For the first time in Utah, physicians have performed a new life-saving operation on fetuses, inserting tiny plastic shunts into their abdomens.
Doctors announced Monday that they corrected a kidney defect in two fetuses - a defect that generally results in death - by penetrating the mothers' abdominal and uterine walls and amniotic sac with a long needle to insert the `s-shaped' shunt."This is a very technical procedure," said Steven Clark, director of the Intermountain Health Care's maternal/fetal medicine program. "Without very precise, sophisticated ultrasound machinery to help us guide the catheter in an incredibly small area, it wouldn't be possible."
He called the surgery a "wonderful step for maternal/fetal medicine in Utah."
But the mothers of the babies whose lives were saved call the procedure a miracle.
Carrie Mims, mother of Cameron, now 8 months old, expressed gratitude to the doctors who performed the operation for giving her and her husband, Alex, the opportunity to raise their first-born child. "I know he (Cameron) would not be here without their help."
Cameron's condition was detected by ultrasound when the fetus was 18 weeks old.
Linda Young and her husband, Brett, said they "would have done anything to save their son Winston's life." The fetus was operated on at 16 weeks. Clark described Winston as looking like a "giant bladder with tiny arms and a head" when doctors saw the fetus through ultrasound. The fetus' bladder was twice as big as the rest of the baby because it was not emptying at all.
Winston, now 7 months old, and Cameron may have kidney problems in the future. But both children squirmed and squealed during the press conference, confirming the health of their lungs.
Without the operations, both infants would have died before birth or shortly after. The operation saved their lungs. Kidney damage can be repaired and dealt with after a child is born, explained Clark.
Inserting the shunt is performed under a local anesthetic, requiring about an hour. Patients are usually hospitalized overnight for observation, said Clark.
The catheter remains in place throughout the pregnancy, allowing fetal urine - which constitutes most of the amniotic fluid - to properly drain into the amniotic sac. There it is utilized by the fetus for pulmonary development.
To help adults understand the impact this congenital defect of the bladder has on fetuses, Clark compares it to tying off the urethra in an adult and preventing urine from leaving the body. "You can imagine the the damaging effect this has on a developing fetus, said Clark.
The new pathway created by the surgery from the baby's bladder out of the amniotic cavity allows the fetus' kidneys to decompress. The lungs can then breathe this vital fluid and develop properly.
Unfortunately, if the conditiongoes untreated for the full term of a pregnancy, kidney and lung damage is so severe that the baby often only survives a matter of days.
The operation has been performed on three fetuses in Utah so far. "Although the procedure itself was successful (in all three cases), the defect was detected so late in the pregnancy that when the baby was born, its kidneys were too severely damaged and its lungs too underdeveloped to sustain life," said Clark. The baby died shortly after it was born.
In the cases of the two other fetuses, the defects were caught early. Now, they are basically "healthy, screaming little babies. One of the babies has some residual problems, but generally, both can look forward to a nice, relatively normal, healthy life. Without this procedure, we couldn't have said that," said Clark.
The fetal surgery has been performed elsewhere in the nation, but these cases represent the first procedure done by Utah perinato-logists.
The surgeries were a collaborative effort between perinatologists, including Dr. Gary Dildy, director of the perinatal center at Utah Valley Regional Medical Center and Michael Varner, director of the maternal/fetal program at the University of Utah Health Sciences Center.
"Many claim that this kind of cooperation between medical facilities is a bad or harmful thing," said Clark, referring to some antitrust laws. "But ask these two kids (Cameron and Winston) what they think." If there had not been cooperation between the University of Utah School of Medicine and Intermountain Health Care in pooling expertise between doctors and facilities, the children would not be alive today, he said.
"We're very optimistic," he said. "As we gain more experience, the greater the potential is for universal applications of these type of fetal invasive procedures."
Additional Information
Graphic: 1. A catheter is inserted through the mother's abdominal wall, the uterine wall and the amniotic sac into the fetus' abdomen. 2. The catheter allows the bladder to drain into the amniontic fluid, decompressisng the kidneys so the lungs can breathe vital fluid in order to develop properly.