text: An anatomy scan is routine for pregnant women at 20 weeks. That was when Kristine Barry learned her baby had a heart defect that would require what’s believed to be the world’s first use of in utero surgery to treat this condition. Doctors at the Hospital for Sick Children and Mount Sinai Hospital were quick to assure Barry, 25, and her husband, Christopher Havill, 27, that they could fix the problem. 
   
   Doctors in Toronto performed in-utero surgery when a now two-month-old baby boy had a life-threatening heart condition. The boy?s parents say it was ?intense? to learn the procedure would be carried out in the womb. (The Canadian Press) 
   
   They diagnosed the couple’s first child, Sebastian Havill, now 9 weeks old, with severe complete transposition of the great arteries (TGA). It’s a congenital heart defect that occurs when the pulmonary artery and aorta are switched, and the heart can’t adequately circulate blood through the body. Barry said her first thoughts were “Why me, why my baby?” To fix the problem, surgeons normally perform open-heart surgery on the infant to switch the arteries within a week of birth. But there was a complication in this case. 
   
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   All the walls in Sebastian’s heart were closed shut, meaning his blood wouldn’t get oxygen after his birth, which could have led to severe brain damage or death within minutes. “Previously, doctors had the baby born by C-section and then rushed it over to Sick Kids for a balloon procedure,” Barry said. “If he was born over at Mount Sinai, he wouldn’t have enough time to be moved to Sick Kids. He likely wasn’t going to make it.” So the doctors — Edgar Jaeggi, Rajiv Chaturvedi and Greg Ryan — devised a different plan to save her baby. On May 18, Barry went into the operating room, and Sebastian had what’s believed to be the world’s first balloon atrial septoplasty surgery in utero to treat TGA. With ultrasound guidance, the doctors inserted a needle into Barry’s uterus and into Sebastian’s heart to blow up a tiny ballon, making a hole about 3.5 millimetres wide in his atrial septum. This allowed the blood and oxygen to circulate properly, a temporary fix until they could perform surgery after birth. 
   
   Baby Sebastian with his parents Christopher Havill and Kristine Barry at The Hospital for Sick Children. Five days before he was born, a surgical procedure was performed on Sebastian's heart while he was still in his mother's womb. ( Randy Risling / Toronto Star ) 
   
   About 30 medical staff were there to assist in the procedure, including surgeons, cardiologists, a person with an incubator and a doctor to do a caesarean section in the likely case that Barry had to give birth early. “I was weirdly calm. I put all my belief in that it was going to work, but I went in with the mindset that I was having a baby that day,” Barry said. “The way they described our options for that day, I had a two-out-of-three chance for having a baby, so I went in thinking, ‘I could be meeting my son today.’” 
   
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   Just 20 minutes later, the surgery was over and the room erupted in applause, said Barry, who cried when she realized that her baby could be born healthy. Five days after the surgery, Barry was induced into labour and gave birth to Sebastian only 10 minutes in. “He came out pink and screaming, and I was just in shock. I didn’t believe that was what was going to happen,” she said. A week after his birth, Sebastian successfully underwent the open-heart surgery that babies with congenital TGA must have, and he was sent home the week after. About three babies a year in Ontario have the same extreme case of congenial heart defect that Sebastian has. His parents will take him to a neuro-development program at Sick Kids to make sure he’s hitting all his milestones at 6, 12, 18, 24 and 36 months old. Barry and Havill have been told that Sebastian may run into issues at any stage in his development, but in general he is expected to lead a normal life. If Sebastian has any development problems, Barry said, the doctors at Sick Kids can help by teaching them exercises to do at home, or sending a support worker to help with speech or physiotherapy. “They want us to let him be a kid and run around and get his blood pumping and his heart working really well. They don’t want us bubble-wrapping him and being too protective,” Barry said. “They want him to live a normal life as much as possible.” ||||| Kristine Barry says when she heard her newborn baby Sebastian scream, it was "the most amazing sound I've ever heard." 
   
   "They always prepped us for a blue baby," she said. "They always said that he was going to be blue and not vocal because of the lack of oxygen." 
   
   But when Sebastian arrived at Mount Sinai Hospital in Toronto in May, "there's this little guy all pink and screaming." 
   
   It would have been a very different and traumatic birth if Sebastian had not undergone a surgical procedure on his heart, known as a balloon atrial septoplasty, five days earlier — while he was still in his mother's womb. 
   
   During Barry's prenatal checkups, Sebastian was diagnosed with a severe congenital heart defect, in which the two main arteries of the heart are reversed. His case was especially complex because the interior walls of his heart were sealed shut, so that blood couldn't flow between the chambers to pick up oxygen. 
   
