It's not often a baby's first foray into the world would be his second time in an operating room. Five days before he was born, a surgical procedure was performed on Sebastian Havill's heart while he was still in his mother's womb.
Sebastian was diagnosed prenatally with Transposition of the Great Arteries (TGA), a severe form of a congenital heart defect. All the walls in his heart – the atrial and ventricular septa – were closed shut, which would have prevented his blood from receiving oxygen after birth.
On May 18, doctors from The Hospital for Sick Children (SickKids) and Mount Sinai Hospital, part of Sinai Health System, inserted a balloon into Sebastian's heart, via a needle through his mother's uterus, to open up the atrial septum. It is believed this is the first time in the world this procedure – a Balloon Atrial Septoplasty (BAS) – has been performed before birth to treat Sebastian's condition.
The BAS procedure did not address his heart condition – Sebastian still needed open-heart surgery after birth. However, by creating a 3.5 mm hole in the atrial septum in utero, Sebastian and his mom, Kristine Barry, were spared a traumatic and potentially life-threatening course after delivery.
Two operating rooms and 30 clinicians were prepared at SickKids for the procedure. One team performed the fetal cardiac procedure and another team of neonatal and cardiac surgery specialists were on standby in the next room, should an emergency delivery and cardiac surgical procedure be required. The procedure went smoothly and an emergency delivery was not needed.
"Had it not been for this procedure, the delivery would have had to be by Caesarian section, with full neonatal resuscitation and cardiac surgery teams at the ready to perform a critical, lifesaving surgical procedure on Sebastian's heart. Once out of the womb, he would have become immediately distressed and we would have had only three minutes to open up his heart. Any longer and he would have been at risk of brain damage, stroke or potentially even death," says Dr. Rajiv Chaturvedi, Staff Interventional Cardiologist at SickKids and a member of the three-physician team that performed Sebastian's procedure.
Sebastian remained safely in his mom's womb until labour was induced at Mount Sinai Hospital five days later. On May 23, Kristine went on to have a vaginal delivery.
"This procedure was extremely high risk, as it had never been done before birth on a baby with this particular condition," says Dr. Greg Ryan, Head of the Fetal Medicine program at Mount Sinai Hospital, another member of the team that performed the procedure. "Sebastian was born vigorous, pink and screaming. He remained well-oxygenated thanks to the atrial hole that had been created in utero."
Sebastian was transferred to SickKids and underwent an arterial switch repair to completely correct his condition a week later. The surgery was successful and there were no complications.
"Our ability to perform BAS in utero is a paradigm shift in how we may treat this condition in the future," says Dr. Edgar Jaeggi, Head of the Fetal Cardiac Program at SickKids, the other key member of the team. "With this innovative procedure, we are able to give these babies a significantly better start to life."
The team from SickKids and Mount Sinai Hospital is Canada's only provider of fetal cardiac procedures and one of only a few worldwide. The group has jointly performed 41 fetal heart surgeries on 32 patients since 2009.
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