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Incomparable care for the tiniest patients

Posted 10/1/2018 by James Strainic, MD
Director, Fetal Heart Program, UH Rainbow Babies & Children’s Hospital
Assistant Professor, Case Western Reserve University School of Medicine

Ellie Ragsdale, MD
Director, Fetal Intervention, UH MacDonald Women’s Hospital
Assistant Professor, Case Western Reserve University School of Medicine

Specialists team up to perform a rare procedure in utero to save a baby’s heart

Anthony, Lorenzo, and Heather Catanese

When Heather Catanese was 22 weeks pregnant with her third son, Lorenzo, she underwent a routine prenatal anatomy scan. The test showed that something was wrong – blood was flowing in the wrong direction through Lorenzo’s heart.

Heather and her husband, Anthony, were referred to James Strainic, MD, Director of the Fetal Heart Program at University Hospitals Rainbow Babies & Children’s Hospital. He was able to see them the next day. During the appointment, testing revealed that Lorenzo had a very serious condition known as impending hypoplastic left heart syndrome (HLHS). “Babies with this condition are born with half a heart,” Dr. Strainic says. “As a result, the left chambers of the heart are too small to pump blood to the body.” In addition, the fetal echocardiogram showed a complex form of this type of heart disease with severe leakage of the left heart valve, the mitral valve.

The outcomes for babies with this combination of problems (severe aortic stenosis and severe mitral valve regurgitation) are grim. They have about a 10 percent chance of surviving to age 6 months. But there was a chance that Lorenzo’s story could be different. Dr. Strainic told Heather and Anthony about an innovative procedure that could be done while the baby was still in utero (in the womb) to help the left side of his heart grow.

That same day, Dr. Strainic discussed Lorenzo’s case with members of the Congenital Heart Collaborative’s Fetal Cardiac Intervention team. This multidisciplinary team includes experts in maternal fetal medicine, fetal cardiology and pediatric interventional cardiology from UH Rainbow and UH MacDonald Women’s hospitals and Nationwide Children’s Hospital. Together, the team agreed that Lorenzo was a candidate for the procedure. Dr. Strainic called Heather and Anthony that evening to offer them the option.

Making the decision

James Strainic, MD

James Strainic, MD

The next few days were a whirlwind. “We met with several members of the team to discuss our questions and help us understand the procedure,” Heather says. The family also received opinions from teams in other parts of the country that performed the same procedure. “Ultimately, we decided to move forward with the team at UH Rainbow,” she says. “We appreciated how communicative and open they were with us and with each other. We felt like no other team of doctors was as invested in our baby as the team here at UH.”

The clock was ticking. “The ideal window for performing this procedure is between 23 to 26 weeks of gestation,” says Ellie Ragsdale, MD, Director of Fetal Intervention at UH MacDonald Women’s Hospital. “The earlier we do it, the better.”

On February 7, 2018, at 24 weeks of pregnancy, Heather underwent the procedure, known as in utero fetal aortic valvuloplasty, at UH Rainbow. Under ultrasound guidance provided by Dr. Strainic, Dr. Ragsdale placed a needle through Heather’s abdomen, into her uterus and into Lorenzo’s heart. Then Aimee Armstrong, MD, Director of Cardiac Catheterization & Interventional Therapies at Nationwide Children’s Hospital, subsequently expanded a balloon in Lorenzo’s aortic valve to increase blood flow through the left ventricle. “The goal is that the increased blood flow will aid the development of the left side of the heart and prevent HLHS,” Dr. Strainic says.

The Congenital Heart Collaborative team is one of only eight centers nationwide that offer this procedure and the only provider of this type of care in Ohio.

“The turning point in this whole experience occurred as we left one of our follow-up appointments with Dr. Strainic a couple months after the procedure,” Heather says. “I realized that Anthony and I had gone from discussing the most important things we wanted to do in the little time that we would get to spend with our baby to talking with Dr. Strainic about what sports he would be able to play in high school!”

A future full of possibilities

Ellie Ragsdale, MD

Ellie Ragsdale, MD

After the successful procedure, the remainder of Heather’s pregnancy progressed smoothly. She visited Dr. Ragsdale and Dr. Strainic nearly every week to make sure that she and Lorenzo were doing well. On May 18, at almost 39 weeks’ gestation, Dr. Ragsdale delivered Lorenzo.

“There were so many unknowns,” Heather says. “We didn’t know how his heart would function outside of the womb or if we’d get to see him or hold him right away.” Happily, they were able to hold him in the delivery room before he was taken to the neonatal intensive care unit for closer examination.

At 4 days old, Lorenzo was ready to go home with his family. “We were so excited to take our son home and are so thankful for the Congenital Heart Collaborative team, especially Drs. Strainic, Ragsdale, Armstrong and Bocks, who not only saved our son’s life, but have given him a higher quality of life than we ever could have hoped for.”

Today, Lorenzo is a healthy baby boy and receives monthly echocardiograms from Dr. Strainic. He loves watching and interacting with his two big brothers, Gianni and Luca. “I can already tell that he’s going to try to keep up with them,” Heather says. “We couldn’t have asked for a better outcome.”

Expert care, before and after birth

To learn more about our Fetal Heart Program, visit Rainbow.org/Heart.

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