Boston doctors successfully perform novel fetal surgery

The baby responded well and is now thriving.
Loukia Papadopoulos
Illustration of a fetus in womb
Illustration of a fetus in womb

ninjaMonkeyStudio/ iStock 

Doctors in Boston successfully undertook a novel fetal surgery to treat a rare brain condition known as vein of Galen malformation, according to a report by CNN published on Wednesday.

The ultrasound-guided procedure was among the first for this condition that develops when the blood vessel that carries blood from the brain to the heart, known as the vein of Galen, doesn’t develop properly. This results in a significant amount of blood stressing the vein and heart and can lead to a variety of health problems.

“Tremendous brain injuries and immediate heart failure after birth are the two big challenges,” Dr. Darren Orbach, a radiologist at Boston Children’s Hospital and expert in treating the condition, told CNN.

In the majority of cases, children are treated after they’re born but this is often too late leading to the death of the infant.

Orbach said that “50 to 60 percent of all babies with this condition will get very sick immediately. And for those, it looks like there’s about a 40 percent mortality.”

Furthermore, approximately half of infants that survive experience severe neurological and cognitive issues.

The right position

In order to proceed with the surgery, doctors had to make sure the fetus was facing the right position. To achieve this, Orbach partnered with Dr. Louise Wilkins-Haug, division director of Maternal Fetal Medicine and Reproductive Genetics at Brigham and Women’s Hospital.

Wilkins-Haug told CNN the doctors used a technique borrowed from previous in utero cardiac surgeries giving the baby in utero “a small injection of medication so that it’s not moving and it is also getting a small injection of medication for pain relief.”

Once that was done, the doctors used a needle inserted through the abdominal wall to slow the blood flow and reduce the pressure.

The baby improved almost immediately.

“It was exhilarating at the moment that we had technical success at doing the embolization,” said Orbach.

The procedure took place in March and its results were published in the journal Stroke on Thursday.

Study abstract:

Despite decades of technique refinement of trans-arterial embolization and the establishment of specialty referral centers, fetuses diagnosed with vein of Galen malformation continue to have high mortality, with survivors facing high rates of severe neurological and cognitive morbidity.1 Low resistance in the vein of Galen malformation arteriovenous shunt induces high-flow physiology that compromises cerebral perfusion and induces cardiopulmonary stress. In utero, the pla-cental circulation is also low resistance, providing com-pensation and fetal protection. Thus, most infants suffer compensation postnatally rather than in fetal life, with exacerbation upon ductus arteriosus closure. Moreover, neonatal embolization itself carries significant risk of iatrogenic cerebral injury, even at the hands of the most experienced practitioners.

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