WTI Magazine #23    2014 Mar, 28
Author : BuoneNotizie.it      Translation by:

They are the doctors of the Unit 4 of Bergamo Hospital "Pope John XXIII", the all-Italian hospital team destined to make history and change the practice of the international modern medicine. In this structure, in fact, 8 Professionals (2 gynecologists, 1 cardiologist, 1 anesthetist, 2 midwives and 2 nurses) have successfully practiced the first prenatal cardiac surgery intervention without opening the abdomen of the pregnant woman. The surgery is the third intrauterine cardiovascular intervention performed in Italy.

The first was in 2011 right in Bergamo, in the same building, then still known as the "United Hospitals". At that time the doctors worked with a team of the University Hospital of Madrid "12 de Octubre", practicing a balloon aortic valvuloplasty. It was then the turn of the doctors from "Le Molinette" Hospital of Turin, who in 2011 practiced a pulmonary valvuloplasty.

So today, once again is the excellence of Bergamo to be brought at our attention. The references for this type of procedure are Toronto and Boston, where already 20 or 30 cases of prenatal surgery have been successful. The procedure is extremely delicate and risky, only done in extreme cases, or when the benefits of the intervention outweigh the risks of the practice. And this was the case of the small patient operated in Bergamo, which, thanks to an early screening, had already been diagnosed with hypoplastic left heart, as to say a heart defect that prevents the development of the left side of the organ.

The already severe disease was in this case further aggravated by a total closure of the atrial septum, which occurred at 32 weeks, which would not allow the small fetus to survive at birth. Here is the procedure of the intervention explained by the protagonists themselves.

The operation was successful, and the blood of the fetus began to move successfully from the heart to the lungs. Although doctors do know "this is only the first step". Now we have to wait for the birth of the little patient and the following actions which patients with cardiac hypoplasia usually undergo. The road to a normal life for the little one is still long, but thanks to technology and to prenatal surgery practiced in some Italian centers of excellence, there is a a growing number of unborn children who are given a greater life expectancy.

Currently in Italy there are several centers for the fetal operations. In addition to Bergamo Hospital "Pope John XXIII", there also are Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico –Mangiagalli Clinic in Milan (where approximately 20 complex operations a year are performed) and OBM, Children's Hospital of Milan Buzzi (with about 80 interventions per year). But it should also be remembered the first center Exit (ex utero intrapartum treatment) Italian, a collaboration between the Policlinico Agostino Gemelli and Children's Hospital Bambino Gesù in Rome.

During the years, in addition to surgery prenatal, also neonatal interventions are becoming more widespread. Another case that made news recently is from the United States and covers a small 14 months child named Roland, who was also suffering from a congenital malformation of the heart. Roland was saved by a singular heart surgery that doctors were able to perform successfully after using a device for printing 3D body (double size of the original) that allowed them to study and apply during the intervention a procedure that otherwise, due to the minimum size of the baby's heart, they would hardly be able to apply. Not to mention that the 3D reproduction of Roland's heart cost just $ 600 and was obtained in only 20 hours of work, allowing the equipe huge savings in time and money.