In a first-of-its-kind procedure, physicians performed a successful in utero surgery to repair a rare and potentially deadly prenatal condition in a fetus. In utero surgery has been used for other conditions, but this is the first time it has been attempted to treat “vein of Galen malformation” — a rare blood vessel abnormality inside the brain that can cause a rush of high-pressure blood into the veins.
Details of the procedure, which was performed in March, were published on Thursday in Stroke, the peer-reviewed journal of the American Stroke Association, a division of the American Heart Association. In a two-hour procedure, when the fetus was at 34 weeks and 2 days gestational age, doctors used ultrasound imaging to guide a needle through the uterus of the mother and into a vein in the back of the fetus’s head. A catheter in the needle was then used to insert tiny coils to decrease blood flow in the vein.
The tiny patient was the first in a clinical trial currently underway at Boston Children’s Hospital and Brigham and Women’s Hospital, performed with oversight from the U.S. Food and Drug Administration, and was delivered by induced vaginal birth two days after the procedure.
The baby’s parents, Derek and Kenyatta Coleman, told CNN that they learned of their child's condition during a 30-week ultrasound, and that the doctor told them that “something wasn’t right in terms of the baby’s brain, and also her heart was enlarged.” Although Kenyatta said she was aware of the possible risks of joining the clinical trial, the Colemans “felt there was no other option for them,” CNN writes.
Weeks later, doctors say the Colemans’ baby daughter, Denver, is thriving.
“In our first treated case, we were thrilled to see that the aggressive decline usually seen after birth simply did not appear,” lead study author Dr. Darren B. Orbach said in a press release. “We are pleased to report that at six weeks, the infant is progressing remarkably well, on no medications, eating normally, gaining weight and is back home. There are no signs of any negative effects on the brain.”
Orbach added that this is only their first treated patient, and that it’s vital to continue the trial to assess safety and efficacy in other patients. Still, the results are promising.
“This approach has the potential to mark a paradigm shift in managing vein of Galen malformation where we repair the malformation prior to birth and head off the heart failure before it occurs, rather than trying to reverse it after birth,” Orbach said. “This may markedly reduce the risk of long-term brain damage, disability or death among these infants.”