Fetal aortic valvuloplasty may rescue fetuses with critical aortic stenosis and hydrops.
Aortic Valve Stenosis
/ diagnostic imaging
Balloon Valvuloplasty
/ methods
Female
Fetal Diseases
/ surgery
Fetal Heart
Fetoscopy
/ methods
Gestational Age
Humans
Hydrops Fetalis
/ diagnostic imaging
Pregnancy
Retrospective Studies
Ultrasonography, Doppler
Ultrasonography, Prenatal
Ventricular Function
congenital heart disease
congestive heart failure
critical aortic stenosis
fetal cardiac intervention
hydrops
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
15
05
2020
revised:
15
06
2020
accepted:
25
06
2020
pubmed:
6
7
2020
medline:
15
12
2021
entrez:
5
7
2020
Statut:
ppublish
Résumé
Critical aortic stenosis (CAS) with a restrictive interatrial septum may lead to fetal congestive heart failure and hydrops, usually culminating in fetal demise if left untreated. The aim of this study was to assess the effects of fetal aortic valvuloplasty (FAV) on hemodynamics and outcome in these patients. This was a retrospective review of fetuses with CAS and signs of hydrops that underwent FAV in our center between 2000 and 2020. Echocardiograms and patients' charts were analyzed for ventricular and valvular dimensions and for outcome. Hydrops was present at the time of intervention in 15 fetuses with CAS that underwent FAV at our center during the study period. All but one patient had at least one technically successful procedure. There were no procedure-related deaths, but three intrauterine deaths occurred. Twelve subjects were liveborn, of whom two died within 24 h after birth owing to persistent hydrops. Ventricular function improved and hydrops resolved within 3-4 weeks after FAV in 71.4% (10/14) of fetuses with a technically successful intervention. A biventricular outcome was achieved in 50% of the successfully treated patients. Fetuses with CAS and hydrops can be successfully treated with FAV. The procedure has the potential to restore sufficient fetal cardiac output, which may lead to resolution of hydrops. Surviving patients seem to be good candidates for a biventricular outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
119-125Informations de copyright
© 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Vogel M, McElhinney DB, Wilkins-Haug LE, Marshall AC, Benson CB, Juraszek AL, Silva V, Lock JE, Marx GR, Tworetzky W. Aortic stenosis and severe mitral regurgitation in the fetus resulting in giant left atrium and hydrops: pathophysiology, outcomes, and preliminary experience with pre-natal cardiac intervention. J Am Coll Cardiol 2011; 57: 348-355.
Mallmann MR, Herberg U, Gottschalk I, Strizek B, Hellmund A, Geipel A, Breuer J, Gembruch U, Berg C. Fetal Cardiac Intervention in Critical Aortic Stenosis with Severe Mitral Regurgitation, Severe Left Atrial Enlargement, and Restrictive Foramen Ovale. Fetal Diagn Ther 2020; 47: 440-447.
Taketazu M, Barrea C, Smallhorn JF, Wilson GJ, Hornberger LK. Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome. J Am Coll Cardiol 2004; 43: 1902-1907.
Tulzer G, Arzt W, Franklin RCG, Loughna PV, Mair R, Gardiner HM. Fetal pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum. Lancet 2002; 360: 1567-1568.
Wohlmuth C, Tulzer G, Arzt W, Gitter R, Wertaschnigg D. Maternal aspects of fetal cardiac intervention. Ultrasound Obstet Gynecol 2014; 44: 532-537.
Bitar FF, Byrum CJ, Kveselis DA, Lawrence DA, Smith FC. In utero management of hydrops fetalis caused by critical aortic stenosis. Am J Perinatol 1997; 14: 389-391.
Goltz D, Lunkenheimer J-M, Abedini M, Herberg U, Berg C, Gembruch U, Fischer HP. Left ventricular obstruction with restrictive inter-atrial communication leads to retardation in fetal lung maturation. Prenat Diagn 2015; 35: 463-470.
Schmider A, Henrich W, Dähnert I, Dudenhausen JW. Prenatal therapy of non-immunologic hydrops fetalis caused by severe aortic stenosis. Ultrasound Obstet Gynecol 2000; 16: 275-278.
Sames-Dolzer E, Wickenhauser E, Kreuzer M, Benedikt P, Gitter R, Prandstetter C, Gierlinger G, Tulzer G, Mair R. The Ross-Konno procedure in neonates and infants less than 3 months of age. Eur J Cardiothorac Surg 2018; 54: 71-77.