US medical professionals have successfully operated on an unborn baby’s brain to stop heart failure and brain damage from occurring after birth.
The in-utero surgery, which was done on a fetus with a gestational age of 34 weeks and 2 days, was described in the journal Stroke. The aggressive vascular abnormality known as the vein of Galen deformity was treated in order to alleviate a potentially fatal developmental problem.
Denver Coleman’s daughter was delivered two days after surgery at 1.9 kg with few problems and no birth abnormalities. According to the doctors from Boston Children’s Hospital and Brigham and Women’s Hospital, who carried out the procedure — in utero embolization — as part of a clinical trial and under the direction of the US Food and Drug Administration, she is now doing well and is not on any medicine.
Lead study author Darren B. Orbach, co-director of the Cerebrovascular Surgery & Interventions Centre at the Boston Children’s Hospital, said, “In our ongoing clinical trial, we are using ultrasound-guided transuterine embolization to address the vein of Galen malformation before birth, and in our first treated case, we were thrilled to see that the aggressive decline usually seen after birth simply did not appear.”
“We are happy to announce that the baby is doing extremely well at six weeks, isn’t using any drugs, is eating properly, gaining weight, and is back at home. There are no indications that there would be any detrimental impacts on the brain, continued Orbach, a radiology associate professor at Harvard Medical School.
The baby was born by induction of vaginal birth two days after the in-utero embolisation due to premature rupture of membranes.
Following birth, echocardiography revealed that the cardiac output gradually returned to normal. Due to prematurity, the newborn in this case was monitored in the neonatal intensive care unit for a few weeks after birth but did not need any circulatory support or surgery after the in utero treatment. He was then released home.
The infant underwent a routine neurological examination at that time and an MRI of the brain revealed no signs of bleeding, fluid buildup, or strokes.
One in every 60,000 births is thought to involve VOGM, the most prevalent congenital vascular brain malformation.
Prenatal ultrasounds are where VOGM is most frequently first detected, while MRIs are when VOGM is finally identified during the late second or third trimester of pregnancy.
Colin P. Derdeyn, a neurointerventional radiologist at University of Iowa Health Care who performs VOGM embolisations on newborns and who was not involved in the study, noted that the treatment has certain drawbacks.
The most important step forward in this case is to take action before the physiological processes of delivery can result in fatal heart failure. There are limitations; we cannot draw the conclusion that the hazards of this operation outweigh the advantages based on one successful example. Future treatments may involve safety concerns, and it’s possible that this method of preventing heart failure through the veins won’t always work. According to Derdeyn, the method described here is intended to lessen the flow through the abnormality rather than to treat it.
The beneficial hemodynamic changes that they saw in gestation and after birth, such as a decrease in flow, a shrinkage of the draining vein, and a reversal of the anomalous reversed flow in the aorta, are quite encouraging, though. These are among of this case report’s most intriguing and unexpected features, he continued.
This is innovative work being carried out in a thoughtful and responsible manner.