Tracheal Occlusion Surgery: Inserting The Balloon

tracheal occlusion surgeryMarch 25, 2014

We arrived at UCSF Fetal Treatment Center at 8:30 am on Thursday, March 20, 2014. Today was the day.  Today we undergo balloon tracheal occlusion surgery.  According to UCSF doctors, this is a last measure for extreme CDH cases and for us, a chance at life.

First things first, an ultrasound to determine her position. From our previous fetal treatment diagnosis at UCSF, we understood that not only was she in the most difficult position possible—head down, but the location of my placenta made the surgery even more challenging.  There was a strong possibility that we could go through all the steps leading up to the surgery and doctors wouldn’t be able to implant the balloon.  After scanning, we discovered baby Savannah is still head down. 

Before we were omitted to labor and delivery, we met with our perinatologist. She delivered even more disheartening news.

‘If something happens during the procedure or within the first two weeks after implanting the balloon, we will not make any heroic efforts to resuscitate baby.  With the severity of her condition, there just isn’t enough time for her lungs to improve.  The risk becomes greater to you and future pregnancies.’

She proceeded to say …

‘After the two-week marker, we’ll make every heroic effort to save baby—ventilator, breathing tube, ECMO …’

I just looked at Nicholas with glossy eyes and confusion.  I thought to myself … no heroic efforts, than what am I doing?!  I understood, but hearing that right before surgery was difficult.  I knew this was our last effort and without the surgery her chances were so bleak. Preterm labor is common with fetal intervention and if she’s born while the balloon is still in-place, doctors would need to do an EXIT procedure.

After being omitted to L&D, I knew it was time.  The nurses prepped me for surgery. I was so scared.  I knew this just had to work.  Doctor, upon doctor, upon doctor visited our room explaining the procedure and their specialty surrounding the procedure. UCSF is a research-based hospital, so I really appreciate the team effort.

Savannah Hopes Surgery

Before we went into surgery, Dr. Hirose, Nicholas, and I joined hands and asked God for his presence … his hand to guide the surgeons hands … his miracle.  Instantly, tears rolled down my face.  

I just kept repeating in my head … God, please, please guide his hands and save my baby.  Please give her a chance at life!

Once I entered the operating room everything happened so fast.  The room filled with even more doctors, nurses, perinatologists, and anesthesiologists.  Once the epidermal was administrated, I began to feel numb.  I couldn’t move my legs.  The anticipation and noise started to raise my anxiety levels.  I keep fidgeting and trying to move—as desperate as I was to move, I couldn’t.  Instantly, I lost all sense of calmness.  The anesthesiologist heard me struggling and administered a mild sedative to calm me down.  As my anxiety began to ease, I could focus on the doctors words.  I’ll never forget them.

‘There is an opening, right there … we can enter throughout that pocket.’

The sound in their voice was one of surprise.  She literally turned, opened her mouth, and gave them a clear pathway to do the surgery.  It was a miracle.  There was no need for the perinatologists to even move her.  I was relieved. They quickly finished the procedure and rolled me back into recovery with Nicholas.  As soon as the doors opened Nicholas just looked at me and cried.  We celebrate each moment we have with her—each step is a blessing.

Now, she just needs to stay put for six weeks to allow the balloon work and improve her lung development.  The doctor mentioned, on average, the balloon has increased development by 55%, but they are hopeful for 25%.  I’ll take even 5%—anything giving her a better chance at sustaining life after birth.

baby_diaphragm

PHOTO CREDIT: BBC NEWS

What is fetal tracheal occlusion?

Fetoscopic Tracheal Occlusion (FETO) is a minimally invasive procedure that uses a tiny detachable balloon placed inside the fetal trachea to temporarily block it in order to enlarge the fetal lungs.  Once the baby is in position a small 3 mm skin incision is made in the mothers uterus. The fetoscope is placed through the skin, into the uterus, and guided into the mouth and trachea of the fetus.  When the fetoscope has been directed into the trachea, a small catheter is used to guide the balloon to its proper placement site.  The balloon is inflated and detached in the trachea.

Once the fetal lungs develop, the balloon can be deflated and removed between 32-34 weeks.  Typically, it stays in for six weeks, but preterm labor is a common risk.  The goal is to keep in long enough for her lungs to develop.

Interestingly, the balloon is no larger than a single piece of arroz rice when inflated.

What happens once the balloon is inflated?

While in uterus, the fetal lung constantly makes fluid that escapes through the mouth and into the amniotic fluid.  When the balloon is inserted and the trachea ia blocked, the fluid stays in the lungs.  The lung fluid expands the lungs, stimulates growth, and pushes the organs away from the heart and back down into the abdomen. This allows the lungs to develop and grow in order to sustain life after birth.

Michael Harrison, MD, at the UCSF Fetal Treatment Center explains tracheal occlusion and exit procedure.

Please visit Prayers For Savannah Hope Facebook Page to celebrate her through encouraging words, inspirational photos, and prayer.  To stay connected with our full story, visit Savannah Hope’s Journey.  Thank you for all your love and support. 

My dearest friend Maytrella, who has been my guiding light and angel through all of this, shared the most powerful prayer on the day of Savannah’s surgery.  I love you my dearest friend.  You give us such HOPE and appreciation for life.  We are forever grateful and humbled by your beautiful soul.  xoxo ♥♥♥

“Heavenly Father, we ask that you intercede and place your divine grace and hands over this delicate surgery to give Savannah the best opportunity to develop and grow strong for the time of her birth. We pray that if there are any problems that they will be resolved through the specialists guided by You. We trust in You and ask You to graciously grant peace, patience, and strength to her parents, Heather & Nick, and the entire family. Amen.”

Next Entry:

One Small Miracle Followed by One Big Question Mark

Savannah Hope Fundraiser Button

Our dearest friend has set up a wonderful medical fundraiser for dearest Savannah.  We are so humbled and thankful for all your support.

References:

Congenital Diaphragmatic Hernia, UCSF Medical Center

Fetoscopic Endotracheal Balloon Occlusion, University of Maryland Medical Center

BBC News: Deadly Hernia Corrected in Womb

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