First in Canada: Baby has heart procedure while inside her mother’s womb

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Throughout a seemingly routine pregnancy with her third child, Vicki McKenzie, her husband Ian, and their two sons looked forward to becoming a family of five. But after an ultrasound at 30 weeks revealed the baby had a serious heart condition called Critical Aortic Stenosis, everything changed. All of a sudden, McKenzie stopped making plans; she no longer expected to be able to take her baby home. “I did not get anything ready for the baby,” says McKenzie. “I was just not convinced she would be okay.”

McKenzie, who lives in Gatineau, Quebec, was immediately referred to Toronto, where doctors at The Hospital for Sick Children (SickKids) and Mount Sinai Hospital offered her an experimental procedure called Balloon Dilation of Critical Aortic Stenosis in the Fetus to repair a severe narrowing of the main outlet valve of the baby’s left ventricle. The successful intervention, which was a Canadian first, involved expanding the baby’s aortic valve using a balloon catheter inserted through the mother’s abdomen while the baby was still in her womb to reverse the baby’s heart failure before birth.

The team of doctors, including Dr. Edgar Jaeggi, Head of the Fetal Cardiac Program at SickKids, Dr. Greg Ryan, Head of the Fetal Medicine Unit at Mount Sinai and Dr. Lee Benson, Director of the Cardiac Diagnostic and Interventional Unit at SickKids, performed the lifesaving heart intervention in her mother’s womb. This allowed the baby to remain safely in utero for a crucial extra month.

“It can only be offered to a few babies in utero who are detected at the correct stage and when their aorta hasn’t yet narrowed too much. This baby came to us at just the right time,” explains Jaeggi.

Under continuous ultrasound guidance, the team of doctors inserted a needle into the left ventricle of the baby’s heart through McKenzie’s abdomen; a guide wire was passed through the narrowed valve so the special balloon would open the valve leading to the baby’s aorta.

“The fetal intervention was minimally invasive for the mother and lifesaving for the baby,” says Ryan. “Our ability to repair the aortic valve at 31 weeks gestation allowed the fetus to grow and thrive for four more weeks in the mother’s uterus, resulting in a bigger, healthier baby at birth with decreased likelihood of additional health risks. The collaboration of expertise between SickKids and Mount Sinai saved this infant’s life.”

Océane McKenzie was successfully delivered on April 15, 2009 and within an hour of her birth at Mount Sinai she was stabilized and transported by the neonatal team to the Cardiac Diagnostic & Interventional Unit at SickKids, where she underwent another procedure. A third procedure followed a few weeks later.

Untreated, Océane’s condition would have inevitably led to lifelong Hypoplastic Left Heart Syndrome (HLHS). Children with HLHS typically need to undergo at least three major heart surgeries and are not expected to live a normal lifespan. The 10-year survival rate for children with HLHS is only 65 per cent. The innovative but risky procedure aims to repair the heart early, allowing it to recover its normal function to avoid risky surgeries after birth and hopefully lead to a longer and better quality of life.

“The intervention recovered Océane’s ventricle function completely. It is operating at a normal level now. We hope this successful collaboration opens the door to giving other babies a healthier start in life,” says Jaeggi.

Océane, her parents and her older brothers, Gavin, 7, and Owen, 4, are now back home in Gatineau enjoying what they didn’t think was possible since that ultrasound at 30 weeks – life as a family of five.

“They have saved my daughter’s life,” says McKenzie. “Having access to the expertise at these two hospitals was a comfort. I could confidently have my baby at Mount Sinai and know that she would immediately receive the urgent care she needed across the street at SickKids.”