When Malea Potter decided she wanted kids, she knew her congenital heart condition would complicate her journey. Born with a bicuspid aortic valve, Potter consulted with a cardiologist who ran some tests.
The cardiologist chalked up one number that was out of the ordinary as an error, and cleared her to start a family. But when Potter was referred to University Health cardiologist Dr. Ildiko Agoston as an extra precaution, Agoston didn’t like the numbers she was seeing.
“At the time, I was annoyed with how thorough she was,” Potter said. “We were like, ‘This cardiologist already said that we can have children. So stop doing all these tests and just tell us what we want to hear.’”
Agoston’s wariness, though, might have been life-saving. Through further testing, it became clear that Potter needed a valve replacement, and that getting pregnant without that surgery would have been risky, possibly life-threatening.
“She wouldn’t just let good enough be, and we’re grateful for that, because it likely saved my life as well as any child that was that could have come,” Potter said.
Potter, now 33, gave birth to a boy in 2018 and a girl in 2020 without any complications during her pregnancies.
And Agoston, who had been interested in women’s heart health since she was a medical student, now runs the public hospital’s Women’s Heart Center, which opened in May.
The center has two locations: one focused on pregnant women’s heart health at University Hospital in the South Texas Medical Center at 4502 Medical Drive, and another at 14615 San Pedro, providing cardiovascular care for women 18 and older.
Agoston, a 20-year veteran, was going through medical school in the early 2000s, a time when the medical community’s understanding of how heart problems manifested differently in women was lagging.
“When I was younger in my career, we did not have that part of cardiology,” she said. “I was among the first cardiologists who attended the first women in cardiology section meeting for the [American College of Cardiology].”
Women with heart conditions might present with shortness of breath, indigestion, chest pressure instead of pain, among other atypical symptoms compared to men, Agoston explained.
These nuances were even more complex when it came to dealing with pregnant women with heart problems.
“Quite honestly, nobody wanted to take care of them,” Agoston said, reflecting on her career path. “It’s a highly [litigious] specialty. You are taking care of two patients at the same time, the mom and the baby. It is a highly challenging but also rewarding specialty.”
In the U.S., from 2018-2022, cardiovascular disease was the leading cause of pregnancy-related deaths, according to a paper published in the Journal of the American Medical Association. The U.S. maternal death rate is particularly high compared to nations with other developed nations.
Texas has an above average maternal death rate, with 38 deaths per 100,000 pregnancies, but not as high as some other Southern states, according to a report by The Commonwealth Fund released in July.
There’s limited county-level data, but Agoston said that the higher rates of diabetes, hypertension and poor access to health care in South Texas contributes to maternal deaths and complications locally.
Agoston said she sees women like Potter who knew of their condition before getting pregnant, as well as women who discover underlying heart problems for the first time while pregnant.
There’s also a subset of patients who develop hypertension during pregnancy, gestational hypertension, which can lead to a “dreaded complication” known as preeclampsia, which can cause maternal and fetal complications, including premature births, Agoston said.
The Women’s Heart Center is equipped with a multidisciplinary team of fetal medicine specialists, anesthesiologists, pulmonologists and surgeons coordinating care for patients.
Agoston and other cardiologists in her clinic meet monthly with the specialists to discuss their pregnant patients’ cases and make delivery care plans.
“When the time comes that they deliver, everybody’s ready and has a very good plan of what to do with these patients,” Agoston said. “So both the mom and the baby have a great outcome.”
