In EKSMO publishing house published a book by journalist for the Times and the Financial Times of Thomas Morris “a Matter of heart. 11 key operations in the history of cardiac surgery”. “Pravmir” prints a passage about how doctors have learned to operate on the hearts of unborn babies.
- Cardiologist: Save the person – ask for the cap
- On the posthumous donation, heart transplants, and pregnancy after transplant – Sergey Gautier
- Mark Kurtser: Today, the fruit for us was the patient
- Cardiologist Alex Light: Glad that I’m a doctor, when in the plane yelled “doctor!”
- Oncohematology Mikhail Maschan: Of good intensive care, breakthrough technologies and puppies in the hospital
Nowhere has the progress of cardiac surgery not more striking than in the treatment of congenital heart disease. Defects of the structure of the heart is the most common type of congenital malformations of up to five percent of all children are born with a particular heart defect, although most of these deviations does not lead to serious chronic problems. The body is especially susceptible to malformations, while the child is in the womb — its structure can be distorted or inverted countless ways. With some we are already familiar, but there are dozens of others, some of which are extremely rare.
Over decades of development of pediatric cardiac surgery specialists have a cure for most evils, but one remains a serious challenge for even the best surgeons syndrome hypoplastic left heart (SPOS), in which the whole left half of the heart is formed not as it should be. Ventricle and aorta are much smaller than they should be, and the mitral valve or significantly reduced in size or totally absent. Until the beginning of 1980-ies this defect was fatal, and the children inevitably died in the first days after birth, however, the complex palliative surgery now allows many of them to survive to adult years.
Since the left ventricle is unable to push through the body the oxygen-rich blood, born with SGOS children can survive only if we manage to link the big and small circles of blood circulation, allowing the right ventricle to pump blood through the lungs and around the rest of the body.
The ductus arteriosus (connects aorta and pulmonary artery) and the oval window (between the left and right Atria) to allow oxygenated blood to return to the pulmonary circulation, however, a few days after birth they close. Some children with SPOS also has a atrial septal defect — a permanent hole in the wall between the Atria, which greatly increases their chances of survival by increasing the number of oxygen-rich blood that enters the only functioning chamber of her heart.
Thomas Morris
When surgeons realized that the presence of ASD helps these children to survive, they began to artificially make such a hole in the septum in children with SGOS born without this additional defect. Usually this was done in a few hours after birth, but it usually was too late: high blood pressure could cause irreversible damage to thin blood vessels of the lungs, while the child was in the womb.
Therefore, a logical — albeit risky — the decision was an intervention earlier. Thus, in 2000, a team of doctors at Boston children’s hospital began using a new procedure for creating artificial defect of the septum at the last trimester of pregnancy: they purposefully created a defect to correct the other.
Through the wall of the uterus in the child’s heart the needle was inserted, with the balloon catheter between the right and left Atria was made necessary hole. Due to this, the pressure in the pulmonary circulation was reduced and lung injury were not significant.
The problem was that the fabric of the developing fetus have the amazing ability to heal itself, and after a few weeks done the hole was covered. Cardiologists had to find a way to keep it close to the birth when surgeons could have a more serious reconstructive surgery.
In September 2005 the married couple from Virginia, Angela and Jay Vanderwerken came to a local hospital on an ordinary ultrasound. With horror they found out that their unborn child had the syndrome hypoplastic left heart, and the prognosis was very pessimistic. Ultrasound images showed that the interatrial septum not broken — this meant that even before birth fetal lungs are likely to suffer irreversible damage. They were told that they could either terminate the pregnancy or accept the fact that their daughter a few hours after birth will have to undertake open-heart surgery, the probability to survive after which she will be only twenty percent.
Shaken by these sad prospects, the couple returned home, and Angela began to search the Internet for information about this pathology. Although treatment SPOS was carried out only in several hospitals, she found information about the program of fetal cardiac interventions in Boston, which was attended by doctors, the first to use a balloon catheterization done on pregnant women.
They agreed to meet with Wayne Tworetzky, head of the Department of cardiology of the fetus at Boston children’s hospital that did the ultrasound, confirmed that the pathology can be treated. Tworetzky, white-haired doctor with a soft voice come from South Africa, explained that his medical team has recently developed a new procedure, which, however, has not yet been tested on patients. She was to make a hole in the partition, and then install it in a device that would not allow him to become overgrown. After some hesitation, Vanderwerken still agreed to try, otherwise the chances of survival of their daughters was minimal.
“She had an open heart surgery — the first of three that she had to move in infancy”
The procedure was conducted on the seventh of November 2005, in the jam-Packed operating women’s hospital Brigham at the thirtieth week of pregnancy. It was attended by sixteen doctors of various specialties: cardiologists, surgeons and four anesthesiologists, two for the mother and her unborn child. The mother of the child had to remain perfectly still throughout the procedure which lasted several hours, so both placed under General anesthesia.
The doctors watched on the ultrasound screen, as the thin needle pierces the wall of the uterus, passes through the chest and finally finds himself in the girl’s heart, no bigger than a grape. Through a needle introduced wire guide, and on it — a thin balloon-catheter, which in the interventricular septum caved.
All of this has been done before on other patients, but further actions were carried out for the first time. The catheter with the probe removed, and then, this time providing the stent with a thickness of two and a half millimeters, back into the heart. The stent is mounted in a hole between the left and right Atria. When the balloon to expand the stent began to inflate, the air hung tense silence. Then, as soon as the doctors saw on the monitor that the blood freely flows through the stent, the room came the cries of approval.
Grace Vanderwerken was born in early January. The delivery was normal, and after a while she had an open heart surgery — the first of three that she had to move in infancy. Two weeks later she was discharged home the pink color of the body pointed to the fact that the doctors were able to provide a functional circulatory system.
But when it seemed that the life of grace is in no danger, she died suddenly at the age of thirty-six days, not for operation, but due to a rare arrhythmia — complications SPOS, which happens only five percent of cases.
It was a terribly unfortunate coincidence — she only just managed to defeat death, despite all the gloomy Outlook, and suddenly everything collapsed. The loss of a child was a tragedy, but her parents their courageous act launched a new era of surgery to the fetus. Grace was the first child, who implanted a mechanical device is still in the womb — it was a historic moment, after which the procedure has successfully carried out many other women with diagnosed fetal SPOS.
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The story of grace is the harbinger of a new frontier of medicine, the world of microscopic precision and wonderful engineering solutions, in which the disease, life-threatening, are treated without a scalpel and sutures.