January 30, 2006

Baby who had heart surgery in womb goes home

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - An infant, named Grace, who
underwent the world's first heart "stent" procedure in the womb
was discharged to go home on Friday, according to a press
release from Children's Hospital Boston, the center where the
landmark operation took place.

The stent was placed in the developing fetus at 30 weeks of
pregnancy on November 7, 2005 to treat a heart defect called
hypoplastic left heart syndrome (HLHS). She was born January 10
and underwent the first part of a definitive three-stage
corrective operation on January 13. The physicians credit the
earlier stent placement with protecting her lungs and making
her recent operation run more smoothly than usual for these
types of cases.

With HLHS, the most common heart disease-related cause of
death during the first week of life, the left side of the heart
is underdeveloped and can accept very little blood. Frequently,
there is a hole that lets blood from the left side flow to the
right before leaving the heart. In Grace's case, however, there
wasn't a hole, so blood accumulated on the left side and backed
up into her lungs, which over time can cause serious damage.

To prevent the lung damage that would occur as the
pregnancy went on, Dr. James Lock, from Children's Hospital
Boston, and colleagues decided to create a connection between
the left and right sides of Grace's heart using a stent, which
acted like a tiny channel for the blood.

Under ultrasound guidance, the doctors inserted a small
catheter into the mother's abdomen and uterus and then into the
fetal heart. After two holes were created in the wall between
the left and right sides of the heart, the stent was placed.

After several uneventful weeks, the mother returned to the
hospital in January for delivery. An ultrasound performed just
before birth suggested that the stent procedure had worked:
Grace looked like a typical HLHS baby, instead of one in the
highest risk category as would have been expected without
treatment. At birth, Grace was breathing without major
difficulty and did not need to be put on a mechanical

When the first stage of the definitive corrective procedure
was performed a few days later, Grace's recovery was described
as "extraordinarily smooth -- a course unlike any other baby
with HLHS and an intact" wall between the left and right sides
of the heart.

The second stage of the operation will take place at 4 to 6
months of age and the third and final stage is usually
performed between 1 and 3 years of age.