Mika Hartman was 42 years old and a little late. She knew what being a little late can mean: she had brought son Hayden to the world half her life ago; daughter Henley had come a decade after that. But it had been so long. Maybe it was menopause.
She and husband C.J., an Air Force officer and nurse anesthetist, had recently bought what they called their “forever home” in Colorado Springs’ Flying Horse Community. With Hayden out of the house and Henley moving her way through school, they had downsized a bit and looked forward to years of spending time at the edge of the mountains.
Then came an Air Force Academy football game in 2017, a favorite autumn pastime. C.J. handed Mika a beer; Mika surprised herself with second thoughts about drinking it. What if? On the way home, they stopped at Walgreens for a pregnancy testing kit. You never know, right?
The verdict arrived in the form of a bright pink line: positive. The family’s reaction was equally positive. The Hartmans would become a family of five, each child with his or her own personal decade of birth. But they were embarking on a course harder than any of them might imagine, one complicated by a pregnancy that earned its high-risk distinction and a baby with serious health problems from day one. Thankfully, that baby’s arrival had two big things going for him: great parents and the collaborations of a diverse team of experts across the UCHealth and Children’s Hospital Colorado systems.
Trisomy 21
Twelve weeks and five days into Mika’s pregnancy, Dr. Laura Klein, medical director of Maternal-Fetal Medicine at UCHealth Memorial Hospital, considered the first-trimester ultrasound. A combination of visual cues and a separate chromosome screening confirmed that the person one day to be named Hudson would have Down syndrome. Hudson’s heart – tiny, as the fetus was all of 3 inches long – showed signs of having an atrioventricular septal defect, common in babies with Down syndrome. Such a heart develops without the usual four chambers fully intact, causing a mixing of oxygenated and oxygen-depleted blood that usually flows in its own spaces. The Hartmans’ only question was how to best bring Hudson into the world with a heart defect. Another heart – Mika’s – would complicate the matter.
Mika’s heart had for years had an electrical issue called a left bundle branch block. It can cause the left ventricle to contract out of sync with the right ventricle, potentially compromising blood flow. Often that doesn’t happen, and you live a completely normal, healthy life. So it had been for Mika.
But as her pregnancy continued, Mika felt worse than she remembered in pregnancies one and two. Just shy of 30 weeks, she was throwing up, she was uncomfortable, she was having a hard time sleeping, and she was short of breath. Klein recognized these as common prenatal pitfalls. Mika’s reports of occasional chest pain and periodic rapid heartbeat were not. Nor was gasping for breath, which Mika was clearly having to do.
Klein ordered an echocardiogram. UCHealth Memorial Hospital cardiologist Dr. Janice Huang recognized a weakening heart, possibly from cardiomyopathy – a serious concern with potentially long-term and even fatal consequences. Layer these findings atop a high-risk pregnancy involving a prenatal heart defect and Huang and Klein quickly admitted Mika to Memorial Hospital.
Call in the cavalry
Huang then contacted Dr. Joseph Kay, the University of Colorado School of Medicine cardiologist who had mentored her during her cardiology fellowship. They are colleagues now, separated by a stretch of Interstate 25. Kay leads Colorado’s Adult and Teen Congenital Heart (CATCH) program, a collaboration between the Adult Congenital Heart Disease Clinic at UCHealth University of Colorado Hospital at the Anschutz Medical Campus (UCH) and the congenital heart disease program at Children’s Hospital Colorado.
Cases as complex as Mika’s are rare: Klein says she has seen perhaps 10 of them in the past 15 years. The CATCH program, which gets referrals from across the region, has seen many more. That sort of experience – plus routine collaboration with the joint UCHealth-Children’s Maternal Fetal Medicine Program at Anschutz – can improve the chances of a patient such as Mika and the baby she carried.
First came the question of whether to induce labor and deliver Hudson early. Doing that would be much safer for Mika, but given Hudson’s heart defect, being delivered 10 weeks preterm would be hard for him to overcome. Waiting would be better for him; waiting could put Mika’s life at risk. The UCHealth medical team was divided on which course to take. Mika and C.J. wanted to extend her pregnancy to boost Hudson’s chances. Their call proved decisive. Mika was whisked north to UCH by ambulance.
The next day, Kay performed a heart catheterization to understand the nature of Mika’s problem. Was it pericardial cardiomyopathy? Was it pulmonary hypertension? A high-risk obstetrician monitored the baby all the while. During the procedure, Mika’s heart rhythm was further disrupted, slowing her heart to about 30 beats per minute. Kay’s team tried to speed it back up with medicine. That didn’t work. The baby started showing signs of stress. A colleague of Kay’s used the catheter tube to insert a temporary pacemaker – an emergency measure. That worked.
Mika woke up in the intensive care unit amid a forest of tubes and monitors. The skin of her chest was tender from multiple defibrillations. Her throat hurt and she couldn’t tell if she was pregnant anymore. She burst into tears.
“I’m so sorry,” she told a nurse. “I didn’t want to give birth this early.”
“What are you talking about?” the nurse said. “You’re still pregnant.”
Walking the halls
Mika stayed at UCH until the 33-week mark, at which point her pericardial myopathy was under control enough that she could go home to Colorado Springs. At week 37, she was back in Aurora to deliver her third child.
“We got the nurses donuts and had a baby,” Mika said. “After all we went through, it was about the most normal thing we could do.”
Since week 30, Hudson had grown from the 32nd percentile in weight to the 67th percentile. Born on April 12, 2018, he was jaundiced, his lungs weren’t working right, he had a feeding tube, and his heart’s chambers lacked closure. Adding to Hudson’s challenges was transient leukemia, another Down syndrome complication. Fortunately, that form of leukemia disappears on its own in 80 percent of cases, which it did for Hudson. He spent four weeks at Children’s Hospital Colorado before finally going home. At three-and-a-half months of age, CU School of Medicine and UCHealth cardiac surgeon Dr. James Jaggers performed surgery to close Hudson’s heart’s chambers. A future surgery will add a missing heart valve.
Mika’s heart problems seem to have cleared up with Hudson’s arrival. Her bundle branch block remains, and she’ll need long-term monitoring of her heart to make sure it stays healthy.
Sixteen months old on Aug. 12, Hudson was walking the hallways at home with help from a gait trainer, and he could crawl up exactly three stairs. His wispy blonde hair capped a ridiculously cute face whose smile stopped people in their tracks and sparked conversations with his mom or dad or both, Mika says. A mobile-phone photo of the boy that Mika posted on her Facebook page led to Hudson’s selection as a National Down Syndrome Society poster child: Hudson will be one of two grand marshals at the annual NDSS Buddy Walk in New York City on Sept. 14.
The house through which Hudson walks is now more than a thousand miles from the Hartmans’ “forever home.” More importantly, it’s about a mile lower.
When it became clear that Front Range altitude was making life harder for Hudson, C.J. requested a transfer to sea level. In June 2019, the Hartmans moved to Ocean Springs, Miss. C.J. oversees surgeries at the Keesler Air Force Base hospital in neighboring Biloxi. They miss Colorado and the UCHealth team – though being Facebook friends with several of her nurses helps, Mika says.
“I’m just blessed to have so much love and support and a team that really encouraged me and made it all possible,” Mika said. “Dr. Kay and the whole UCHealth team made amazing decisions and were able to save us both and give Hudson the chance I was asking for.”