Adult Congenital Heart Surgery Team Saves a Life, Sparks an Idea

Newswise — LOS ANGELES (Oct. 26, 2023) -- She was five days postpartum. Her first child was a perfect baby girl. What was supposed to be among the happiest times in Marisa Dominguez’s life was, instead, the scariest.

Dizzy, lightheaded and having trouble breathing, Dominguez rushed to her neighborhood hospital. There she was given a diuretic for fluid retention and sent home—a pattern that continued for five months as Dominguez grew increasingly worried and frustrated. On her fourth visit, an echocardiogram revealed that she needed heart valve replacement—which meant open-heart surgery.

“Immediately, I knew I needed the very best heart hospital,” Dominguez said. “And that was Cedars-Sinai.”

Cedars-Sinai is ranked #1 in California for Cardiology, Heart & Vascular Surgery by U.S. News and World Report’s “Best Hospitals 2023-2024.”

Dominguez, 40, had two open-heart surgeries as a child. She was born with transposition of the great arteries, which means the heart’s ventricles—and their functions—are reversed. The weaker right ventricle must pump blood to the entire body, while the stronger left ventricle is charged only with pumping blood to the lungs. This rare condition affects less than 1% of congenital heart patients, according to the National Institutes of Health.

Growing up, Dominguez’s heart condition hadn’t interfered in her very active lifestyle—she was a runner, enjoyed weightlifting and boxing, and prioritized daily workouts. She was closely monitored by a cardiologist and passed every stress test. One day she might need an intervention, they’d say, but not yet. 

Even her pregnancy, though it was deemed high-risk, seemed to go smoothly.

That all changed after childbirth.

Once Dominguez transferred to Cedars-Sinai for her heart care, she began seeing Rose Tompkins, MD, director of the Adult Congenital Heart Program in the Department of Cardiology in the Smidt Heart Institute. Tompkins diagnosed Dominguez with decompensated heart failure—a serious condition that meant she needed urgent, high-risk surgery to save her life.

“Pregnancy is the No. 1 stressor on the heart,” Tompkins said. “While Marisa got through pregnancy relatively unscathed, after delivery she went into heart failure. In addition to the heart muscle being weak, her valves weren’t working well and her pump could no longer keep up with her body’s needs.”

Tompkins turned to her Smidt Heart Institute colleagues, including cardiothoracic surgeons Richard Kim, MD, and Dominic Emerson, MD, to discuss the best treatment options for Dominguez. The multidisciplinary team, including adult congenital heart cardiologist Prashanth Venkatesh, MD, recommended a complex open-heart surgery to replace the valves and improve her heart’s efficiency. If it failed to work, a heart transplant would be next.

“Despite my fears of having a complex surgery, when Dr. Tompkins entered my room, it was like a light had walked through the door,” Dominguez said. “She was knowledgeable and caring and talked to my husband and me like friends. She answered every question—none too small—and took time to introduce me to every physician on my care team. I knew that she would advocate for me. I knew I was not going to die.”

An Accredited Congenital Heart Program

According to the Adult Congenital Heart Association, nearly 2 million adults in the U.S. have congenital heart disease—making it the most common birth defect. 

The accredited Guerin Family Congenital Heart Program treats patients from before birth to older adulthood; research shows that patients have better outcomes when they are treated at an accredited center by physicians specialized in the disease. The Smidt Heart Institute takes it one step further, pioneering a unified cardiac team concept that does not require awkward handoffs in care as children become adults. Cedars-Sinai’s adult congenital heart experts are embedded within a larger comprehensive program.

“Adult congenital heart is a relatively new, and growing, specialty,” said Christine Albert, MD, MPH, professor, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology. “People with congenital heart disease may not have been evaluated by a congenital heart specialist as adults. This can present challenges, especially for women considering pregnancy.”

Dominguez felt great. She exercised every day. She thought there was little reason for concern. But pregnancy was the tipping point.

A Special Doctor Inspires

Dominguez was at Cedars-Sinai for nearly a month post-surgery, as she recovered, rehabilitated and regained strength.

She left the hospital on Oct. 31, 2022—Halloween—eager to get home to her baby and to catch up on the milestones she had missed.  

“Dr. Tompkins and the entire team that cared for me came into my room, and I told them that they were the reason I was able to go home and raise my daughter,” Dominguez said. “We were all crying. I couldn’t thank them enough.”

Pastel Dominguez dressed as Rose Tompkins, MD, for Halloween. Photo courtesy of Marisa Dominguez.

Dominguez’s husband added that he hoped their daughter, Pastel, would grow up to be just like Tompkins.

As it turns out, the timing of her release from the hospital sparked an idea. Halloween offered the perfect opportunity to honor and thank Dominguez’s knowledgeable, caring, “light” of a doctor.

The couple dressed up little Pastel for her first Halloween as Tompkins—complete with long dark hair, a Cedars-Sinai hospital badge and clear-rimmed glasses like Tompkins wears.

“It was the biggest compliment I’ve ever received,” Tompkins said. “Marisa said she worked very hard to find the glasses and get the right look, and it was amazing. I was so touched.”

Tompkins keeps a Halloween photo of her “mini-me” in her office as a reminder of her purpose.

“Marisa represents why we go into this field,” Tompkins said. “She has been so positive and vibrant through an incredibly difficult time, and she is not squandering the opportunity to live life and be the best mom and wife she can be. Patients like Marisa fulfill us, making what we do 100% worth it.”

Read more on the Cedars-Sinai Blog: How Congenital Heart Patients Can Move from Pediatric to Adult Care