardiac cases—cases like Madi’s.

“When Madi came to us from Children’s she was 17 years old, extremely sick, scared and on heavy doses of hard medications. She had to grow up really fast”, Vlad Cotarlan, MD, cardiologist at UC Health and associate professor at the University of Cincinnati College of Medicine said.

During Madi’s 91-day stay at UC Medical Center, she had intra-aortic balloon pump (IABP) therapy for about a week, extracorporeal membrane oxygenation (ECMO) for about 2 weeks, had an external right ventricular assist device (RVAD) placed outside her chest for 15 days and a left ventricular assist device (LVAD) implanted. She had even been placed on the transplant list at status 1—the highest priority status—for 2 weeks while on ECMO prior to receiving the RVAD and LVAD.

“She got the LVAD because she was getting sicker and no suitable donor was available,” Dr. Cotarlan explained.

During the RVAD scheduled removal—15 days after it was temporarily placed—a blood clot was discovered in her lungs that had to be aspirated.

“The blood clot traveled from the right side of the heart where the RVAD was to the lungs,” Dr. Cotarlan said, explaining that blood clots are a possible complication for any sort of mechanical support or pump.

Madi had two open heart surgeries in 15 days, almost dying on the operating table.

But her family credits Dr. Louis with saving her life.

“Madi had several people there to support her during her hospital stay, especially her grandparents,” Katherine Hembree, RN, said. “I remember when we brought her grandmother, Denise, back to the unit to see Madi walking around with the ECMO circuit in place, when only several days before that, she had a breathing tube and several other circuits supporting her. It was touching to see her grandmother brought to tears at the sight of her up and walking.”

Denise, or Mimi to Madi, has been a big supporter of Madi through her journey.

“I’m a nurse, and the last 7 years that I worked in hospice,” Denise explained. “So, I know the signs and I saw the signs on more than one occasion. There were times when I went home and wondered if she would still be there when I went back the next day—that’s how close I saw her to death.”

The expert multidisciplinary care team consisted of a number of UC Health subspecialized physicians, nurses, therapists and countless staff members—all of whom played a vital part in Madi’s care.

 “He’s very upfront and he’s very honest,” Denise said of Dr. Louis. “When we were talking about the very first open-heart surgery, he said he might hurt her and she may hate me, but I will save her life.”

“I don’t hate him,” Madi said with a giggle, “and all the doctors are great, but he was upfront and always brought laughter to the room.”

After five different hospital stays and four surgeries—including 91 days at UC Medical Center—Madi and her newborn daughter Emily finally got to go home on June 17, 2022

A few weeks later, Madi returned to UC Medical Center to take her senior photos and thank some of her care team members.

“That experience meant a lot to me because I love my care team—all the doctors and nurses that took care of me are the reason that I am here today. I love them like they are my own family,” Madi said. “I especially love Dr. Louis”.

Madi’s senior pictures were taken with Louis Louis, MD, Saad Ahmad, MD, Vlad Cotarlan, MD, and Katherine Hembree, RN, all of whom were very involved with Madi’s care during her stay.

“It’s just so unfair that anybody had to go through what Madi did, let alone, go through it as young as she did,” Dr. Louis said.  “Yet, I am completely in awe of her strength and perseverance. Seeing her healthy again, doing the normal things she should be doing, like taking senior pictures, was enormously gratifying.”

A New Chapter: Life with a LVAD

Now, at 18 years old, despite her LVAD remaining intact, Madi is ready to start the next chapter in her life—one filled with hope, love, recovery and awareness. She spends her time with her daughter Emily—who is now almost a year old, trying to crawl and stand up on her own—and telling her story in hopes that it can help others like her.

Madi has started to write her own book detailing her experience and is at the point where she wants to begin working with other women LVAD patients or women considering an LVAD as an option to help.

“I like talking to people about what I have been through—it gives me hope and it gives me courage,” she said.

Her health journey did not stop after she was discharged from the hospital—she was still very weak and had to continue with both her physical and mental recovery, all while adjusting to her role as a new mom.

“I love it when people talk to me; that’s kind of my therapy. It makes me happy and it makes me feel whole, but also, I talk to a counselor about what I have been through,” Madi shared.

While she may no longer be fighting for her life in a hospital bed, a new set of struggles come with everyday life. After four surgeries—and the scars to show for it—support from her loved ones and talking to a professional about her feelings has allowed her to reframe her mindset in a healthy way.

“What I’ve learned along the way of recovery is that I am beautiful the way I am and that the scars tell a story—and I’m going to tell it to the world,” Madi shared proudly.