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Milestones |
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- November 2005 - First placement of a cardiac devise in utero
In a first-of-its kind procedure on November 7, 2005, cardiologists from Children's Hospital Boston and high-risk obstetrical specialists from Brigham and Women's Hospital placed a tiny stent in the heart of a 30-week fetus with a major congenital heart defect. The fine mesh tube, approximately 9 mm by 2.5 mm, was used to prop open a hole in the atrial septum (the wall between the heart's upper chambers) in an attempt to prevent permanent damage to the fetus's fragile lungs and pulmonary vessels in the final weeks of gestation.
- December 2001 - EXIT to ECMO for Congenital Cystic Adenomatoid Malformation (CCAM)
When diagnostic tests on a fetus revealed a large mass of abnormal lung tissue called a congenital cystic adenomatoid malformation (CCAM), the Advanced Fetal Care Center team prepared to use a combination of procedures called EXIT to ECMO for the first time on this type of growth. Although the growth was benign (non-cancerous), it was so massive that the heart was pushed to one side and blood vessels were compressed, making the lungs, heart and vessels work increasingly harder to circulate blood. Fortunately, the heart was able to sustain the fetus until 36 weeks. Upon delivery, physicians used the EXIT (ex utero intrapartum treatment) procedure to partially deliver the fetus through Cesarean section. Physicians immediately placed the infant on ECMO (extra corporeal membranous oxygenation), a heart and lung bypass system that circulates oxygenated blood throughout the body. Once ECMO was functioning, the umbilical cord was cut, the mother's Cesarean section was completed and she moved into recovery. With ECMO, team members were then able to remove the growth and give the infant's heart, vessels and lungs time to develop and heal.
- September 2001 - Heart Defect Repair for Unborn Child
Children's physicians repaired a critical heart valve defect in a fetus - the first time this type of surgery was performed successfully in the United States. The aortic valve, which regulates the flow of oxygen-rich blood from the heart to the rest of the body, was unusually narrow and was expected to lead to a critical condition called hypoplastic left heart syndrome (HLHS), in which most of the structures on the left side of the heart are small and underdeveloped. Advanced Fetal Care Center physicians repaired the narrowed valve through a needle inserted into the mother's abdomen during the 23rd week of fetal development. Using ultrasound technology to guide them, the team placed a small balloon through the needle and inflated it to widen the valve opening. The infant was born in November 2001, six weeks early, but with a healthy, functioning heart.
- November 2000 - EXIT to ECMO for a Congenital Diaphragmatic Hernia
The Advanced Fetal Care Center team has extensive experience treating congenital diaphragmatic hernias (CDH), and the team is the first to use a combination of procedures called EXIT to ECMO to treat this condition. A hole in the diaphragm allowed the contents of the abdomen, including the stomach, intestines, liver and spleen to protrude into the chest. This prevented normal lung development, and physicians determined that the infant would be unable to breathe effectively at birth. During the EXIT (ex utero intrapartum treatment) procedure, the fetus was partially delivered through Cesarean section. AFCC physicians placed the infant on ECMO (extra corporeal membranous oxygenation), a heart and lung bypass system that circulates oxygenated blood throughout the body. Once ECMO was functioning, the umbilical cord was cut, the mother's Cesarean section was completed and she moved into recovery. With ECMO, team members were able to repair the CDH and give the infant's lungs time to develop.
- March 2000 - EXIT to ECMO for a Bronchogenic Cyst
The Advanced Fetal Care Center team at Children's Hospital Boston was the first to use a combination of procedures called EXIT to ECMO to treat a bronchogenic cyst, a growth that invaded the fetal trachea, causing complete airway obstruction. During the EXIT (ex utero intrapartum treatment) procedure, the fetus was partially delivered through Cesarean section. The fetus continued to survive on placental circulation until the airway was examined. Because the newborn's airway was found to be completely obstructed, physicians immediately placed the infant on ECMO (extra corporeal membranous oxygenation), a heart and lung bypass system that circulates oxygenated blood throughout the body. Once ECMO was functioning, the umbilical cord was cut, the mother's Cesarean section was completed and the mother was moved into recovery. When the infant's condition stabilized on ECMO, members of the AFCC surgical team removed the growth, allowing a normal airway to develop.
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