   "We had a baby with the two sides of the circulation that were not communicating. There was no opening between the upper chambers and the lower chambers and the vessels were coming off the wrong side," says Dr. Greg Ryan, head of the fetal medicine program at Mount Sinai Hospital. 
   
   "So what we had to do was to create a communication to allow the blood to mix." 
   
   'The clock ticks' 
   
   In most cases, newborn babies with heart defects can be rushed from the neonatal unit at Mount Sinai Hospital to the Hospital for Sick Children (SickKids) across the street, says Dr. Rajiv Chaturvedi, a cardiologist at SickKids. 
   
   But the closed walls of Sebastian's heart made it unable to automatically circulate oxygen once he lost access to the oxygen supplied via the placenta. That meant there would be little time to save Sebastian from severe complications after he left his mother's womb. 
   
   "The clock ticks [so] that you have a few minutes and you start having brain damage and other organ damage," says Dr. Edgar Jaeggi, head of the fetal cardiac program at SickKids. 
   
   Christopher Havill and Kristine Barry are enjoying a normal life at home with their newborn son, Sebastian, thanks to his heart surgeries — one of which was performed while he was still in his mother's womb. (CBC News) 
   
   So on May 18, Ryan, Chaturvedi and Jaeggi, along with dozens of clinicians from both Mount Sinai Hospital and SickKids performed a risky and remarkable procedure: a balloon atrial septoplasty while the baby is still in the uterus. 
   
   With neonatal and cardiac surgeons on standby in case an emergency cesarean section became necessary, the doctors used a needle to insert a balloon through Barry's uterus and into Sebastian's heart, making a small hole to open up the heart's interior wall, so oxygenated blood could pass through. 
   
   Although the procedure was a success, it wasn't a cure for Sebastian's original heart defect, and he would still require open-heart surgery after birth. But it meant that Barry could deliver him normally, without the trauma of knowing it would be a frantic race against time to whisk her baby away and supply him with oxygen. 
   
   A healthy start 
   
   In fact, Sebastian's father, Christopher Havill, had time to cut the umbilical cord — and he remembers the team even told them they could take pictures. 
   
   Surgeons repeated the same procedure they had done in-utero on Sebastian that day to further ensure the flow of oxygen. A week later, he had open-heart surgery to fix his reversed arteries. Two months later, he's a normal baby at home in Barrie, Ont., fussing on his mother's lap as his dad smiles and soothes him. 
   
   "He's such a good little cuddle buddy," Havill says. 
   
   The doctors have even told the couple that Sebastian's scar from his open heart surgery will eventually fade, and will be barely visible by adulthood. 
   
   "These kids can play soccer, play hockey, go to university, have pretty normal lives," Chaturvedi says. ||||| 
   
   Sheryl Ubelacker, The Canadian Press 
   
   
   
   
   
   TORONTO -- Watching Kristine Barry and husband Christopher Havill cuddle their two-month-old son Sebastian, it's hard to believe their little guy has been through more major medical procedures in his short life -- and even before being born -- than many people experience in a lifetime. 
   
   Weeks before his birth in May, Toronto doctors discovered through imaging scans that Sebastian had not one, but two congenital heart defects -- and they knew they had to do something fairly radical to bring him into the world and give him a chance at a full and healthy life. 
   
   That something was an in-utero procedure to poke a hole in the wall between the upper chambers of his tiny heart, which had developed with no opening, followed by an operation after birth to repair his major cardiac arteries, which weren't in the proper locations. 
   
   Scans of Sebastian while in his mother's womb showed his aorta, the vessel that takes oxygen-rich blood to the brain and body, and his pulmonary artery, which channels blood to the lungs to be oxygenated, were switched -- a condition known as transposition of the great arteries, or TGA. 
   
   Doctors also discovered there were no openings in the walls between either the two upper chambers (the atria) of his heart or the bottom two chambers (the ventricles), which would have prevented his blood from circulating properly after birth. While in the womb, fetal blood is oxygenated through the placenta. 
   
   "If a baby doesn't have any holes between the two sides, so the right and left half, the child would be deeply blue, and eventually will die from this condition unless we are able to create the hole after birth rapidly," said cardiologist Dr. Edgar Jaeggi, head of the fetal cardiac program at Sick Kids Hospital and part of the two-hospital team that cared for Barry and her soon-to-be born baby. 
   
   "This is a life-threatening condition that could result in rapid brain damage, with the baby doing very poorly and dying from this," Jaeggi explained. 
   
   However, after Sebastian's birth, doctors would have had only a few minutes to open up his chest and repair his heart, requiring full neonatal resuscitation and cardiac surgery teams to be on stand-by. 
   
   To avoid such a high-risk delivery and the dangers to the newborn, a team of doctors from Mount Sinai Hospital and Sick Kids opted to perform the procedure to create an opening between the upper chambers of Sebastian's heart while he was in the womb. 
   
