Baby Grace goes home after having heart surgery as a fetus

Jan 31 2006

A baby girl, who had the world's first heart "stent" procedure in the womb was discharged from hospital on Friday and went home 17 days after her birth.

Baby Grace Vanderwerken received the tiny stent while still in her mother's womb at 30 weeks into the pregnancy on November 7th, and was born on January 10th, weighing 4.2kg with a full head of dark hair.

The procedure was carried out by cardiologists from the Children's Hospital Boston and high-risk obstetrical specialists from Brigham and Women's Hospital in Massachusetts.

The baby needed the stent to correct a heart defect called hypoplastic left heart syndrome (HLHS) and to prevent permanent damage to the fetus's fragile lungs and pulmonary vessels in the final weeks of gestation.

Grace underwent the first part of a definitive three-stage corrective operation on January 13 and will undergo the second stage of the operation at 4 to 6 months of age.

The third and final stage is expected to be performed between age 1 and 3 years.

According to a press release from the Children's Hospital Boston, where the landmark operation took place, her doctors believe the earlier stent placement protected her lungs and ensured her recent operation would run more smoothly than usual for such cases.

With HLHS the left side of the heart is underdeveloped and can accept very little blood; it is the most common heart disease-related cause of death during the first week of life.

Very often there is a hole that lets blood from the left side flow to the right before leaving the heart, but in Grace's case, the lack of a hole meant blood accumulated on the left side and backed up into her lungs, which over time would have caused serious damage.

In order to prevent the lung damage occurring as the pregnancy progressed, Dr. James Lock and colleagues decided to create a connection between the left and right sides of Grace's heart using a stent, which acted like a tiny channel for the blood.

Using ultrasound guidance, the doctors inserted a small catheter into the mother's abdomen and uterus and then into the fetal heart.

Two holes were created in the wall between the left and right sides of the heart, and the stent was inserted.

Grace's mother returned to the hospital in January for the delivery after an ultrasound performed just before birth indicated that the stent procedure had worked.

At birth Grace looked like a typical HLHS baby, instead of one in the highest risk category as would have been expected without treatment.

At birth, Grace was breathing without major difficulty and did not need to be put on a mechanical ventilator.

When the first stage of the definitive corrective procedure was performed a few days later, Grace's recovery was described as "extraordinarily smooth - a course unlike any other baby with HLHS and an intact" wall between the left and right sides of the heart.