How this baby survived heart surgery — before he was born
Toronto MDs perform what’s thought to be world’s first use of in utero procedure to treat Sebastian’s congenital heart defect
An anatomy scan is routine for pregnant women at 20 weeks. That was when Kristine Barry learned her baby had a heart defect that would require what’s believed to be the world’s first use of in utero surgery to treat this condition.
Doctors at the Hospital for Sick Children and Mount Sinai Hospital were quick to assure Barry, 25, and her husband, Christopher Havill, 27, that they could fix the problem.
They diagnosed the couple’s first child, Sebastian Havill, now 9 weeks old, with severe complete transposition of the great arteries (TGA).
It’s a congenital heart defect that occurs when the pulmonary artery and aorta are switched, and the heart can’t adequately circulate blood through the body.
Barry said her first thoughts were “Why me, why my baby?”
To fix the problem, surgeons normally perform open-heart surgery on the infant to switch the arteries within a week of birth. But there was a complication in this case.
All the walls in Sebastian’s heart were closed shut, meaning his blood wouldn’t get oxygen after his birth, which could have led to severe brain damage or death within minutes.
“Previously, doctors had the baby born by C-section and then rushed it over to Sick Kids for a balloon procedure,” Barry said. “If he was born over at Mount Sinai, he wouldn’t have enough time to be moved to Sick Kids. He likely wasn’t going to make it.”
So the doctors — Edgar Jaeggi, Rajiv Chaturvedi and Greg Ryan — devised a different plan to save her baby.
On May 18, Barry went into the operating room, and Sebastian had what’s believed to be the world’s first balloon atrial septoplasty surgery in utero to treat TGA.
With ultrasound guidance, the doctors inserted a needle into Barry’s uterus and into Sebastian’s heart to blow up a tiny ballon, making a hole about 3.5 millimetres wide in his atrial septum. This allowed the blood and oxygen to circulate properly, a temporary fix until they could per- form surgery after birth.
About 30 medical staff were there to assist in the procedure, including surgeons, cardiologists, a person with an incubator and a doctor to do a caesarean section in the likely case that Barry had to give birth early.
“I was weirdly calm. I put all my belief in that it was going to work, but I went in with the mindset that I was having a baby that day,” Barry said. “The way they described our options for that day, I had a two-out-of-three chance for having a baby, so I went in thinking, ‘I could be meeting my son today.’ ”
Just 20 minutes later, the surgery was over and the room erupted in applause, Barry said, who cried when she realized that her baby could be born healthy.
Five days after the surgery, Barry was induced into labour and gave birth to Sebastian only10 minutes in.
“He came out pink and screaming, and I was just in shock. I didn’t believe that was what was going to happen,” she said.
A week after his birth, Sebastian successfully underwent the openheart surgery that babies with congenital TGA must have, and he was sent home the week after.
About three babies a year in Ontario have the same extreme case of congenital heart defect that Sebastian has. His parents will take him to a neurodevelopment program at Sick Kids to make sure he’s hitting all his milestones at 6, 12, 18, 24 and 36 months old.
Barry and Havill have been told that Sebastian may run into issues at any stage in his development, but in general he is expected to lead a normal life.
If Sebastian has any development problems, Barry said, the doctors at Sick Kids can help by teaching them exercises to do at home, or sending a support worker to help with speech or physiotherapy.
“They want us to let him be a kid and run around and get his blood pumping and his heart working really well. They don’t want us bubble-wrapping him and being too protective,” Barry said. “They want him to live a normal life as much as possible.”