European Stars and Stripes (Newspaper) - August 14, 1990, Darmstadt, Hesse Surgery before birth Quick fix in the womb Bojoh Barbour associated press he fetus that incredible Assembly of cells following its own blueprint toward human life was once a Citadel As daunting to doctors As the human brain. Not anymore. The surgeon s knife is entering the womb to Correct errors of nature in the fetus Only 23 weeks into pregnancy a 1 Pound humanoid with arms the size of your Little Finger a heart the size of a Walnut and tiny lungs that would fit inside the skin of an Orange. These dramatic techniques and some to come that Are even More dramatic Are used to Rescue a very few fetuses just As heart repair and transplants for very few newborns. Not everyone agrees that fetal surgeries Are appropriate or even necessary. Rarely some doctors say Are they so critical that they can t be postponed until afterbirth with the same results. But they offer a window to the future a future that is not very far off. And they reflect the advances in paediatric surgery Over the last decade a decade that has seen Newborn heart transplants become almost commonplace with doctors reaching into tiny chests to do All kinds of shunts and plumbing repairs restructuring valves replacing what nature forgot. Of the 4 million or so live births each year in the United states about 200,000 infants have serious defects and about 40,000 of those die. There is a lot of work to do. Researchers Are working now on ways to implant cells or genes into 12-week-pld fetuses whose unctions Are limited because of the Lack of even a single enzyme or protein their cells Are missing a vital blueprint to make those chemicals and ensure Normal growth. But for the time being at least fetal surgery remains anatomical the of structures gone awry. The most recent instance a surgeon in san Francisco opens the womb makes a 2-Inch incision in the Chest Wall of the fetus below the ribs on the left Side. He finds what the sound pictures told him he would the diaphragm that separates the Chest and abdominal cavities has not grown properly a disorder that occurs once in Only 2,000 pregnancies. The organs and intestines from the lower cavity Are crushing the developing left lung. He delicately rearranges things patches the diaphragm to hold everything in the right place and departs the Sanctity of the womb to let the pregnancy Progress. His patient Tho Mother delivers a Normal baby. Bui in six attempts at this kind of surgery Only two i causes have survived. What astonishes the doctors is these fetuses heal without a scar says Tho surgeon or. Michael r. Harrison of to University of California san Francisco. Now a and his colleagues arc trying to find out Why. Is it something the Youthful cells produce that allows Ilia kind of Healing and what would that mean to the adult world that is not so equipped at the very least Harrison says it suggests it might be a Good idea to Correct Somo serious. Defects to the fetus before birth to take advantage of this Scarless Healing he emphasizes How few Are the candidates for any of these new advances in Pedia Wiatric and fetal surgery. What makes much of it possible is the diagnosis of Many ailments shortly Afler gestation. In the 1970s, chinese and soviet scientists discovered that they could look into the future of the fetus by studying the Cho Nonic Villi the primordial Placenta cells the gestational bed in the uterus. They used a Needle to enter the uterus very Early in pregnancy and using suction they removed some of the Ulli for study this is Cho Nonic Villi sampling or tvs developed As an alternative for amniocentesis which is an analysis of the fluid in the womb which cannot be done As Early. Concurrent with the refinement of this work was the use of ultrasound to actually picture the fetus in the womb enabling doctors to see what they were doing. I guess the Basic idea is that we can do Bone marrow transplants a whole lot better before birth Harrison says. But what of the rejection problem working with sheep and monkeys Harrison says amazingly the rejection was circumvented if you took Stem cells the blood forming cells from the liver at a time when the liver acts As the Bone we re using fetal cells that won t recognize they Are not at Home. It seemed like a fantastic script and it is. The alternative strategy is rather than transplanting the whole cell Why not transplant the Gene Harrison says. The Gene folks Are getting so Clever that they Are pretty close to being Able to do that.". Rejection is still the major problem in Newborn heart transplants and so they Are not considered a cure for a bad heart in the traditional sense of the word they Are Only a treatment and patients with transplanted hearts must continue to take anti rejection Medicine for the rest of their lives. Which is Why a heart transplant is a last ditch method. Surgeons try first to repair the heart its malformed valves its missing Chambers its badly arranged plumbing. The heart of a Newborn is about the size of a Plum yet surgery is possible shortly after birth if not always practical. A heart transplant is an open heart procedure and it is technically sometimes much less demanding than some of the repairs that we Are doing says or. Jan m. Quae Geber who has recently come to new York s Columbia presbyterian babies Hospital from the Netherlands. We know that babies Are Strong enough to go through the operations. The question is whether you have to do a transplant. The reason you would do a. Transplant is because you have doubts you could do a Good or. Jan quae Geber changes bandages on a 1s-month-Otdbaby who had heart surgery. Or. Michael r. Harrison performs fetal surgery at the University of California san Francisco. The human heart is in essence a pumping machine the right Side of which pumps blood to the lungs to be oxygenated while the left Side sends the freshened blood coursing through the body again taking oxygen to Distant tissues and picking up Carbon dioxide for exhalation from the lungs. When a baby is born with an underdeveloped left or right ventricle the main pumping Chambers of the heart it basically has a single chamber heart. It was just Ruchama development that led to the first