Heart op on five-month foetus

Foetal operations are becoming more common

Doctors believe they have successfully carried out a heart operation on their youngest-ever patient - a 23-week old foetus.

The procedure, carried out in Boston, US, in summer 2001, may have prevented the development of a heart defect which could have proved fatal.

The baby, called Jack, has now been born, and appears to be thriving.

Similar procedures have been carried out before - including several in the UK - but with limited success, and on older foetuses.

In order to reach Jack's heart - which, at 23 weeks, would be little bigger than a grape, cardiologists inserted a tiny catheter tube into the abdomen of his mother, through to the womb, and on into the organ itself.

A tiny wire was then pushed through the tube, and guided towards an obstructed heart valve - a target likely to be no more than 2mm to 3mm in diameter.

Doctors guide the catheter and wire using images produced by an ultrasound scanner.

Once across the valve, a minute balloon was inflated to widen the valve, then the balloon, wire and catheter pulled back out.

In total, it took no more than 20 minutes for a team of 12 doctors, nurses and technicians to complete.

Problem spotted

Doctors were able to operate on Jack because routine pregnancy scans had spotted the telltale signs that his heart was not developing properly.

In fact, he was in the early stages of hypoplastic left heart syndrome - one of the most life-threatening heart defects.

The blocked aortic valve prevents the left side of the heart from doing its job properly - pumping oxygen rich blood out around the body.

The malfunction means that the powerful left hand side muscles gradually stop working properly, normally withering away and becoming useless.

Only the limited pumping action of the right hand side of the heart keeps the baby alive.

By the time the baby is born, the damage has been done, and while there are complex operations to try to correct the problems, these still carry high mortality rates.

The foetal operation, despite being carried out on such a small heart, is relatively simple in comparison with the reconstructive or transplant operations needed once the baby is born.

Opening the valve so early meant that the normal development of the left hand side of the heart was allowed to continue.

There is a chance that the valve will close up again, but that has not happened so far - and doctors are hopeful that Jack will have a normal childhood.

Original team

Dr Lindsey Allan, a foetal cardiologist from the Harris Birthright Centre at King's College Hospital in London, was one of the original team who carried out the first operation of this type - on a 26 week old foetus - at Guy's Hospital in 1991.

She told BBC News Online that while the US operation was encouraging, this was likely to remain a very rare procedure.

She said: "You have to identify them early enough so that it will make a difference, and now success rates of other options are improving, there will be fewer parents willing to choose this method.

"But where there are suitable patients, this could be a route to go."