The La Fe Hospital in Valencia has successfully performed, for the first time in Spain, a surgical intervention to remove a cardiac tumor from a baby diagnosed in the fetal period, that is, before birth.
It was a rare cardiac tumor known as pericardial teratoma diagnosed in the 24th week of gestation (five and a half months) and which behaved aggressively, compressing the heart and neighboring structures, therefore, threatening the life of the baby and also from the mother.
As reported by the Generalitat in a statement, given the complexity of the situation, an exhaustive monitoring of the pregnancy was carried out by the fetal malformations commission of the La Fe Hospital, made up of a multidisciplinary group made up of specialists in obstetrics, neonatology, genetics, pediatric surgery, cardiology, neurology and radiology.
This committee initially decided on intrauterine management with obstetrics performing techniques to relieve tumor compression in order for the baby to complete weeks of gestation and avoid premature birth. In week 28 of gestation, that is, at six and a half months, and given the extreme severity, it was decided to extract the baby by cesarean section, weighing only 900 grams.
According to Raquel Escrig, head of the Neonatology section, “the complexity of the procedure was given by the fact that, due to the characteristics of the tumor, the patient could die immediately after cutting the umbilical cord that held her to the mother, so there was “We had to keep it attached to the placenta while the patient was stabilized and the surgical procedure began.” This is the technique known as EXIT (Ex Utero Intrapartum Treatment).
surgical operation
A surgical operation of more than thirty professionals was organized, consisting of two complete surgical teams: one for the mother with obstetric anesthesiology and specialists in obstetrics and gynecology; and the second for the baby, with neonatology, pediatric anesthesiology, pediatric surgery, pediatric cardiology and children’s cardiac surgery, in the same operating room.
For several days, the surgery was studied and rehearsed, recreating the scenario through clinical simulation. It is the first time that this type of operation is carried out at La Fe Hospital.
After the cesarean section, the girl was kept alive thanks to the placental assistance provided by her mother, allowing her to be intubated prior to clamping the umbilical cord and her immediate surgical intervention to remove the tumor that was compromising her life.
Sonia Garcés, specialist in pediatric anesthesiology at La Fe Hospital, explained that “this is an exceptional case because it is a premature baby. There are few reports in the scientific literature of children who, with such low weight, have survived this type of cardiac tumor without sequelae.”
Recovery and second intervention
The patient required a new intervention two months later by the pediatric surgery services, pediatric cardiac surgery, pediatric anesthesiology and the Pediatric Intensive Care and Resuscitation Unit to remove remains of the tumor that had grown again. After the same and two cycles of chemotherapy in children’s oncology at Hospital La Fe, the patient is free of the disease.
According to the manager of Hospital La Fe, José Luis Poveda, “the coordination and experience of the professionals at our hospital have been the key to the success of this operation. “This was a very complex challenge that represents a fundamental milestone in the treatment of cardiac tumors in premature babies.”