Balloon dilation of severe aortic stenosis in the fetus: Technical advances

Tworetzky, Wayne; Jennings, Russell W.; Wilkins‐Haug, Louise; Benson, Carol B.; Marshall, Audrey C.; Colan, Steven D.; Velde, Mary van der; Perry, Stanton B.; Lock, James E.

doi:10.1016/s0735-1097(03)82700-6

Cited by 7 publications

(3 citation statements)

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“…The lesion that has been the main focus of fetal cardiac intervention over the past 2 decades is severe AS in early gestation and midgestation, which has been shown to evolve into HLHS at birth. 165,236,[467][468][469][470][471][472][473][474] AS in the fetus is rarely isolated. The papillary muscles, mitral valve, and endomyocardium are affected to various degrees, raising the question of whether this is a more diffuse developmental defect or secondary as a result of the valvar abnormality.…”

Section: As With Evolving Hlhsmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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983

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: As With Evolving Hlhsmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

983

543

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“…Intervention to prevent development of progressive lesions such as a hypoplastic left heart syndrome by an aortic valvuloplasty has been carried out elsewhere [17] but was only considered in one subject with severe aortic stenosis and a marginally small left ventricle. It was not proceeded with for logistic and other reasons.…”

Section: Discussionmentioning

confidence: 99%

Fetal Cardiac Diagnosis and Its Influence on the Pregnancy and Newborn – A Tertiary Centre Experience

et al. 2008

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Objectives: To evaluate the impact of an abnormal fetal cardiac scan on the management of the pregnancy and the outcome of the newborn. Methods: We reviewed all pregnancies that were referred to the Fetal Cardiac Unit for assessment to determine if the finding of a cardiac abnormality influenced the pregnancy and fetus, timing and mode of delivery, the treatment and outcome of the newborn. Diagnoses were confirmed by echocardiography following the baby’s delivery. Results: Between January 2005 and July 2006, there were 251 detailed fetal cardiac scans carried out on at risk pregnancies or those with suspected abnormal scans in 127 fetuses. Seven of the 92 mothers with abnormal fetal cardiac scans opted for termination. Two were successfully treated during the pregnancy for hydrops fetalis arising from a tachyarrhythmia. One was induced early because of deterioration of fetal well-being and increasing cardiac size. Twenty-six infants required a prostaglandin infusion prior to surgery. Two required intensive care for associated malformations. There were 24 survivors following complex surgery, and 2 deaths. Two infants with severe tricuspid valve incompetence from a dysplastic valve died, one associated with a septicaemia and the other where surgery was delayed because of prematurity and low birth weight. There was no maternal morbidity or mortality. Conclusions: Early detection of fetal cardiac malformation allows for careful counselling of the parents, ongoing antenatal review with a planned site and timing of delivery, and anticipatory postnatal care for optimum outcomes. The importance of careful screening is emphasized to allow for referral of mothers with potentially abnormal scans to an appropriate tertiary centre for confirmation and management.

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“…Lower urinary tract obstruction secondary to posterior urethral valves can be diagnosed and treated with a cystoscopic approach (fig 2). 30 31 Stenotic cardiac valves can now be treated by in utero valvuloplasty, thereby improving the prospects for a biventricular repair after birth 32 33…”

Section: Fetal Therapymentioning

confidence: 99%