Advances and Answers in Pediatric Health
Both patients remained stable and in good health throughout the surgery , allowing the team to complete their tasks without incident . Once they addressed the tumor , physicians carefully repositioned the fetus back in the uterus , added fluid to help avoid preterm labor and closed the uterus so both patients could begin the recovery process .
For nearly two weeks after the surgery , the fetus remained in utero before being delivered . Removing the tumor made such an impact on the baby boy ’ s heart that he only required a few days of care in the cardiac ICU before being transferred to the NICU to finish growing and developing .
generated a new level of complexity . Instead of simply removing the tumor from a delivered baby , the team would have to carefully monitor both the health of the mother and the fetus and draw a delicate balance between each patient ’ s needs .
“ This is one of the situations where there ’ s a potential 200 % mortality ,” Dr . Jaggers explains . “ You ’ re not just operating on one patient — you ’ re operating on two . And so , you always have to make sure that the safety of both of those patients is paramount .”
With that plan in mind , Drs . Jaggers , Cuneo and Liechty assembled a large team spanning multiple disciplines , from neonatology , maternal fetal medicine and cardiology to anesthesiology and obstetrics . It was vital that the team included experts who could be on hand for any complications that might arise . And of course , even more team members worked behind the scenes to make this surgery possible , including social workers and more .
“ This is sort of the Super Bowl of multidisciplinary care , if you will ,” Dr . Jaggers says . “ It involves a lot of different services and a lot of highly specialized physicians , nurses and anesthesiologists .”
The surgery began with an obstetrician delivering the fetus partially outside the uterus , exposing only the arms and chest . This gave the team intravenous access to the fetus to administer anesthesia and ensure the heart would remain properly loaded with a constant supply of blood during the surgery . It also allowed them access to the tumor , which they were able to remove while the fetus remained connected to the placenta and uterus . With the tumor removed , the team was happy to find that the fetus ’ heart was functioning normally .
In addition to saving two lives , the surgery has the potential to have an impact beyond this one family , as the team plans to share its work with the larger medical community . The case is a strong example of how rare defects like this one could be addressed using innovative surgical approaches that could help countless children in the future .
“ In the past this would have been viewed as a lethal problem ,” Dr . Liechty says . “ If people see that there are cases of survival in the literature , they won ’ t be counseled that it ’ s lethal . And so , I think it provides a better understanding of the pathophysiology and what contributes to the disease , and it pushes the boundaries of what we can do to treat patients .” •
BETTINA CUNEO , MD
Director of Perinatal Cardiology and Fetal Cardiac Telemedicine , Children ’ s Hospital Colorado
Professor , Pediatrics-Cardiology , University of Colorado School of Medicine
JAMES JAGGERS , MD
Co-Medical Director , Heart Institute , Children ’ s Hospital Colorado
Barton-Elliman Chair in Pediatric Cardiothoracic Surgery
Professor , Surgery-Cardiothoracic , University of Colorado School of Medicine
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