U-M Health Lab: Fetal Intervention Saves Ryleigh’s Heart

By Shelley Zalewski / U-M

The 20-week fetal checkup is usually filled with anticipation and excitement, but for the Ostrander family of Dundee, Michigan, it also uncovered something frightening.

“The doctors suspected that our baby’s heart was not developing normally,” says mom Christina Ostrander. A fetal echocardiogram confirmed the diagnosis: hypoplastic left heart syndrome with restrictive or intact atrial septum (HLHS-IAS). In HLHS, which occurs in about one in 1,000 babies born in the United States each year, the left side of the heart doesn’t develop properly, leaving it unable to pump sufficient blood. The condition is further complicated when blood flow out of the lungs, into the heart and then out to the body, is compromised by a closure of an opening between the upper chambers of the heart called a restrictive or intact atrial septum.

Babies with HLHS must undergo a series of three heart surgeries beginning shortly after birth. The procedures reroute how blood is pumped to the lungs, shifting the task from the left side of the heart to the right side. The presence of an IAS makes the condition even riskier.

“Because the opening through which blood flows is constricted, pressure can build, causing the blood vessels in the lungs to develop abnormally,” explains Mott pediatric cardiologist Sarah Gelehrter, M.D. “At birth, as soon as she begins breathing, the baby’s oxygen levels can fall to dangerously low levels, requiring surgery immediately after delivery to resolve the problem.”

When possible, this dangerous complication can be avoided by opening the blockage in utero. A multidisciplinary Mott team, led by Gelehrter, determined that the baby was a good candidate for a fetal intervention to implant an atrial septal stent.