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In recent years, huge advances have been made in the surgical treatment of serious conditions that have developed in the womb. These groundbreaking interventions - often carried out in the first few years of life - have the power to dramatically increase life expectancy. But the risks are often high, and the surgeons who specialise in these procedures need to cope with the added pressure of wanting to get the best possible results for their patients鈥� desperately anxious parents.

Birmingham Children鈥檚 Hospital has a reputation as a world-leading centre for complex paediatric procedures. Consultant paediatric cardiac surgeon David Barron is a specialist in heart conditions that are diagnosed before birth, and his patient, three-year-old Madison, has a rare condition which prevents blood from reaching her lungs 鈥� giving her low blood-oxygen levels, and impeding her growth and the development of her organs.

To correct Madison鈥檚 unusual anatomy, David must carry out an intricate 12-hour operation to reconstruct the blood supply between her heart and lungs. This is a rarely performed, multi-stage procedure that requires extraordinary stamina and skill on the part of the surgical team, and during which Madison鈥檚 heart will be stopped altogether.

Madison鈥檚 body has compensated for being born without a proper arterial connection carrying blood from her heart to her lungs by relying on a network of tiny vessels called MAPCAs. We all have these vessels to allow for circulation while we are in the womb, but normally they become redundant after birth. In the operation, David will have to locate the minute MAPCAs in Madison鈥檚 chest and combine them with her malformed artery, in order to build a new connection between her heart and lungs.

A second surgical team is led by consultant paediatric urology and transplant surgeon Liam McCarthy 鈥� a specialist in conditions affecting the kidneys and bladder. Two-year-old Isaac鈥檚 kidneys were damaged in the womb, and to avoid long-term dialysis, he needs a transplant. His father Lee is a match 鈥� so he will donate one of his healthy kidneys. He has never had doubts about that decision - after all, as he says, Isaac is 鈥渉alf of me鈥�, and this is a chance to make a drastic difference to the quality and length of his son鈥檚 life.

They both undergo surgery on the same day. Lee鈥檚 kidney is removed at the Queen Elizabeth Hospital Birmingham and rushed across the city to theatre at Birmingham Children鈥檚 Hospital, ready for the transplant. Isaac鈥檚 damaged kidneys will not be removed - instead, the donor kidney will be connected in an entirely new position, lower down in the abdomen. The challenge for Liam and consultant hepatobiliary and transplant surgeon Khalid Sharif is to fit this adult kidney safely into the body of a two-year-old, and to make the connections quickly, before the donor organ begins to degrade. If they succeed, they will dramatically improve the quality of Isaac鈥檚 life and extend his life expectancy by many decades.

Birmingham Children鈥檚 Hospital is part of Birmingham Women鈥檚 and Children鈥檚 NHS Foundation Trust.