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Stitch In Time: Fixing A Heart Defect Before Birth

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Stitch In Time: Fixing A Heart Defect Before Birth

Health

Stitch In Time: Fixing A Heart Defect Before Birth

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RICHARD KNOX:

This is Richard Knox, in Boston.

A team of doctors here has been perfecting an incredibly delicate operation, one that can prevent the heart defect Jeni Busta has. But the surgery has to be done before a baby is born. Kim Wells had that operation a little over four years ago, when she was 23 weeks' pregnant with her second daughter.

Ms. KIM WELLS: They told me that they were going to go directly through my stomach, with a needle, into my uterine wall - directly into her heart.

KNOX: The fetus's main heart valve was stuck partly closed. If the valve's not fixed right away, the tiny heart becomes exhausted, and the main pumping chamber withers away. Fortunately, a cardiologist in Iowa, where Kim Wells lives, knew about the Boston team. So two days after a routine ultrasound found the problem, she was lying on an operating table at Brigham and Women's Hospital.

(Soundbite of heart monitor)

Unidentified Man: Yeah, that should be OK right there.

Unidentified Woman #1: You're good. That's it.

KNOX: As she went under anesthesia, Kim remembers that her legs wouldn't stop shaking.

Ms. WELLS: It was terrifying, but also a level of excitement that it could save her.

(Soundbite of heart monitor)

Unidentified Woman #1: Good, good, good.

KNOX: What we're hearing is a recording of that operation.

Dr. WAYNE TWORETZKY (Advanced Fetal Care Center, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital): You want to turn some more that way.

Unidentified Woman #1: We're good.

KNOX: Dr. Wayne Tworetzky, of Children's Hospital, narrates. His job was to watch a big ultrasound screen, and interpret it for the other doctors.

Dr. TWORETZKY: See here we see Dr. Wilkins-Haug making a small incision with a scalpel.

KNOX: The others watch while an obstetrician inserts a long needle through that incision, through Kim's uterus, between the fetus's ribs, and into the beating fetal heart.

Unidentified Woman #1: OK.

KNOX: That heart is tiny - only about three-quarters of an inch long.

Dr. TWORETZKY: It's about the size of a grape.

KNOX: The heart valve they're aiming at is even tinier.

Dr. TWORETZKY: Probably the size of the tip of a ballpoint pen.

KNOX: They'll use the long needle, and a wire they thread through it, to put a miniature balloon in that teensy valve and then inflate it. Everybody watches the ultrasound screen, and they can see they're in the wrong place.

Dr. TWORETZKY: It's too proximal. It's too proximal.

Unidentified Woman #1: It's way proximal.

Dr. TWORETZKY: It's in the ventricle.

Dr. JAMES LOCK (Chief of cardiology, Children's Hospital): What do you mean, it's way proximal?

Dr. TWORETZKY: It's in the ventricle.

Unidentified Woman #1: In the ventricle.

KNOX: They pull the wire back and try again.

Dr. TWORETZKY: You want to aim for this thing up here.

KNOX: This time, the wire bumps up against the inside wall of the heart and curls over.

Dr. TWORETZKY: No, no, no, no, no.

KNOX: Tworetzky remembers how tense it was.

Dr. TWORETZKY: It's like trying to find a golf ball in a snowstorm.

KNOX: They make another try.

Unidentified Woman #1: OK, hold on right there.

KNOX: And finally, they hit the target.

Dr. TWORETZKY: I think that's across the valve. Yeah.

Unidentified Woman #2: I think it's across.

Dr. TWORETZKY: Yeah.

Unidentified Woman #1: Me, too.

Unidentified Woman #2: I think it's across the valve.

KNOX: They inflate the balloon.

Dr. LOCK: All right, do it again. Do it again.

KNOX: And then do it a second time, just to make sure, because the valve is so tiny, they can't actually see what's happening.

Meanwhile, the clock is ticking. Dr. Tworetzky says time was critical.

Dr. TWORETZKY: We really have to get this done - either within seconds or at most, several minutes.

KNOX: Several minutes from when?

Dr. TWORETZKY: From when the needle is first placed inside the heart.

KNOX: Otherwise, there's a danger the fetus's heart will slow down.

Dr. TWORETZKY: If the heart slows down or even stops, there's a chance that we may lose the fetus.

KNOX: And in fact, the tiny heart does slow down. Then another bad sign: fluid around the heart.

Dr. TWORETZKY: That can compress the heart.

KNOX: Which can also be fatal. So the lead doctor makes the call. He says, bring everything out of the body; it's time to stop the operation.

Dr. LOCK: Just everything out of the body.

KNOX: They quickly pull out the guide wire, the balloon and the long needle. At this point, nobody can be sure if the operation was a success. As the pregnancy continued, ultrasound scans showed things were looking good. And when Kim Wells had her baby girl four months later, the newborn's heart had developed normally.

Ms. HANNAH WELLS: My name is Hannah Wells, and I'm 4 years old.

Ms. WELLS: She runs circles around our oldest daughter, who's completely healthy.

(Soundbite of laughter)

Ms. WELLS: Yeah, she's a ball of energy.

KNOX: Hannah did need two heart operations to do a little bit more work on that valve, and she'll probably need some more down the road. But her father, John Wells, says that's nothing.

Mr. JOHN WELLS: She has four chambers of her heart that are functioning.

Ms. WELLS: Yes.

Mr. WELLS: So that is the success story of the fetal intervention.

KNOX: Hannah's one of the lucky ones. There are others born every year who could have the same success - but their heart problems aren't usually recognized in time.

Richard Knox, NPR News, Boston.

(Soundbite of music)

INSKEEP: It's MORNING EDITION, from NPR News.

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