PACI greatly improves fetal visualization during fetoscopic interventions when fetoscopy within fluid meets with difficulties. Continued assessment of its benefits, risks, and safety margins at specialist centers is required.

The application of PACI during minimally invasive fetoscopic interventions seems safe for the fetal brain. Due to the still limited clinical experience with PACI, continued assessment of its maternal and fetal risks as well as management are required.

A 26-year old pregnant women had been referred to our center at 28ϩ1 weeks of gestation. Maternal transabdominal fetal ultrasound imaging at that time revealed severe fetal aortic valve stenosis with a poorly contracting, dilated left ventricle, moderate-to-severe mitral valve regurgitation, and local hyperechogenicity of the endocardium. Left-to-right shunting across the oval foramen and retrograde flow inside the aortic arch heralded loss of left ventricular function with ongoing pregnancy. 1

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