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operating surgeon in Philadelphia of late removed a neoplasm from what may be the diminutive heart ever to undergo surgery . The heart belong to a 21 - calendar week - old fetus , still inside the womb .
" The fetus was just about 6 in [ 15 centimeter ] in total distance , and his centre was the size of a peanut , perhaps a cm or less , " say Dr. Jack Rychik , music director of the Fetal Heart Program at Children ’s Hospital of Philadelphia ( CHOP ) .
This photo was taken during a fetal surgery performed at 24 weeks of gestation, to remove a tumor on the heart called an intrapericardial teratoma. The fetal arms (indicated with blue arrows) have been pulled out of the uterus and lifted, so the surgeons could make their incision into the fetal chest. The yellow arrows indicate the wall of the mother’s uterus. (This photo does not show Baby Juan’s surgery, but rather that of the first time the procedure was performed.)
Doctors at CHOP have perform more than 1,400fetal operationssince 1995 , according to the hospital ’s functionary . Most of those procedures have been done to remedycases of spina bifida , a birth blemish of the spine .
Operating on a fetus ’s heart , however , is extremely risky and rarely done , Rychik said . He told Live Science the CHOP team undertook the procedure only because it was a matter of life or end for the foetus . The tumor was the size of a walnut tree , larger thanthe heartitself , and was twitch the tiny harmonium , Rychik said .
The female parent , Cecilia Cella , lives in Uruguay . She had snuff it to see a pediatric heart specialist there , Dr. Roberto Canessa , who texted Rychik with video recording of a strange flock he saw on Cella ’s sonogram . [ 7 Baby Myths Debunked ]
This photo was taken during a fetal surgery performed at 24 weeks of gestation, to remove a tumor on the heart called an intrapericardial teratoma. The fetal arms (indicated with blue arrows) have been pulled out of the uterus and lifted, so the surgeons could make their incision into the fetal chest. The yellow arrows indicate the wall of the mother’s uterus. (This photo does not show Baby Juan’s surgery, but rather that of the first time the procedure was performed.)
" He sent it to me and say , ' What the Hades is this ? ' " Rychik said .
Rychik said he recognize the mass as an exceedingly rare , rapidly grow tumor call an intrapericardial teratoma . Such tumors grow on the sac surrounding the nitty-gritty and can place lethal imperativeness ona fetus ’s heartif left unchecked .
Fortunately , Cella and her collaborator , Pablo Paladino , were able to aviate to Philadelphia in a matter of days , and the CHOP team readied for operation .
This photo shows the removal of the tumor during the fetal surgery. (This photo does not show Baby Juan’s surgery, but rather that of the first time the procedure was performed.)
" Had we waited another Clarence Shepard Day Jr. , I retrieve it would have been too former , " Rychik said . " The tumor was just too big . "
To operate on the foetus , the doctors first point the female parent undergeneral anesthesia , which anesthetizes both female parent and the foetus . The operating team included lead surgeon Dr. Holly Hedrick , Rychik and three other surgeons .
Then , the sawbones made an incision into the female parent ’s uterus and drained theamniotic fluid(it was later replaced with artificial amniotic fluid ) . At this point , the fetus , a male , was further anesthetized , to ensure it would remain still for the process .
Then , it was a matter of gaining approach to the foetus ’s heart and soul . To do this , Rychik explain , the squad finely lift the foetus ’s armsout of the uterus , go forth the head and repose of the torso inside the uterus .
" By bringing the sleeve out and the chest up , [ we insure that ] the dresser is available to the operating theater , " Rychik aver . " Then , an incision is made into the chest and the rib are cut as they would be in an adult . "
The doctors were able to scratch the tumor from the fetal inwardness ’s sac . They then sewed up the scratch in the fetus , put it into the uterus and tailor-make up the uterus , so the pregnancy could proceed . Cella was then sew back up .
While the function was underway , the squad incessantly monitor the fetus ’s warmness through simulacrum projected by a very tiny ultrasound probe , which Rychick guided . The live echogram images aid the surgeons avoid compress the heart during the procedure and blocking parentage current .
The 3 - hour function was mostly a success , but the surgeon were n’t able to ignore away all of the tumour , Rychik say . About 2 percent of the tumor was " too intimately attach " to the heart , he tell .
" We worried if we removed that last bit , it may have caused price to the heart , " he say .
Three workweek after the surgical operation , the tumor had started to farm and appeared again on sonograms . even so , Rychik said the surgical operation boughtthe foetus vital extra weeksinside the female parent ’s womb .
The babe , named Juan , was born on Dec. 11 , 2016 , at 31 weeks . Two week later , Juan underwent another surgery to remove all remaining traces of the neoplasm . He is now nearly 4 months onetime , back home in Uruguay and reportedly doing well .
Before Juan , the CHOP team had previously performed an in utero core operating theatre like this just once , on a 24 - hebdomad - old fetus , who is now a tidy 3 - year - old thriving at his home in Vermont . [ Social Surgery : Images of Live - Tweeted Operations ]
The MD wrote about that case , along with seven other fetal heart - tumor cases that they saw from 2009 to 2015 in a news report they published in December 2016 in theAmerican Journal of Obstetrics and Gynecology . In six of those fount , the doctors could not operate and the fetus died . In one caseful , the doctors were capable to deliver the baby too soon and execute the surgical operation after rescue .
The one typesetter’s case that necessitate a successful in utero surgery was that of the now-3 - year - old Tucker Roussin , who have intercourse sandboxes and freak trucks , the Philadelphia Inquirer reportedat the time . Juan and Tucker are now the only two known fetus to have undergone the procedure .
" Until now , we ’ve only been able-bodied to watch these tumors grow and inform the female parent that the foetus probably would not be able to survive , " Rychik said . " Now , we ’re demonstrate that a unlike outcome is possible . "
to begin with published onLive Science .
