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The High Tech Heart: Fetal Heart Surgery

separator When you think of heart surgery, you probably assume we’re talking about an operation on a person who’s not in the womb. But today, cardiac surgeons are operating on babies who have not yet been born. This type of surgery is still rare and extremely risky, and is generally recommended only for babies whose conditions are considered to be fatal or extremely debilitating.

Consider the story of a couple in Boston. During an ultrasound when the woman was 20 weeks pregnant, they learned that their baby had a condition called hypoplastic left heart syndrome. The scan showed that the baby’s aortic valve was severely narrowed, and that his left ventricle was hardly working at all.

There weren’t a lot of good options for them. Doctors told them they could end the pregnancy, have the baby and let him die or put him through three heart surgeries. The fourth option was radical: open the heart valve now, so that the ventricle would have a chance to grow and function normally.

A heart the size of a grape.
Last September, when the fetus was 23 weeks old, both mother and baby received general anesthesia and the operation began. An obstetrician, guided by ultrasound, kneaded the mother’s abdomen to get the baby in position, and then a fetal surgeon held him in place. This step took several hours. The heart was the size of a grape, and don’t forget—it was constantly moving. Next, the obstetrician had to insert the needle into the abdomen at just the right angle. Improper placement of the needle could pierce the coronary arteries or cause disruptions in the heart rhythm. Her first attempt was a little off, so she tried once more. This time, the angle was correct. She pushed the needle into the ventricle and held it in place.

Then, watching a monitor, cardiac surgeons passed a wire as thin as a thread through the center of the needle, into the ventricle and through the small opening of the aortic valve. They slid a catheter over the wire, carrying the type of balloon that’s used to open blocked arteries in adult heart procedures. They inflated the balloon to about an eighth of an inch, passed it back and forth several times and then removed it. That part of the procedure took 20 minutes. Blood flow through the valve improved immediately. Doctors induced labor 11 weeks later, and the baby boy was born healthy and breathing on his own. They had thought it might be necessary to open the valve again, but the valve was actually wide enough. In the future, the boy may need surgery to widen the valve, but more importantly, the affected ventricle is healthy. 

Not a good option for everyone.
According to a study in the American Journal of Cardiology, this fetal heart surgery had been performed 12 times form 1989 to 1997. Only 2 babies survived it. For one of the survivors, the surgery itself was a failure, and the baby had surgery after birth. For the second baby, the valve closed completely after the operation, and the child had to have surgery several times after birth.

The team that operated on the “G’s” baby had tried the surgery once before, but they weren’t able to get the needle into the baby’s heart. Doctors are cautious about the surgery, and warn that one successful case is just that—one case only. But their caution is tinged with optimism.

Source:
The American Journal of Cardiology, May 2000; The New York Times, 25 February 2002



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