Risk of cardiac decompensation in utero
Before the intervention, scheduled for December 12, a transplacental treatment was administered from the 24th week of pregnancy in order to accelerate the heart rate. “The risk of cardiac decompensation was already high in utero, and this child would not be able to grow normally after birth.“, explains Dr. Vô.
It is impossible to consider the installation of a traditional pacemaker, which is far too bulky, in an infant who is also at high risk of premature birth and therefore low birth weight. The medical team therefore opted for a device suitable for newborns, the Medtronic micro-pacemaker.
This device, offered free of charge by the American firm, having never before been implemented in Belgium, it was necessary to first obtain the agreement of the Federal Agency for Medicines and Health Products (FAMHP).
“Most of the devices that we put in place in children are the same as those implanted in adults but we wait until the child has reached a certain weight, around ten to 10 kilos, and we adapt the place where we place the pacemaker, at the level of the stomach rather than under the collarbone”, specifies the pediatric cardiologist.
Less than 5 grams
The micro-pacemaker box, which measures less than 3 cm long and weighs 5 grams, was placed at abdominal level. The probe connecting the box to the heart was placed via a small opening made at the ribs.
The intervention lasted about an hour but mobilized an entire team, neonatologists, pediatric intensivists, anesthesiologists, etc., recalls Dr. Vô. “On didn’t know how theThe child would adapt to birth given his low heart rate. Hewent directly from the cesarean section to the operating room for the installation of the micro-pacemaker“.
In addition to its small volume, this device has the advantage of reducing the duration of hospitalization and avoiding the need for alternatives such as a temporary pacemaker to accelerate the heart before the operation.
Remote monitoring
After staying a few days in pediatric intensive care and then in pediatric cardiology, the baby was able to return to his family shortly before Christmas. He now has a normal heart rate and will be regularly monitored by pediatric cardiology to ensure that he is growing well and that the device implanted in him is working properly.
Telemonitoring – remote monitoring – was set up to see how the micro-pacemaker behaves.
Around ten cases per year
Heart malformations are the most common malformations, affecting 1% of births, emphasizes Dr. Vô.
“On the other hand, congenital atrioventricular block, the heart rhythm disorder from which the infant who has been operated on suffers and which requires the installation of a pacemaker, is rareunderlines Dr Christophe Vô. It is estimated that around ten children are born each year in Belgium with this arrhythmia. Most do not need a pacemaker at birth. We wait some time for the child to grow up to implant it. Most children with a pacemaker lead a completely normal life. We just ask parents to avoid contact sports“.
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