Breakthrough operation on unborn child in Durban a first in SA

2016-09-14 09:21
This image shows the actual procedure with the needle insertion and tip of the needle in the pericardial space; i.e. the space around the foetal heart. (Supplied)

This image shows the actual procedure with the needle insertion and tip of the needle in the pericardial space; i.e. the space around the foetal heart. (Supplied)

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Durban – A foetal specialist from Durban has made history by successfully performing a rare operation on an unborn child. The surgery involves draining fluid from the foetus's chest cavity while it is still in the womb.

Less than two weeks ago, a woman from Stanger who was six-and-a-half months pregnant was referred to the Inkosi Albert Luthuli Central Hospital's foetal unit in Durban after complications arose with her pregnancy.

- Health24: Pregnancy

Following a number of scans and tests, Dr Ismail Bhorat and his team discovered that the woman's baby was suffering from a rare condition which affected its breathing as well as the contraction of the heart.

A malformation on the outer part of the baby's heart was causing fluid to fill the pericardial spaces around its heart, and this resulted in the compression of the foetus' heart and lungs. The official term for the condition is 'pericardial effusion'.

"This case is extremely rare, so we're looking at one-in-300 to one-in-600 000 cases. It's extremely rare," Bhorat said.

"The problem is this was not done previously in the foetus, but that was the only chance we had to save [the baby]. So I had to make a call at the time to say 'Hey, I'm going ahead, I'm going to do this'," he said.

Experience and skill

The procedure was extremely risky and required the team to be both delicate and intricate, but Bhorat was confident they would be successful.

"I was quite comfortable that we could try and actually do the procedure, and it was extremely successful… but I think the issue is that it hadn't been done previously, we didn't have a precedent to actually go by, and we had to use a lot of our training that we developed over the years."

Bhorat and the team managed to drain 30ml of fluid from the foetus's pericardial space and soon after the operation was complete, the baby could be seen kicking and moving normally again.

A week-and-a-half after the procedure, Bhorat was impressed with the outcome.

"It was a culmination of all that experience and skill that we developed in order to do this intricate foetal cardiac surgery. I just saw the baby now and the baby is absolutely fine, kicking beautifully. The mother is fine, she is happy."

However, Bhorat had experienced a bout of nerves ahead of the procedure itself, he admitted.

Adrenaline rush

"There is lots of nervousness but I think once the adrenaline kicks in, you're really focused to actually do this. Also in the back of your mind [you think] if you're not going to do this, the baby is going to die."

He said once he had made the call to go ahead with the procedure, there was no turning back.

"You are literally committed. Once the adrenaline kicks you just want to go and get this thing right."

The father of five recalls shaking and sweating after realising the job had been successfully done.

The image on the left was taken before the procedu
The image on the left was taken before the procedure, showing fluid accumulation around the heart (pericardial effusion) and the fluid compressing the heart and lungs. The image on the right was taken after the procedure, showing resolution of the fluid around the heart, now noted to be contracting normally. (Supplied)

Bhorat has been working with the hospital's foetal unit since 2012.

He believes that finding ways to solve complications before the foetuses come to term gives them a better fighting chance in the real world.

"I think if you wait to try and solve problems when the foetuses are born it will be a bit late.

"A lot of the problems can be sorted out inside the womb, so that when the babies are born the problems are all resolved. It's harder to sometimes solve problems once they are born," he said.

Family support

The feeling of knowing that he had played a part in improving a child's chances at living a full life was very satisfying, he said.

"It's an absolutely fantastic feeling when you can have a foetus who is really sick, inside the uterus, and seeing the baby being born well and actually developing normally. There is no greater feeling than that. It is an absolutely satisfying feeling."

Bhorat is a father to four daughters and a son. Three of his daughters are currently following in his footsteps and studying medicine at the University of KwaZulu-Natal, just as he did. His wife is a pharmacist.

The 55-year-old said he had also been inspired to study medicine by his own father, who was a GP in the 1950s in Stanger, where Bhorat grew up.

"I really enjoyed what he was doing. He used to go out in the middle of the night to see patients and he was a role model for me. I think that kind of vision that he was doing got inculcated into me and I really wanted to help people as well," he said.

When he is not busy saving lives, he prefers to unwind by swimming and spending time with his family.

"I need the support of a family to actually do this kind of thing because it is emotionally draining, so you need to have a strong family structure to balance things out."

Read more on:    durban  |  health  |  good news

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