Historic Fetal Surgery Successfully Removes Rare Heart Tumor

fetal surgery
Hani Najm, M.D., who led the heart surgery team, inserts an IV line in the fetus’s right arm to deliver fluids and medications as needed. Source: Cleveland Clinic

For only the second time, surgeons successfully conducted a fetal surgery within the womb to remove a rare heart tumor.

When Rylan Harrison Drinnon was just a 26-week-old fetus, he developed a rare condition – an intrapericardial teratoma with fetal hydrops. The 3cm tumor was seen compressing the left side of his heart and impairing circulation. Thus, resulting in an accumulation of fluid around the heart and other organs. As Rylan began developing signs of heart failure, the need for fetal surgery became more and more crucial. But the surgery would need to be done in-utero, an almost impossible feat.

This tumor was growing rapidly in the exact wrong spot. It was compressing the heart of the fetus, causing fluid accumulation, and we started seeing signs that the cardiac function was deteriorating.

Dr. Darrell Cass, director at Cleveland Clinic’s Fetal Surgery

Although this particular tumor is extremely rare with an incidence of only 1 in 40,000 births, it is extremely lethal. Previously, there had only been one successful case of an in-utero surgical resection of intrapericardial teratoma with survival of the fetus to term.

Only the Second in the World

In May of this year, Dr. Hani Najm of Cleveland Clinic led a team of doctors and surgeons to perform the life-saving surgery. Using ultrasound, the surgeons located the best site for access to the placenta and fetus. A 12 cm Cesarean section-like incision helped expose the fetus. The team then brought out the fetus’ arms for insertion of an IV line to deliver fluids and medications. Next, they opened the chest and pericardium and removed the tumor. Afterwards, doctors noticed a significant improvement in heart compression and fluid circulation.

After completion of the procedure, surgeons stitched close the fetus’ chest, the placenta and then the mother’s abdomen. The whole surgery lasted a total of three-and-a-half hours. For the remainder of the pregnancy, the team monitored the mother and fetus for any complications. The fetus’ cardiac function continued to improve further, and the prenatal checkups showed no signs of tumor recurrence. Ten weeks later, on July 13, Ryan was delivered via Cesarean section.

As far as we know, Cleveland Clinic is the second academic medical center in the world to have performed this fetal surgery successfully with continued pregnancy and delivery.

Dr. Darrell Cass, director at Cleveland Clinic’s Fetal Surgery

Born at 36 weeks and two days, Rylan is currently recovering well. The pediatric team will continue to monitor his cardiac health. Moreover, in the future, the child will likely undergo surgery for the repositioning of his sternum.

Source: Cleveland Clinic


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