Doctors Perform First Ever In-utero Embolization in the State of Florida at Holtz Children’s Hospital
By: Miranda Torres
Lainey Ramos Arango, 19, was shocked to discover she was six months pregnant when she went to the doctor complaining of stomach pains. A Cuban native who recently moved to Miami, Arango wasn’t planning to start a family yet, but that wasn’t the only surprise in store for her.
Arango’s excitement about her pregnancy quickly turned to worry after an ultrasound at 35 weeks revealed a potential anomaly in her baby’s brain. While waiting for additional testing, she was greeted by Rodrigo Ruano, MD, PhD, director of the UHealth Jackson Fetal Care Center and division chief of UHealth Jackson Maternal-Fetal Medicine.
Once she received a neurologist ultrasound, it revealed a vein of Galen malformation, a rare blood vessel abnormality in the baby’s brain. If left untreated, the condition can increase the pressure in the brain, which can cause a flood of blood to rush to the heart and lungs. The potential side effects include brain damage and heart failure. As the leading expert in this condition, Robert M. Starke, MD, co-director of endovascular neurosurgery at Jackson Memorial Hospital, and a UHealth – University of Miami Health System neurosurgeon and neuroradiologist, was consulted.
With no known cause, this condition is typically treated with anembolization once the baby is born. Dr. Ruano, Dr. Starke, and their multidisciplinary team came together to brainstorm innovative ways to save the baby’s life. These subspecialties included neonatal intensive care, pediatric neurology, maternal fetal medicine, high risk obstetrics, gynecology, pediatric radiology, pediatric cardiology, pediatric pulmonology, fetal anesthesia, neurosurgery, neuroendovascular surgery, as well as the FDA, ethics board, and international review board.
“In that moment, I realized my baby’s life was in danger, and no one knew just how bad it could be,” Arango said. “I was terrified and extremely sad worrying over my child’s future.”
The care team decided to perform an in-utero embolization, or an embolization on the baby while still inside the uterus, for the first time in the state of Florida. This procedure had only ever been performed a handful of times around the world, and only once before by Dr. Ruano, meaning specialists from all different fields would be essential to the procedure’s success.
“If we can treat the vein of Galen malformation in utero, then we can help the baby physiologically to improve the function of the heart,” Dr. Ruano said. “There’s a high chance the baby can have complications if we do the surgery postnatal, so keeping the surgery in utero helps the heart improve and gives the baby a better condition.”
On April 5, Holtz Children’s Hospital’s neonatal team, pediatric anesthesiologists, pediatric cardiologists, and pediatric radiologists joined Dr. Ruano and Dr. Starke for this groundbreaking surgery. Once the malformation was treated, the baby’s heart returned back to normal.
Three weeks later, Lucas Hormachea was born healthy and happy via C-section. Lucas has continued to show normal heart function and development. The malformation will continue to be followed with imaging.
“Thank you a thousand times over to Dr. Ruano and Dr. Starke. If it wasn’t for them, nothing would be possible,” Arango said. “I wouldn’t have the opportunity to hold my baby in my arms and be the happiest mom on earth.”