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t m c » p u l s e | j u n e 2 0 1 4 36 Team Performs Successful Open Fetal Surgery to Treat Rare Condition SHORT TAKES the good outcome achieved in this case is the result of great teamwork, including the contributions by our expert fetal radiologists, cardiologists and maternal fetal surgery team. — darrel caSS, M.d. co-director of texas children's fetal center During the procedure, surgeons partially removed the baby from his mother's womb, opened the baby's chest and removed the giant mass, returning him safely back into his mother's womb less than 30 minutes later. (Credit: Texas Children's Fetal Center) B aby Cabellotrejo was born healthy last month at Texas Children's Pavilion for Women following a com- plex pregnancy that involved open fetal surgery. The announcement was made by the physicians at Texas Children's Fetal Center, who, early in the preg- nancy, diagnosed baby boy Cabellotrejo with a very large lung mass, called congenital cystic adenomatoid malformation (CCAM). Mom and baby were transferred from their hometown of Austin to Texas Children's Fetal Center in Houston, where a nationally recognized, multidisciplinary team of surgeons intervened with an open fetal surgery that saved the baby's life. During the procedure, surgeons par- tially removed the baby from his moth- er's womb, opened the baby's chest and removed the giant mass, returning him safely back into his mother's womb less than 30 minutes later. The fetal heart failure resolved, and the baby and mother subsequently recovered smoothly. Mom remained pregnant for over 11 weeks before she delivered her health baby boy. To date, only two other centers in the world have been successful at treating this rare and complex medi- cal condition, an abnormal growth of malformed lung tissue that is the result of abnormal organ development. The adenomatous overgrowth of terminal bronchioles and reduced number of normal alveoli may cause significant pulmonary effects. It is incredibly rare for these malformations to grow to such a large size as to lead to fetal heart fail- ure, a condition that is very difficult to treat prenatally. The fetus continued to deteriorate despite medical treatment. "Fetal surgery was the only hope for this baby boy who was sure to die without surgical intervention. The good outcome achieved in this case is the result of great teamwork, including the contributions by our expert fetal radiol- ogists, cardiologists and maternal fetal surgery team. I am so pleased this baby has recovered fully and now has the hope of a completely normal life," said Dr. Darrell Cass, co-director of Texas Children's Fetal Center, and lead sur- geon on this case. "Baby Cabellotrejo is a fighter and a survivor. We are ecstatic that his parents have delivered a healthy baby boy." The open fetal surgery involved removing the mass, which had over- grown the left lower lung of the fetus. In order to reach the mass, the arm and part of the shoulder were extracted from the mother's womb. Time and precision are, of course, crucial in the success of this surgery. In addition to an expert operating room team and pediatric anesthesiologists, a multidisciplinary team of specialists led the surgery from Texas Children's Fetal Center. "Texas Children's Fetal Center is one of only a few centers in the world capable of such a complex surgical intervention," Belfort says of his team. "We have acquired a team of experts from around the world who focus specifically on fetal surgery, all with top technical skills and a commitment to medical innovation, which makes our center one of a kind." — Sarah Frankoff, Texas Children's Hospital