   "It's pretty intense hearing something like that, that they're going to do it while he's still inside of her," Havill, 27, said Tuesday after he and his wife travelled to Sick Kids from their home in Barrie, Ont., north of Toronto. 
   
   "It's something you would think would only happen on a TV medical show, not in real life," agreed Barry, 25. "Doing the in-utero procedure actually sounded like the best possible thing. In my gut, we knew this was what we wanted to happen, what we needed to do." 
   
   On May 18, doctors at Mount Sinai took the first steps, injecting drugs through Barry's abdomen that put Sebastian to sleep, paralyzed his body to prevent him from moving, and provided pain relief. 
   
   "The baby obviously has to be in the right position," said Dr. Greg Ryan, head of the fetal medicine program at Mount Sinai. 
   
   "Because if the baby is not aligned in-utero, it's a non-starter, and we've sometimes had to wait for two or three days for the baby to come into position where it gives us our best shot -- because you have one shot and you need to make that work." 
   
   Barry was then transported to Sick Kids across the street via an underground tunnel that connects the two hospitals, where Ryan performed the next part of the procedure under ultrasound-guided imagery, inserting a fine needle through Barry's abdomen and uterus, then into the upper chamber of Sebastian's heart and passing it through the wall to the adjacent atrium. 
   
   A catheter was then fed through the needle and a tiny balloon inserted between the wall, a process that's similar to balloon angioplasty to open up a blocked coronary artery in those at risk of a heart attack. 
   
   "Then, essentially, we blow up the balloon in that wall which had been closed," explained Ryan. "By blowing it up, we could open up a hole in the wall between the two chambers, and this allows the mixing of the blood. 
   
   "Once we've done that, we withdraw the needle and withdraw the catheter out of the baby's heart," he said, adding that he believes this is the first time in the world that the in-utero procedure has been performed in a fetus with TGA. 
   
   Jaeggi said the team waited until Sebastian was almost full-term to do the in-utero surgery -- called a balloon atrial septoplasty, or BAS -- because doing so earlier might have allowed the hole to close up again. 
   
   "We wanted the biggest hole closest to delivery," he said, describing the opening as about 3.5 millimetres in diameter. 
   
   On May 23, Barry gave birth through a regular vaginal delivery after being induced and Sebastian was born "pink and screaming." 
   
   "They always primed us that we would be having a blue baby, so when he came out, I'm like 'That's not blue,"' said Barry, recalling her huge sense of relief. "He was here and he looked as babies should when they're born." 
   
   Sebastian had a second BAS procedure after birth to ensure the atrial opening was large enough. Then five days later, surgeons at Sick Kids performed open-heart surgery on the infant to switch his aorta and pulmonary artery into their proper positions. 
   
   Now weighing 10 pounds and meeting all his developmental milestones, Sebastian is like any other healthy two-month-old, his parents say. 
   
   "He's a pretty calm, pretty chill baby. He lets us know when he's not happy. He still has that very strong set of lungs that he was born with," Barry said. "We just recently started getting our smiles from him." 
   
   "You barely even know that anything had happened to him unless you take off his shirt and see his scars," added Havill. "He's just awesome." 
   
   The couple say it's hard to express how grateful they are to the medical teams at the two hospitals. 
   
   "Thank you doesn't seem like enough, but definitely thanks to them for saving my baby's life," Barry said. 
   
   "It's just amazing what they're able and capable of doing."
target: – Doctors in Canada are patting themselves on the back after what is believed to be a first-of-its-kind heart surgery that saved the life of an unborn child. Halfway through her pregnancy, Kristine Barry of Barrie, Ont., learned her unborn son had a heart defect in which the two main arteries of his heart were reversed, reports the CBC. Putting the aorta and pulmonary artery in their rightful places would require open-heart surgery after birth. But because Barry's unborn son also had no opening to allow blood to flow between the upper and lower chambers of his heart, he would be unable to circulate oxygen through his body once separated from his mother's placenta, with brain and other organ damage occurring within minutes. "He likely wasn't going to make it," Barry, 25, tells the Toronto Star. But doctors weren't about to give up. In what may be the first balloon atrial septoplasty performed on a baby in the womb, doctors from Mount Sinai Hospital and Sick Kids Hospital in Toronto used a needle to insert a balloon through Barry's uterus and into the boy's heart, opening a passageway between the chambers. Five days later on May 23, Sebastian was delivered "all pink and screaming," rather than "blue and not vocal" as initially expected, Barry says. Two months after undergoing open-heart surgery to repair his heart defect, he's healthy and happy and Barry can't thank doctors enough. "It's just amazing what they're able and capable of doing," she tells the Canadian Press. (Read about another heart surgery in the womb.)