Med Student trains with Doctor who Saved her Mother’s Life 23 years ago
Priyanka Kugamoorthy with her mother, Mangayatgarasi Kugamoorthy, and Dr. Jack Colman
When Dr. Jack Colman first met Mangayatgarasi Kugamoorthy 23 years ago in his cardiology clinic, he had no idea that not only would the course of his career change, but that he would get to help shape what has now become one of the world’s most respected programs dedicated to treating complications of pregnancy. A recent immigrant from Sri Lanka, Mangayatgarasi was 4 months pregnant when her serious congenital heart condition was exacerbated by the pregnancy, putting her life and the life of her unborn baby in jeopardy.
Diagnosed with aortic stenosis, which is narrowing of the heart valve that guards the exit of blood carrying oxygen from the heart to the body, the challenge that Dr. Colman’s patient was facing wasn’t small. “Pregnancy puts extra stress on a mother’s heart, progressively increasing heart work to about 50% above normal by the end of the 6th month of pregnancy. And Mangayatgarasi already had symptoms at the 4 month mark,” explains Dr. Colman.
In the early 90’s the typical course of action would have been to tell the parents that continuing the pregnancy constituted a life-threatening risk to mother and child. But Mangayatgarasi was determined to have her baby, and Dr. Colman decided to recommend a more groundbreaking approach. He arranged for Mangayatgarasi to have an aortic balloon valvuloplasty, a rare and difficult procedure for an adult in those days, especially during pregnancy. The procedure involved inserting and inflating a balloon across the aortic valve, which required stopping the heart briefly several times during the procedure. “I remember, I was very scared,” explains Mangayatgarasi. “Dr. Colman was so kind and was there in the room while the procedure was taking place.” The procedure, one of the first to be performed during pregnancy anywhere, was a success, and Mangayatgarasi gave birth to a healthy baby girl.
“Dr. Colman is big part of who I am and how my family is”
Twenty-three years later, that baby, Priyanka Kugamoorthy, stands beside her mother and her younger brother, beaming as she tells the story about what inspired her to want to become a doctor. Now in her fourth year of medical school, Priyanka recently spent several weeks at Mount Sinai Hospital for an Observership with Dr. Colman and the cardiology team. “I remember as a little girl coming with my mother and father to appointments with Dr. Colman over the course of many years. It was always inspiring to me, and my mother has always encouraged me to specialize in cardiology,” explains Priyanka. “Dr. Colman was incredibly supportive during the Observership, making sure to explain everything that I was seeing, and even bringing me along to the Heart Disease and Pregnancy Clinic where I observed pregnant women being cared for by Obstetrics and Cardiology at the same time, in the same place, some of them with problems similar to the one my mother had. Dr. Colman is a big part of who I am and how my family is. This part of my medical education was so meaningful to me. It’s one of the best experiences I’ve ever had.”
“Well, I have to be honest, it did make me teary when I heard from Priyanka that she not only wanted to be a doctor, but was interested in pursuing her learning here,” says Dr. Colman. “Looking after Priyanka’s mother was one of my early seminal medical experiences, reinforcing my decision to devote a significant portion of my career to pregnancy and heart disease.”
“We are the go-to centre for international Fellows who want to further their learning and bring back our expertise to their own countries”
It was around the same time that Dr. Colman was looking after Mangayatgarasi through her first pregnancy, that the Medical Complications in Pregnancy program was being shaped by Dr. Mathew Sermer, first at Toronto General Hospital, and then, a few years later, moving to Mount Sinai. Dr. Sermer, who is now Chief of Obstetrics and Gyneacology, was building a program that is now considered a world leader. “I am incredibly proud of what this program has become. Patients from across Canada who face the most serious medical issues, from congenital heart disease, the largest of our areas of expertise, to other areas including infectious disease and other complications, are referred here to Mount Sinai because of our reputation. Two-thirds of the births here at Sinai are considered high risk. And we are the go-to centre for international Fellows who want to further their learning and bring back our expertise to their own countries”.
“The timing of Mangayatgarasi’s arrival to my clinic was important,” continues Dr. Colman. “We were only then beginning to see women who were not only surviving congenital heart disease, but reaching adulthood in larger numbers and wanting to go on to have healthy pregnancies and babies. Prior to the early nineties most people thought that was impossible. Mangayatgarasi was a pioneer in our program.” With Dr. Colman’s assistance, Mangayatgarasi went on to have a second healthy pregnancy, giving birth to her son Brenaven in 1997. She continues to see Dr. Colman regularly for cardiac care.
“One of the things that makes our program unique is that the cardiologists are part of the obstetrics program.”
A great deal has changed since Dr. Colman joined Dr. Sermer in the new program over 20 years ago. Today, it is the largest such program in the world, and both Drs. Colman and Sermer, along with the program’s Director, Dr. Candice Silversides, and 3 other cardiologists- Dr. Rachel Wald, Dr. Danna Spears, and Dr. Jay Udell, continue to care for pregnant women with heart disease, with approximately 130 deliveries a year. One of the things that has changed since the early days of the program is that they begin the patient’s care before pregnancy. “I recently met with one of Dr. Colman’s patients, a heart transplant recipient, who wants to begin planning for a pregnancy in a few years… I feel confident that we can help this woman when she is ready,” says Dr. Sermer. “One of the things that makes our program unique is that the cardiologists are part of the obstetrics program. Every aspect of patient care - the cardiology appointments, obstetrics appointments, the work we do with anaesthesiologists to accommodate the heart issues, the modified labour plan, is coordinated in a way that puts the patient at the centre of care. And we are seeing great outcomes,” continues Dr. Colman.
“I am so grateful for the privilege of having looked after Mangayatgarasi. Patients often think about what they need from their doctors, but I suspect few think about what they give to their doctors. Mangayatgarasi and her daughter Priyanka were as much a part of our journey here at Mount Sinai as our clinical team has been, in building one of the finest programs in the world,” says Dr. Colman. “And I hope that Priyanka’s medical career will be as fulfilling as mine continues to be here at Sinai.”
(Dr. Colman was recognized this past year at the International Symposium on Cardiac Problems in Pregnancy in Venice, Italy, with the Distinguished Contribution Award for the international impact that he has made in his field. Dr. Colman was the second Mount Sinai cardiologist to win the award. Dr. Samuel Siu was the inaugural awardee in 2010.)
