Stitch In Time: Fixing A Heart Defect Before Birth Doctors in Boston are performing an experimental surgery on the tiny heart of a fetus to prevent a rare but devastating heart defect before the baby is born. Only 200 women have undergone the operation and only half of serious heart defects are detected during pregnancy.
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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

Stitch In Time: Fixing A Heart Defect Before Birth

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RICHARD KNOX: 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.

M: 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.


U: Yeah, that should be OK right there.

U: You're good. That's it.

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

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


U: Good, good, good.

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

KNOX: You want to turn some more that way.

U: 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.

KNOX: 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.

U: OK.

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

KNOX: It's about the size of a grape.

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

KNOX: 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.

KNOX: It's too proximal. It's too proximal.

U: It's way proximal.

KNOX: It's in the ventricle.

KNOX: What do you mean, it's way proximal?

KNOX: It's in the ventricle.

U: It's in the ventricle.

KNOX: They pull the wire back and try again.

KNOX: 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.

KNOX: No, no, no, no, no.

KNOX: Tworetzky remembers how tense it was.

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

KNOX: They make another try.

U: OK, hold on right there.

KNOX: And finally, they hit the target.

KNOX: I think that's across the valve. Yeah.

U: I think it's across.

KNOX: Yeah.

U: Me, too.

KNOX: They inflate the balloon.

KNOX: All right, do it again. Do it again.

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

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

KNOX: Several minutes from when?

KNOX: From when the needle is first placed inside the heart.

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

KNOX: 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.

KNOX: 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.

KNOX: 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.

M: My name is Hannah Wells, and I'm 4 years old.

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


M: 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.

M: She has four chambers of her heart that are functioning.

M: Yes.

M: So that is the success story of the fetal intervention.

KNOX: Richard Knox, NPR News, Boston.



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