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In This Issue:
Baby Jack, one of thousands of babies born at BWH in 2001, is a healthy and happy four-month-old thanks to a historic procedure performed in an obstetrical operating room at BWH while he was still in utero.
When Baby Jack was born in November, he did not need a risky newborn surgery to treat his heart condition, thanks to an in utero aortic valve dilation performed by the BWH fetal therapy team in collaboration with specialists from neighboring Children’s Hospital.
At 20 weeks gestation, ultrasound images revealed that Baby Jack’s aortic valve was severely narrowed and his left ventricle was barely working—signs that Baby Jack would have hypoplastic left heart syndrome. This condition cripples the left ventricle—the heart’s main pumping chamber—and if left untreated, is fatal soon after birth. Standard treatment includes either three risky heart surgeries after the child is born or possibly a heart transplant.
Baby Jack’s parents sought the expertise of both the BWH Fetal Therapy Program and the Children’s Advanced Fetal Care Center —two teams of medical professionals who are collaboratively approaching a number of fetal therapies. His parents decided to move forward with a proposed fetal surgery that could possibly prevent hypoplastic left heart syndrome, and knew that if the fetal surgery failed, they would accept the three operations after birth.
The novel fetal surgical procedure performed on Baby Jack’s tiny heart was recently highlighted in The New York Times, Time Magazine, CBS News, Channel 4 (WBZ-TV) and Channel 5 (WCVB-TV). The articles showcased the stellar team effort exhibited by specialists from BWH and Children’s Hospital that went into repairing the valve in Jack’s grape-sized heart, while being certain not to harm the fetus or the mother.
Opening the heart valve one-eighth of an inch was all that was required, but it was the process that led to this that was so outstanding. BWH high risk obstetrician and director of the Fetal Therapy Program Louise Wilkins-Haug, MD, PhD, had only one shot at inserting a long hollow needle at precisely the right angle, through the mother’s abdomen, past the uterine wall, and into the baby’s heart. Guided by BWH radiologist Carol Benson, MD and ultrasound imaging, Wilkins-Haug found the fetus’ left ventricle with the needle. Children’s Hospital physicians then threaded a wire through the needle before using a tiny balloon to unblock the aortic valve.
In a procedure as delicate and complex as this one, many specialists were needed to assure its success. The anesthesiology team led by William Camann, MD, made sure the mother and baby were anesthetized in a manner that would not harm either her or her unborn child. Highly skilled nurses, neonatologists, surgical technicians and other clinicians—those involved in BWH’s other fetal surgery cases—were also called upon to assist with this intricate operation.
Even though Jack was born six weeks early, his heart valve has yet to need further widening. “We were handed a miracle,” said Jack’s mother upon the birth of her healthy child.