New Delhi: For the first time in India, the All India Institute of Medical Sciences (AIIMS) Delhi received a referral of a 27-week old fetus suffering from Bronchopulmonary Sequestration (BPS). The fetus had a large lung mass which was causing a collection of fluid in the chest, leading to compression of the heart and lungs.
BPS is a rare birth defect in which an abnormal mass of nonfunctioning lung tissue forms during prenatal development. It can form outside (extralobar) or inside (intralobar) the lungs but is not connected directly to the airways.
The abnormal lung tissue does not function like normal lung tissue. These masses are characterized by abnormal blood supply, in which a systemic arterial blood vessel coming from the aorta feeds the lung mass.
Professor Dr. Vatsala Dadhwal of the maternal-fetal medicine division of the department of gynecology and obstetrics told "usually in some cases, shunts are inserted to drain the fluid from the lungs so that compression on the heart can be removed to prevent heart failure. But this is a temporary measure."
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"The other option is to burn the blood vessel supplying the tumor or abnormal lung tissue under ultrasound guidance inside the womb. This is a technically demanding procedure requiring a high level of expertise. This procedure can be done by laser energy, which has been reported previously. The other technique which can be performed is the Radio-Frequency Ablation (RFA) which uses radiofrequency energy for ablating the vessel. We chose the latter to operate on the fetus as the vessel supplying blood to the tumor was quite big," she added.
The professor explained, "Till date, the use of RFA for such a condition has been reported previously only in three cases of which only one baby has survived. Ours is the second most successful case in the world. Ours is the first case of the same from India," she added.
AIIMS performed the surgery on December 23. The baby was delivered on February 5. "The day following the procedure, the fluid started decreasing. It disappeared completely by day seven and the lungs also expanded."
She confirmed that the tumor had been completely disappeared in comparison to the size of the mass at birth. "The baby was discharged in a healthy condition," she added.
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Dr. Aparna Sharma assisted with the case, supported by Prof Bhatla, head of the department.
The AIIMS doctors reported to TOI "parents should be aware that many conditions of the fetus are amenable to treatment inside the womb. There are others wherein some temporary interventions can be done inside the womb and definitive management provided after birth so that the baby can survive in the womb till delivery. This knowledge should be used both by patients and the general physicians to refer patients to fetal medicine centers like AIIMS, New Delhi in time for possible treatment."
As the country's first center to offer diagnostics and therapeutics for fetal conditions, AIIMS has a division of fetal medicine operating since the 1980s. With more than 1,500 procedures performed so far, AIIMS has been the first medical center in the country to start fetal blood transfusions. "We are probably performing the maximum number of such procedures in the world presently. In the last 10 years, we have started and perfected the procedures for managing complicated twin pregnancies that need treatment inside the womb using laser and radiofrequency ablation. We have also got experience of inserting shunts for draining fluids from the bladder or the lungs and managing various fetal heart rate abnormalities inside the womb," Dr. Dadhwal said.
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