Physicians at Boston Children's Hospital and Boston-based Brigham and Women's Hospital performed the first successful in-utero surgery to repair an aggressive vascular malformation in the fetus's brain before birth.
The procedure, published in Stroke, repaired a vein of Galen malformation — a rare prenatal condition where high-flow, high-pressure arteries connect directly with one of the main collecting veins at the base of the brain rather than to capillaries. Due to changes in the infant's vascular physiology during and after birth, the malformation can cause pulmonary hypertension, heart failure or other life-threatening conditions, according to a May 4 American Heart Association press release.
Researchers performed the in-utero embolization on the fetus at 34 weeks and 2 days gestational age. It is the first patient in a clinical trial at Boston Children's and Brigham and Women's. The infant was delivered by induction of vaginal birth two days later due to premature rupture of membranes during the embolization.
The infant had normal cardiac output following birth and did not require any cardiovascular support or surgery.
"While this is only our first treated patient and it is vital that we continue the trial to assess the safety and efficacy in other patients, 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," lead study author Darren Orbach, MD, PhD, co-director of the Cerebrovascular Surgery and Interventions Center at Boston Children's Hospital, said in the release. "This may markedly reduce the risk of long-term brain damage, disability or death among these infants."