At just 24 weeks of gestation, Tucker Roussin underwent fetal surgery at the Children’s Hospital of Philadelphia to treat a life-threatening tumor connected to his heart. Now, he is a healthy 3-year-old preschooler, the hospital reported today.
Intrapericardial teratoma is a rare, rapidly growing tumor that can be detected while the child is in utero. The tumor is lethal if untreated. The traditional strategy to deal with them is to drain pericardial fluid and to remove the tumor surgically following delivery. But rapid prenatal growth of the tumor puts a dangerous amount of pressure on the heart and can lead to poor fetal circulation and death.
The team at the Children’s Hospital of Philadelphia are the first to remove the tumor surgically while the child was in-utero.
“Managing this type of teratoma presenting before birth is a challenge, but we show that survival with good outcome may be possible in some patients,” Dr. Jack Rychik, director of the Fetal Heart Program at The Children’s Hospital of Philadelphia, said in prepared remarks. “It was the ability to bring so many different disciplines to the table that made us confident enough to take the leap to offer in-utero surgery on a fetal heart as a viable option.”
The hospital reported a case series of 8 fetuses with suspected intrapericardial teratoma seen at the hospital between 2009 and 2015. 6 of the fetuses were confirmed to have the rare tumor and only 2 survived, both following surgery. 1 patient underwent open fetal surgery at 24 weeks gestation and the other patient had an ex utero procedure at 31 weeks gestation.
The 4 patients with an intrapericardial teratoma who died did not undergo fetal surgery, because the referral was late the fetuses were too sick to benefit from the procedure.
The team’s fetal surgeons have performed more than 1,350 in utero surgeries, according to the hospital.
“The current era offers technological advantages, such as improved prenatal imaging, improved cardiovascular surveillance through fetal echocardiography, and fetal surgery techniques,” co-study leader Dr. Nahla Khalek added. “A crucial factor is implementing treatment before fetal heart failure occurs. Our findings underscore the importance of promptly referring these cases to a multidisciplinary fetal therapy center during the optimal window of opportunity for both the fetus and mother.”
“Removing a tumor from a baby’s heart in-utero present significant risks for both the mother and the baby. Timing and coordination early in the illness is vitally important,” co-author Dr. Holly L. Hedrick explained.
“The pioneering fetal surgery to remove a tumor from a baby’s heart is an incredible breakthrough and an innovation in the care that can be provided to a family who receives this devastating diagnosis,” co-author Dr. J. William Gaynor said. “We need to constantly ask new questions and take our work in new directions by bringing the top experts in their fields to counsel and provide state-of-the-art care to our mothers and babies.”