By Matet Nebres and Sally Szuster
It’s not very often that a baby’s first foray into the world would also mark his second time in an operating room. Five days before he was born, a surgical procedure was performed on Baby Sebastian Havill’s heart while he was still in his mother’s womb.
Sebastian was diagnosed prenatally with a severe form of a congenital heart defect called Transposition of the Great Arteries (TGA), which affects about five to seven per cent of babies with congenital heart defects. Complicating his heart disease was the fact that all the walls in his heart – the atrial and ventricular septa – were closed shut, which would have prevented his blood from receiving oxygen after birth.
On May 18, doctors from The Hospital for Sick Children (SickKids) and Mount Sinai Hospital, part of Sinai Health System, inserted a balloon into Sebastian’s heart, via a needle placed under ultrasound guidance through his mother’s uterus, to open up the atrial septum. It is believed that this is the first time in the world that this procedure – a Balloon Atrial Septoplasty (BAS) – has been performed before birth to treat Sebastian’s particular condition.
The BAS procedure did not address his heart condition – Sebastian still needed open-heart surgery after birth. However, by creating a 3.5 mm hole in the atrial septum in utero, Sebastian and his mom, Kristine Barry, were spared a traumatic and potentially life-threatening course after delivery, which may have prevented him from being eligible for the surgery at all.
On the day of the procedure, two operating rooms were prepared at SickKids. One team focused on performing the fetal cardiac procedure and another team of neonatal and cardiac surgery specialists were on standby in the next room, should an emergency delivery and cardiac surgical procedure be required. In total, there were more than 30 clinicians, including surgeons, anaesthesiologists, neonatologists, fetal medicine specialists, interventionists, heart and lung bypass specialists and nurses. The procedure went smoothly, as planned, and an emergency delivery was not needed.
“Had it not been for this procedure, the delivery would have had to be by Caesarian section, with full neonatal resuscitation and cardiac surgery teams at the ready to perform a critical, lifesaving surgical procedure on Sebastian’s heart. Once out of the womb, he would have become immediately distressed and we would have had only three minutes to open up his heart. Any longer and he would have been at risk of brain damage, stroke or potentially even death,” says Dr. Rajiv Chaturvedi, Staff Interventional Cardiologist at SickKids and a member of the three- physician team that performed Sebastian’s procedure.
Sebastian remained safely in his mom’s womb until labour was induced at Mount Sinai Hospital five days later. On May 23, Kristine went on to have a vaginal delivery.
“This procedure was extremely high risk, as it had never been done before birth on a baby with this particular condition. This was the bridge we needed to allow Sebastian to have open-heart surgical correction of his TGA,” says Dr. Greg Ryan, Head of the Fetal Medicine program at Mount Sinai Hospital, another member of the team that performed the procedure. “Sebastian was born vigorous, pink and screaming. He remained well-oxygenated thanks to the atrial hole that had been created in utero.”
Sebastian was transferred to SickKids and underwent an arterial switch repair to completely correct his condition five days later. The surgery was successful and there were no complications.
“Our ability to perform BAS in utero is a paradigm shift in how we may treat this condition in the future,” says Dr. Edgar Jaeggi, Head of the Fetal Cardiac Program at SickKids, the other key member of the team. “With this innovative procedure, we are able to give these babies a significantly better start to life.”
The team from SickKids and Mount Sinai Hospital is Canada’s only provider of fetal cardiac procedures and one of only a few worldwide. The group has jointly performed 41 fetal heart surgeries on 32 patients since 2009. “This partnership between our two leading Ontario health centres continues to have a transformative impact on babies’ lives,” says Ryan.
Sebastian’s parents, Kristine Barry and Christopher Havill, are now enjoying the early days of parenthood at home with their son. “In the first moments after we received the diagnosis, it felt like our world crashed around us,” says Kristine. “This team immediately filled us with confidence and we never doubted that we would one day hold our beautiful and healthy son.”
Matet Nebres is Senior Manager of Media Relations at The Hospital for Sick Children and Sally Szuster is Senior Manager of Communications and Public Affairs at Sinai Health System.