Children’s, BWH doctors
perform a fetal first

Children’s made the front page of The New York Times this month when it announced that its doctors, working in collaboration with Brigham and Women’s Hospital (BWH), had performed the first successful fetal cardiac catheterization procedure in the country. The success was also covered on television news both locally and nationally.

The child, whose name is Jack, was born healthy on Nov. 21. But early in his mother’s pregnancy, Jack was diagnosed with severe narrowing of the aortic valve and a poorly functioning left ventricle. Cardiologists at Children’s predicted the unborn child would develop hypoplastic left heart syndrome (HLHS), and would not survive without open heart surgery within days of his birth.

HLHS is a lethal, congenital heart defect in which the left ventricle (the main pumping chamber responsible for sending blood through the aorta to the brain and body) fails to develop. State-of-the-art treatment for HLHS involves a minimum of three open-heart surgeries in a child’s first three or four years, and some of these children will then require heart transplants. The condition carries about a 40 percent mortality rate, and even when successful, the child is left with a single pumping chamber in the heart, rather than the normal two.

As an alternative to this three-surgery treatment, Wayne Tworetzky, MD, assistant in Cardiology, proposed the experimental catheterization procedure to open Jack’s aortic valve with a balloon catheter, which he hoped would allow the ventricle to develop normally. The procedure would carry about the same risk as the three-surgery treatment.

While still in the womb, Jack was scheduled for the catheterization at BWH. Louise Wilkins-Haug, MD, PhD, medical director of the Antenatal Diagnostic Center, Carol Benson, MD, co-director of Maternal/Fetal Ultrasound, and Brigham anesthesiologists managed care for Jack’s mother.

Interventional cardiologists Stanton Perry, MD, and Audrey Marshall, MD, performed the catheterization under the guidance of Rusty Jennings, MD, director of Children’s Advanced Fetal Care Center. Pediatric echocardiographers Mary Vandervelde, MD, associate in Cardiology, and Tworetzky guided the team on the path to Jack’s heart.

On Sept. 13, the team successfully widened Jack’s left ventricle with a balloon catheter. Jack was closely monitored over the next 10 weeks and delivered by Cesarean section at BWH the night before Thanksgiving. He was transferred to Children’s Cardiac Intensive Care Unit, but his heart function and oxygen levels were good.

Jack was discharged from Children’s at 13 days old. He shows no signs of heart failure and is not requiring any special care at home. He has two well-functioning pumping chambers instead of the one he would have been born with. So far, he is a healthy, normal newborn.

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