Dr. Lattouf Helms Precarious Procedure: One Blood Clot, One Mother, and Twins

February 2012

When Emory cardiothoracic surgeon Dr. Omar Lattouf looked at Ashley Patton's echocardiogram for the first time, his own heart rate quickened as he saw the sheer size of the blood clot and where it was positioned.

"It was about three inches long, half of it on the right side, half on the left side, and it was wiggling back and forth with every heart beat," he says.

Dr. Lattouf knew that if the clot broke free and shot into Ashley's lungs, the young mother and her unborn twins would be lost, a fact that was clear to all of the seasoned Emory physicians gathered around Ashley at Emory University Hospital Midtown (EUHM), a group that included pulmonologist and venous thromboembolism authority Dr. Kenneth Leeper, cardiologist and heart failure specialist Dr. Dan Sorescu, and Dr. Joel Zivot, medical director of the cardiothoracic ICU at EUHM.

"We all agreed that time was not on our side and that the risks of the clot breaking away or the babies being damaged were too high to attempt medical therapy or thrombolytic therapy," says Dr. Lattouf. "Immediate surgery was the only option."

The road to that point had already been rough for 21-year-old Ashley, who uses a wheelchair after being paralyzed from the waist down in a car accident at 14. Six months after she and her husband Alex learned that she was pregnant with twins, she started having chest pain and difficulty breathing. After receiving an emergency referral to EUHM, it was discovered that a large blood clot had broken away from her legs and lodged itself through the middle of her heart.

As the clock ticked, the staff at EUH Midtown rushed to clear two operating rooms and gathered together three surgical teams and two teams of adult and neonatal intensivists.

"We had one mom, three lives, three operations," says Dr. Lattouf.

In the first OR, Ashley underwent a caesarean section to deliver the twins. The delivery team worked quickly, being very aware that the general anesthesia going to Ashley was also going to the babies.

"They moved with the speed of light. They were in and out in probably less than 15 minutes," says Dr. Lattouf.

Avery and Brantley Patton, small, sedated, but stable, were born at one-pound-12-ounces and two-pounds-three-ounces.

Ashley was moved to the second OR and placed on a heart-lung machine. Dr. Lattouf and his team opened her chest and found one end of the clot dangling in her right atrium and the other in the left. Dr. Lattouf says he hadn't performed as complicated a surgery in almost 25 years, commenting that "it was like someone shoots a bullet and you have to go in and grab that bullet before it hits the target." He and his team were successful in removing the clot, after which Ashley underwent a third surgery to place a stent.

The twins spent several months in the special care neonatal and perinatal unit at EUHM and are now at home with Alex and Ashley. All are doing well.

"Everyone did an amazing job," says Dr. Lattouf. "It was as if it had been rehearsed a dozen times before!"