Straight to the heart
Children's performs fetal first
Children's made the front page of The New York Times in March when the hospital announced that its doctors, working in collaboration with Brigham and Women's Hospital (BWH), had performed the world's first successful fetal cardiac catheterization repair of a congenital heart defect. 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 three open-heart surgeries in a child's first three or four years, and some of these children will still require heart transplants. The condition carries about a 30 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 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. Brigham physicians managed care for Jack's mother, while Children's interventional cardiologists Stanton Perry, MD, associate in Cardiology, and Audrey Marshall, MD, assistant in Cardiology, performed the catheterization. They worked under the guidance of Rusty Jennings, MD, director of Children's Advanced Fetal Care Center, while 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 aortic valve with a balloon catheter. He 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 Cardiovascular Intensive Care Unit, with good heart function and oxygen levels.
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.