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One operation on a newborn at the SJD Barcelona Children's Hospital resolved two malformations that were causing severe respiratory failure
The infant had tetralogy of Fallot—a severe congenital heart defect that impedes entry of blood to the lungs—and a very narrow trachea that caused respiratory failure. It was the first time that an operation of this type was carried out in Spain.
Staff treating the mother during pregnancy detected the infant’s heart malformation in prenatal ultrasounds. The tracheal stenosis was diagnosed a few days after birth. The infant’s trachea was very narrow throughout its entire length, causing respiratory failure and continual stridor, which was worsening with time.
Staff in the Heart Unit and the ENT Department at the SJD Barcelona Children's Hospital who were treating the infant decided to wait for him to gain weight before operating, and suggested to the family that they repair both malformations in a single operation to help minimise risk.
‘We knew that if they only operated on one of the malformations, the infant would not survive the post-op period,’ explains Stefano Congiu, Head of Heart Surgery at the SJD Barcelona Children's Hospital.
This was the first time that both malformations were tackled in a single operation in Spain. ‘It’s a one-of-a-kind case. There are very few cases worldwide. We found nothing on it in scientific literature. Normally, infants either have one malformation or the other, but having both at the same time is highly uncommon,’ notes Congiu.
The operation was performed on 17 July 2024, when the infant was just eight months old.
The operation was performed on 17 July 2024, when the infant was just eight months old. During the first few hours of the procedure, the surgical team repaired the heart malformation with the help of an extracorporeal circulation device, closing the septal defect between the two ventricles with a pericardial patch.
The outflow of the right ventricle towards the lungs immediately widened, allowing normal circulation and oxygenation of blood. Then, staff confirmed complete correction of the tetralogy of Fallot using an echocardiogram, before the second procedure on the trachea began.
Next, the ENT team—again with the infant attached to extracorporeal bypass—resected a part of the middle section of the trachea, bringing together the two remaining cut ends and stitching them together to expand the windpipe. ‘Thanks to this procedure, the patient's respiratory state has improved and there is no more stridor present,’ highlights Oliver Haag, Head of the ENT Department at the SJD Barcelona Children's Hospital.
After the operation—which lasted five hours and involved 20 different medical staff members—the infant was transferred to the PICU. The patient was discharged one month later.
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