Amniotic air insufflation during minimally invasive fetoscopic fetal cardiac interventions is safe for the fetal brain in sheep

Abstract

Amniotic air insufflation during minimally invasive percutaneous fetoscopic fetal cardiac interventions is safe for the fetal brain and does not compromise maternal hemodynamics in sheep. These findings encourage further investigation of the role this technique might play during fetoscopic fetal cardiac interventions in humans.

Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans

“…These positive neurological and brain imaging findings after the clinical introduction of PACI were hoped for after studies in lambs, where we had previously examined various brain regions particular sensitive to vascular or hypoxic injury after fetoscopic procedures employing gas insufflation of the amniotic cavity: Following 30 fetoscopic procedures that employed amniotic insufflation with compressed air [2] and following nine procedures that employed amniotic insufflation with carbon dioxide (Kohl, unpublished data), no histologically discernible damage was found postnatally in all but two lambs: In these unoperated sibling lambs, following insufflation with compressed air, a small infarct area was observed in a similar location within one of their frontal lobes; both fetuses lay in a different amniotic sac which had remained filled with amniotic fluid and untouched throughout the operation. Given this constellation, it seemed unlikely to us that amniotic insufflation had contributed to these lesions.…”

“…Based on the development of safe and reproducible percutaneous amniotic insufflation techniques in sheep [1,2], partial amniotic carbon dioxide insufflation (PACI) at our center has become the most important strategy for improving visualization of intra-amniotic contents during percutaneous minimally invasive fetoscopic surgery. However, apart from a previous publication of our group describing the use of PACI during minimally invasive percutaneous fetoscopic interventions in five complicated monochorionic twin gestations [3], to our knowledge no other publication has ever focused on the institution, management as well as maternal and fetal safety of this approach in humans.…”

Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention

“…Based on studies with sheep and inanimate models that primarily focused on the development of minimally invasive techniques for fetal cardiac intervention [13][14][15][16], we started with technical modifications and procedure training to rekindle the development of a fetoscopic approach to the management of fetal spina bifida aperta. Using an ovine model, we developed a simple percutaneous fetoscopic patch coverage approach that subsequently was introduced into the clinical arena some years ago [1,2].…”

Percutaneous Fetoscopic Patch Coverage of Spina Bifida Aperta in the Human – Early Clinical Experience and Potential

“…The fetoscopic techniques that allowed successful percutaneous fetoscopic patch coverage of fetal spina bifi da aperta were all developed in pregnant sheep [13,[20][21][22] . As this procedure represents one of the most complex fetoscopic setups ever applied in humans, the major emphasis during its clinical introduction was to monitor maternal safety in each operative step.…”