infant heart transplants. Two Early attempts dating Back to one in 1967 were failures. Then in 1984, or. Leonard Bailey of Loma Linda University medical Center near los Angeles transplanted a Baboon heart into a 12-Day-old infant known Only As baby Fae. Baby Fae survived Only 20 Days. The Cross species transplant was More a reflection of the Lack of human donors than anything else. Baby Fae would have surely died if nothing were done. Desperation is sometimes the Mother of Progress thirteen months later Bailey transplanted a human infant heart into the breast of a 14-Day-old, code named baby Moses who was discharged a month and a half later in 1986. That transplant took and the heart grew with its recipient Eddie Anguiano who will be 5 years old in november. Since then Bailey has done some two thirds of the nearly 70 infant heart transplants performed at Loma Linda 53 of which survive. To this Day not everyone agrees heart transplants Are the answer. There May be other repairs that would do As Well. You can t make a four chamber heart out of a two chamber heart or a three chamber heart says or. Welton Gersony of Columbia presbyterian s babies Hospital. The structures Are just missing. But we have found great Success with a Tofal bypass of fhe missing right heart allowing the blood to flow from the veins directly into the lungs. That s an exciting area. We be shown you can live in Short surgeons have made considerable Progress on infant heart repair since doctors in England showed How to inflate a tiny balloon in infant heart valves to Force them to enlarge. If we look at the scope of operations that have been performed on different kinds of abnormalities we can do Good operations with Low mortality in the first year of me moralities of two or three percent quae Geber a ,5 now there Are diseases which Are so severe thai we Don t have a Good anatomical if 10 conceivable that something might be done in the teat stage in those cases he cays. In Tho last decade a group of surgeons dedicated to repairing As completely As pos Sib s and As Early As possible virtually every defect have come to the fore Gersony says. Not All Are of equal proficiency although Many try. Essentially what we have is earlier and earlier repair and there s a logic to it to make the heart Normal Asea made up of fetal urine if the Block won t let the up then the fluid goes away the uterus collapses i and that affects his lung Ingma Cox who was born with one screwed up heart is recuperating from heart transplant surgery at new York s babies Hospital. New heart for Ingy Bojoh Barbour associated Pressw Hen Susan Cox was pregnant with her second child she had a suspicion that something was wrong. Call it maternal instinct. The doctors did constant tests to reassure me that everything was Fine she says but i just could t believe the 30-year-old woman so reveres life that she named her daughter Zoe and planned to name a son Vidal words derived from life in other languages. When the baby was born the doctors told her he was just Fine except that he was just cold and a Little Ingy As the boy came to be called after his Middle name Ingmar was in intensive care hours after he was born in Morristown . He was transferred to Columbia Presb Stenan babies Hospital in new York City the next Day. His Case demonstrates the uneven Road of Ped Ianc heart surgery and some of the Pitfalls a Ong the Way. Ingy is 3 /2 years old now a Lively Bright bundle of Energy who has had four brushes with death. At babies Hospital a More Complete examination of his heart showed it had inverted ventricles the pumping Chambers with no connection to the pulmonary artery that carries blood to the lungs. In addition there was a wide Hole Between the reversed ventricles. It was one screwed up heart As one Hospital staffer put it. The first surgery came when Ingy was 4 Days old a shunt was installed from one pumping chamber to the pulmonary artery. A Block developed and 10 Days later the infant was operated on again and a new shunt was installed. For three years Ingy seemed to be living a Normal Active life. But then he began turning Blue again a third operation showed he had outgrown the shunt. It was replaced and the Hole Between the two pumping Chambers was fixed it was As close As surgeons could come to a Complete repair considering what they started with there were ups and Downs in the ensuing months after the family moved to Princeton . Ingy developed respiratory problems and then heart failure that miraculously reversed itself. The doctors ascribed the heart failure to a virus and postponed any further work until after december. God gave us Christmas Cox says. We had a wonderful then Ingy developed pneumonia. This time the surgeons decided that no further repair was possible the Only alternative was a heart transplant. At babies Hospital it is or. Daphne Hsu s Job to find a heart and Type if to see if it is immunologically compatible with a potential recipient. We get our donors from the same kind of tragedies As those that Supply our adult patients accidents neurological ailments even tutors she says Well take hearts from donors who have problems that Don t involve the heart because our donor Supply is so the Only Supply of hearts for newborns arc the hearts of othe newborns the heart has to be about fac same size As that of the child who will receive in besides being immunologically compatible and there is urgency. A heart will keep Only four hours after it is removed kidneys can to kept viable longer but a heart has to be rushed to an Airport flown to where the sick recipient is and sped to the bedside they found a heart for Ingy on Valentine s Day this year we were very Lucky to get a heart within a week Cox says most kids have to wait weeks even months getting sicker All the time. This is not a cure she says it s a treatment that s one thing that really has to be emphasized " for the rest of his life Ingy will have to take the drugs that suppress his immune system and Cucuro that he will keep his heart we lost a couple of teen agers who were feeling so Good they did t think of themselves As sick anymore and quit faking their Medicine says Hsu Page 14 the stars and stripes 14,1990 the stars and stripes Page 15
