ORLANDO, FL - In an unprecedented procedure, surgeons at Orlando Health Winnie Palmer Hospital for Women & Babies performed a risky in-utero operation on a 25-week-old fetus diagnosed with a fatal lung condition. The child, Cassian, is now alive and thriving.
The diagnosis of Congenital High Airway Obstruction Syndrome (CHAOS) came from a second-trimester ultrasound, revealing overinflated lungs and a compressed heart. A blockage in the windpipe, a 5-millimeter membrane, was too large to treat with a minimally invasive laser.
Dr. Emanuel Vlastos and Dr. Cole Greves led the team. Typically, the ExIT procedure (ex-utero intrapartum treatment) is performed at birth, around week 37 to 39. But with a 1 in 4 risk of heart failure before that point, and Cassian's heart already failing, the parents urged action.
With ethics committee approval, doctors performed a C-section, exposed the fetal head and neck, drained lung fluid via a catheter, and returned the upper body to the womb. The catheter remained in place for the rest of the pregnancy.
"It is a tightrope walk, sometimes for several hours, while two lives hang in the balance," said Greves.
Cassian was delivered at 31 weeks. He needed a breathing tube at birth but is now being weaned off respiratory support. A future surgery will remove the remaining windpipe obstruction.
Vlastos hopes this case opens the door for global collaboration among fetal surgeons to refine the technique.