“We chose ‘Ragnar’, the name of a warrior even before I knew he was going to have to go through so much,” says 34-year-old journalist Polyana Resende Brant, after giving birth to her first child on May 18.
Upon reaching the second trimester of her pregnancy, tests began to show signs of the presence of a tumor in the region of the baby’s chest. It was a rare condition, called pulmonary sequestration, in which there is a mass that looks like a lung, which is supplied with blood by blood vessels but has no specific function.
“Although that tumor is not malignant, that is, it is not a cancer, it was growing and compressing the baby’s organs, as well as stealing some of the blood from the body and causing water to be deposited in the lung region,” says Danielle do Brasil, a surgeon specializing in fetal surgery at the Santa Lucía Hospital in Brasilia.
There she received the case after Polyana had sought out obstetricians to handle high-risk cases.
Doctors warned Polyana that if the pregnancy continued without any surgical measures, her child would not survive. And even if she gave birth in an emergency, Ragnar, who was only 29 weeks pregnant, an age considered extremely premature, could die too.
“It was desperate. I had to keep the faith and look for the best specialists. We have to value science and know that it can go hand in hand with faith. It is what my husband, who was by my side during all the procedures, and I we did,” says the mother.
As explained by surgeon Danielle do Brasil, who is also a specialist in high-risk cases at King’s College London, the medical literature establishes that for a case like Ragnar’s, one of the vessels that distributed blood to the tumor had to be cauterized.
“So, with a thick needle that contains a laser fiber inside, we can cauterize that vessel, the mass dies and is then absorbed by the body. The idea was also to remove fluid from the chest to help the lungs expand,” he explains.
Polyana sought other opinions, but after listening to different experts, she agreed to the surgery.
“We had burned the vessel perfectly, and the whole team was quite satisfied. But unfortunately, after 10 days, the time we usually wait to see if the technique offered any benefit, we found that the circulation of the tumor had taken another path, causing the mass to grow back and increasing the fluid in the chest,” said the doctor.
The unprecedented procedure
The surgeon says it was difficult to share the news with the parents. “They had already heard from us and from other doctors that a second surgery might be necessary, but expectations were high. Think of a couple who imagined for much of their pregnancy that their baby might die.”
“But out of the difficulties, creativity was born,” says Danielle do Brasil. The team decided to try not to burn a new vessel but, using the same technique, to destroy the entire tumor.
Polyana and her husband agreed to give it a try. “I went through all the procedures with a smile on my face, as the photos show, for having the opportunity to save my son. Somehow, when you become a mother, a colossal force is born.”
The second intervention lasted two and a half hours.
“It was the most difficult of my life. In fetal surgery, we do not always know the steps of everything that is going to happen, we are not always clear about what is inside. I had a moving target, which was the tumor, inside another moving target, which was the amniotic fluid, and I was trying to reach the mass with something that could not move: my needle,” says the surgeon, who operated with the help of Dr. Juliana Rezende, resident doctors, the team of nurses and anesthesia.
This time, the tumor did not grow back, and Ragnar was born at the end of the pregnancy, on May 18. The first X-ray taken after his birth showed no signs of the tumor.
“In three months, we will do a chest tomography, a more complete exam. Our expectation is to find areas with fibrosis due to the healing of the destroyed tumor. And of course that this baby does not need more surgeries,” says the doctor.
Now, the team is compiling the materials of the procedures to submit the case report to some medical journals to share the experience with the medical community worldwide.
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