On May 7, 2021, in the cleveland clinic's operating room, Dr. Darrell Cass slowly cut open Sam Drinnon's uterus, gently lifting the arms and shoulders of fetus Rylan out of the uterus.
This is no ordinary caesarean section. Instead, after the surgery, Rylan was stuffed back into the uterus by the doctor and was not officially born until 10 weeks later. The brief "advent" of Rylan begins a week ago.
The multidisciplinary team at the Cleveland Clinic performed this rare and complex procedure to remove a tumor on the heart of a 26-week fetus. (Image source: References[1])
Rylan is Sam's second child. During a routine B-ultrasound check-up at the end of April, doctors found a lump inside the fetus's heart.
Sam recalls that when she called her husband to tell him the news, countless emotions came to mind at the moment the phone was connected: "I thought I was going to lose my child, but the doctors said they would hire the best team to treat me." ”
Sam was then referred to the Cleveland Clinic, where he was received by Dr. Cass, a specialist in fetal surgery. There, the fetus in her abdomen was diagnosed with an intrapericardial teratoma.
Teratoma is a common tumor in fetuses and newborns, with an incidence of about 1 in 30,000, more women than men, and mainly originates from somatic totipotent stem cells in Henson's nodules in the sacrovascular region. In adults, teratomas also occur from time to time, mainly from unfertilized germ cells.
Among various tumors, teratoma can be said to be a "strange flower". Other tumors are basically a lump of "meat" with uniform texture, but teratomas can exist in skin, teeth, hair, fat, bones and other tissues at the same time, mixed together in a mess, like an undeveloped embryo, which looks scary.
Unlike its "scary" appearance, the vast majority of teratomas are benign tumors, but very few internal structures are unclear, there is no or little formed tissue, and the less frightening-looking teratomas are malignant.
In general, whether it is an adult or neonatal teratoma, it is not a big problem, the survival rate is very high, but the mortality rate of fetal teratoma can reach 50%. This is mainly because fetal teratomas can lead to excessive amniotic fluid, triggering premature rupture of membranes and preterm birth.
Rylan's condition is even more critical, having already crushed the left heart, affecting blood circulation, and continuing to grow. Before the surgery, Rylan had developed a fluid effusion around her heart and other organs, a condition known as fetal edema and a manifestation of deteriorating fetal heart function.
Sam's team talked to her before the operation (Source: Reference[1])
Faced with such a critical situation, Dr. Cass convened a team of experts to develop a treatment plan for Sam and Rylan. Pediatric cardiac surgery expert Hani Najm, maternal-fetal medicine expert Amanda Kalan and other experts believe that even if conservative treatment is carried out to eliminate the effusion in the fetus, the problem will quickly recur, and surgery is the best way to save Rylan.
Dr. Najm had previously performed a new intracapsular teratoma resection for the baby, but it was the first time that the fetus had been operated on. Before the operation, he asked another chief surgeon, Dr Cass, a question: "Can you really get me into his chest safely?" After receiving a positive response, Dr. Najm also said that he would do his duty to complete a great operation together.
On May 7, the surgery began, the initial operation being performed by Dr. Cass. This part of the procedure is similar to a caesarean section, where Dr. Cass cuts open Sam's uterus and pulls out the fetus's arms, exposing the fetus's chest to the incision in the uterus.
Next, Dr. Najm took the stage. In response to what might happen in the next surgery, Dr. Najm managed to insert an intravenous infusion tube in the right arm of the fetus.
Dr. Najm inserts an INTRAD tube in the right arm of the fetus (Image source: Reference[1])
He drained the fluid from the new bag as quickly as possible and removed the tumor, seeing an immediate effect: "All of a sudden, the heart was beating normally. The pressure on the left atrium disappears and blood flows well. ”
Najm then sutured the incision in the fetus's chest, and Dr. Cass and Dr. Kalan teamed up to send the fetus back to the womb, suturing the incision in Sam's abdomen.
▲Schematic of the surgical process (Video source: Reference[1])
A few days later, Sam returned home. After 10 weeks, at a gestational age of 36 weeks and 2 days, Sam felt he was about to give birth and went to the hospital again. On July 13, 2021, Rylan was born by caesarean section with a birth weight of 6 lbs. 4 ounces (about 2.8 kg).
Except for surgery that will be required in the future to repair a scar in the affected sternum and chest during surgery, Rylan is fine.
▲ Rylan was born safely (Video source: Reference[1])
Sam is grateful for Rylan's birth, saying: "Hopefully he can live a normal child's life, just with a scar on his chest." ”
Her husband Dave added: "I come home from work every day to see my son, who goes through a lot of things to be here. Hopefully, when he grows up and looks back on it all, he will think that nothing will bother him. ”
Image source: 123RF
All footage in the text is from the Cleveland Clinic
Some references:
[1] Surgery on Baby in Womb Removes Life-Threatening Tumor on Heart. Retrieved Dec 30, 2021, from https://my.clevelandclinic.org/patient-stories/534-surgery-on-baby-in-womb-removes-life-threatening-tumor-on-heart
[2] Cleveland Clinic Fetal Surgeons Resect Rare Intrapericardial Teratoma. Retrieved Dec 30, 2021, from
https://consultqd.clevelandclinic.org/cleveland-clinic-fetal-surgeons-resect-rare-intrapericardial-teratoma
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