In a first-of-its-kind procedure, doctors in the US have performed brain surgery on an unborn baby to prevent heart failure and brain injury after birth. The in-utero surgery was performed on a foetus with a gestational age of 34 weeks and 2 days, to repair a potentially deadly developmental condition by treating an aggressive vascular malformation called vein of Galen malformation (VOGM).
The procedure, called in-utero embolisation, was performed by a team from Boston Children’s Hospital and Brigham and Women’s Hospital, as part of a clinical trial, with oversight from the US Food and Drug Administration. The baby girl, Denver Coleman, was born two days after the surgery, weighing 1.9 kg, with no birth defects and limited complications. She is doing well and is not on any medication.
The lead study author, Darren B. Orbach, co-director of the Cerebrovascular Surgery & Interventions Centre at the Boston Children’s Hospital, said that the procedure was ultrasound-guided transuterine embolisation, which was used to address the vein of Galen malformation before birth. In their first treated case, he said they were thrilled to see that the aggressive decline usually seen after birth simply did not appear.
The study author added that the infant is progressing remarkably well, on no medications, eating normally, gaining weight, and is back home. There are no signs of any negative effects on the brain, and the echocardiography after birth showed progressive normalization of cardiac output. In this case, the newborn did not require any cardiovascular support or surgery following the in-utero treatment.
However, the procedure was not without limitations, said Colin P. Derdeyn, a neurointerventional radiologist at the University of Iowa Health Care. He said that the key advance was to intervene before the physiologic events of birth could cause life-threatening heart failure. Still, one successful case was not enough experience for them to conclude that the risks of this procedure were worth the benefits. Safety issues may crop up in future procedures, and this approach through the veins may not be consistently successful in preventing heart failure.
VOGM is the most common congenital vascular brain malformation, occurring in as many as one in every 60,000 births. It is most often first seen on a prenatal ultrasound and is definitively diagnosed by MRI during the late second or third trimester of pregnancy. The positive hemodynamic changes observed in this case are encouraging, but the risks and benefits of the procedure must be weighed before further use.
