Magee-Womens Hospital of UPMC expands fetal center

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For the past three years, maternal/fetal medicine specialist Stephen Emery has been working to expand the fetal center at Magee-Womens Hospital of UPMC into a comprehensive and elite program like the renowned Fetal Care Center of Cincinnati.

Magee's Fetal Diagnosis and Treatment Center actually has been around since 1992, but, Dr. Emery said, "there really wasn't a treatment component."

Dr. Emery came to Magee from the Cleveland Clinic with the license to change that.

"The first objective was to put all the pieces in place and develop relationships [outside the program] with the type of people necessary for a fetal therapy program," he said. That includes specialists such as anesthesiologists trained specifically to anesthetize pregnant women and their fetuses, geneticists, radiologists, bioethicists and various pediatric subspecialists.

"The list goes on and on," he said after estimating there could be as many as three dozen specialists involved.

So does the list of treatments being developed. One now available is minimally invasive in utero heart surgery, which means the procedure is done when the fetus is still in the uterus and without an incision.

One little patient named Jackson Barrett, from Pine, had such surgery July 24, roughly four months before his birth on Nov. 30. His aortic heart valve was too small, a problem that left uncorrected could lead to hypoplastic left heart syndrome. Often fatal, that is a condition in which the left ventricle, or lower left chamber of the heart, doesn't develop properly, forcing the right ventricle to do the work of two.

Dr. Emery enlarged the valve, using nothing more than a wire, a needle and a balloon.

Using ultrasound for guidance, he said, "we pass the needle through the maternal skin, through the abdominal wall and through the uterus into the fetal chest and on into the left ventricle. Then we pass a wire through the valve and pass a balloon over the wire to the level of the valve and inflate the balloon and dilate the valve."

The balloon is then deflated and pulled out along with the needle and wire.

Baby Jackson's surgery went "perfectly," Dr. Emery said. Unfortunately, he still needed open-heart surgery shortly after birth, and he will need two more open procedures over the next couple of years.

"We got really good flow through the valve, but I think already there was too much damage to that left ventricle and so we didn't achieve normalization of the ventricle's function," Dr. Emery said.

Still, the in utero surgery on Jackson had to be considered a success and will be used again.

The Magee center also soon will be offering laser treatment for twin-to-twin transfusion syndrome, a disease of the placenta, or afterbirth, that affects identical twin pregnancies. The fetuses share one placenta that contains abnormal blood vessels connecting the twins' umbilical cord and circulations.

Dr. Emery said the new laser equipment is being purchased thanks to a $330,000 grant just given by the Twenty-Five Club, a group of philanthropic business women that has supported Magee since 1939.


Pohla Smith: psmith@post-gazette.com or 412-263-1228.


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