"Science Fiction" Successes Humanize Unborn Children

By Dave Andrusko

Two separate but related surgeries are proving once again the power of ultrasound and skilled physicians to illuminate the humanity of unborn children.
When doctors operated on Serena Brown in January, she became the smallest baby ever to undergo open-heart surgery. Born at 25 weeks' gestation on December 27, Serena, now recuperating at Sutter Memorial Hospital, suffered from a life-threatening heart abnormality.

The high-risk surgery was necessary because the veins around her heart were improperly connected "below the diaphragm into the veins of the abdomen, and that is a lethal condition," Mohan Reddy, the physician who performed the surgery, told the Sacramento Bee.

In a five-hour-long procedure, Dr. Reddy said he rerouted the veins, connecting them back with running, looping stitches which "are about as fine as human hair and are almost not visible unless you are wearing magnified glasses."

Serena would have been 27 gestational weeks old at the time of her surgery. Stories that appeared last month in the New York Times and the British Broadcasting Corporation (BBC) described even more spectacular surgery performed on a 23-week-old unborn child.

Hypoplastic left heart syndrome is a condition so devastating that most parents abort if confronted with the diagnosis. Annually about 600 to 1,400 U.S. children are born with what amounts to half a heart. Most often the cause is a blocked aortic valve which prevents the left side of the heart from growing properly.

If the parents do not abort, the child's prospects are still grim. Untreated, the child dies soon after birth. The typical medical regimen is three operations that still leave the child an eventual candidate for a transplant.

But when an ultrasound at 20 weeks revealed their child's problem, the parents (identified only as "Jennifer and Henry G") were told by doctors at Boston's Brigham and Women's Hospital they had another option. They suggested widening the baby's valve while still in his mother's womb, described by cardiologist Dr. Wayne Tworetzsky as "the science fiction procedure" because "no one in the United States had ever made it work."

After reflection (abortion, thankfully, was not an option), the parents chose surgery for the child they would name Jack. The operation took place September 13.

An obstetrician "carefully kneaded Mrs. G's abdomen and rolled the fetus over to give the doctors better access to his heart," the Times reported. Cardiologists then inserted a tiny catheter tube into the abdomen of Jack's mother, through to the womb, and on into the organ itself.

Next, two doctors "passed a threadlike wire through the tube and the tiny wire was then pushed through the tube," according to the BBC. Doctors guided the catheter and wire using images produced by an ultrasound scanner.

Once across the valve, a minute balloon (the same kind used to dilate blocked arteries in adults) was inflated roughly an eighth of an inch and passed back and forth several times to widen the valve. Then the balloon, wire, and catheter were pulled back out, the BBC reported.

Through all of this doctors had to be very, very precise to avoid piercing coronary arteries or other parts of the heart and because it would be very unsafe to repeatedly jab Jack's heart.

Amazingly, the whole operation took less than 20 minutes. Improved blood flow through the valve began almost immediately. The open question was, would the valve close up again over the remainder of the pregnancy?

At Jack's birth last November, doctors were delighted to see that the aortic valve, though a little narrow, was wide enough to do the job. No additional surgery was needed. "Jack's outlook is good," the Times reported.