Durban - In a pioneering procedure, a healthy baby boy has been safely delivered, two months after a life-saving procedure was done to remove deadly fluid around his heart.
It is believed to be the first time such an operation has been carried out in South Africa and is possibly the first of its kind in the world.
Now, Dr Ismail Bhorat – who heads the special foetal-surgical unit at Inkosi Albert Luthuli Central Hospital in Durban – will write about the unique case in medical journals.
He will detail how his team corrected the foetus’s dangerous and rare cardiac condition, to guide doctors around the world in the management of patients with similar complications.
“It’s been an amazing outcome and there has been a lot of global interest,” said Bhorat, a foetal-maternal specialist.
The still-unnamed little boy, at the centre of all the attention, was born by Caesarean section at the hospital on Wednesday, weighing 2.8kg.
A seven-strong medical team waited in the theatre for his mother, Thandazile Ntheta, and the baby was delivered by Bhorat and Dr Samantha Bhudram.
“He arrived beautifully and in excellent condition, as evidenced by loud screaming: a good sign that there is nothing wrong with his lungs,” said Bhorat.
He said the birth was particularly special for the foetal-surgical team because the baby would not have “had a chance” if the delicate procedure was not performed before he was born.
It had been so successful that Bhorat and his team decided to allow the baby to go full term before delivering him, instead of earlier as usually happened in complicated cases.
Saving the baby’s life before he was due to be born had been a race against time.
Ntheta, who lives in Shakaskraal on the North Coast, had gone for a routine check-up at her clinic and had been referred to the Inkosi Albert Luthuli Central Hospital, after clinic staff believed there was excessive fluid around the heart.
“We did a foetal scan and realised we were looking at an extremely rare foetal cardiac condition,” Bhorat said.
The foetus had a vascular malformation in the outer chamber of the heart (called a ventricular aneurysm) that was leaking fluid and accumulating in the space around the heart, known as the pericardial space.
This was compressing the heart and lungs, resulting in poor contractility of the heart with an abnormal heart rate.
“The foetus was in a critical condition and we realised that if we did not do something quickly, the heart was going to arrest in the next day or so,” Bhorat recalled.
“The problem was that we did not have a precedent and not having anything to go on in terms of management. There had only been a handful of cases reported worldwide and those foetuses had died.”
But Bhorat had the benefit of performing previous life-saving procedures for various other conditions before babies were born and knew that he could use the principles of foetal surgery in this case.
The first foetal procedure was carried out four years ago and there had been 31 successful operations since then.
“These previous procedures paved the way for this case, they allowed us to be innovative and push the envelope,” Bhorat said.
It was an emergency and timing was everything. The expectant mother, who has three other children, was in the operating theatre within hours, where Bhorat and his team carried out a pericardiocentesis (foetal cardiac surgery) through ultrasound control to relieve the pressure on the heart and extract the fluid.
They were operating in a very tiny space and knew that one wrong move with the needle – that had to be inserted to drain off the fluid – and the foetus could bleed to death.
“We had to be very precise. We had to get the procedure just right and it was critical to get the foetus into the correct position. We scanned the foetus for an hour so that we could get to a position where we could get access to the pericardial space,” Bhorat explained.
The tricky procedure involved inserting a needle through the mother’s stomach, through the uterine wall into the amniotic fluid, through the foetal chest wall and into the space around the heart through ultrasonic control.
As the needle went into the foetus’s chest wall, it began to move and Bhorat realised he had to put the needle into the space around the heart immediately, in the event the foetus moved further.
He then extracted 30ml of blood and water.
“Amazingly, once the fluid was extracted, the heart began to expand beautifully, contract normally and the heart rate returned to normality. It was an instant improvement right before our eyes. We did not know if the fluid would accumulate again once we removed the needle. However, it didn’t.
“We believe once the fluid was removed, the vascular malformation stopped leaking as it lay next to the lining of the heart (the pericardium) and thus the foetal pericardiocentesis resulted in a spontaneous resolution of the problem.”
The expectant mother stayed in hospital until the baby was born because she needed intense monitoring, but there were no further problems.
Bhorat said the multi-disciplinary foetal-specialist unit at the hospital was the first in the country. A joint venture between foetal surgeons and paediatricians, it was still being established and would be launched soon.