Fetoscopic and Open Transumbilical Fetal Cardiac Catheterization in Sheep

Kohl, Thomas; Szabó, Zoltán; Suda, Kenji; Petrossian, Edwin; Ko, Eitetsu; Kececioglu, Deniz; Moore, P.J.; Silverman, Norman H.; Harrison, Michael R.; Chou, Tony M.; Hanley, Frank L.

doi:10.1161/01.cir.95.4.1048

Cited by 57 publications

(32 citation statements)

References 7 publications

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“…Fetoscopic and open transumbilical cardiac catheterization has been performed on fetal sheep with successful balloon valvoplasty of surgically created supravalvar pulmonary stenosis. 15 Such feasibility studies are in their infancy, and much more experimental work will be required before such prenatal interventions can be routinely recommended in clinical practice. In the only case in our study in which fetal valvotomy was successfully achieved, virtual atresia had recurred by the time of birth.…”

Section: Daubeney Et Al August 11 1998 565mentioning

confidence: 99%

Pulmonary Atresia With Intact Ventricular Septum

et al. 1998

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Background —Fetal echocardiography is widely established in the United Kingdom for prenatal diagnosis of congenital heart disease. This may result in a substantial reduction in incidence at birth because of selected termination of pregnancy. The objective of this population-based study was to determine the incidence of pulmonary atresia with intact ventricular septum (PAIVS) at birth, the impact of fetal echocardiography on this incidence, and to compare the outcome of cases with and those without prenatal diagnosis. Methods and Results —From 1991 to 1995, all infants born with PAIVS and all fetal diagnoses in the United Kingdom and Eire were studied. There were 183 live births (incidence 4.5/100 000 live births). The incidence was 4.1 cases per 100 000 live births in England and Wales, 4.7 in Scotland, 6.8 in Eire, and 9.6 in Northern Ireland ( P =0.01). There were 86 fetal diagnoses made at a mean of 22.0 weeks of gestation leading to 53 terminations of pregnancy (61%), 4 intrauterine deaths (5%), and 29 live births (34%). The incidence at birth would be 5.6 per 100 000 births in England and Wales, 5.3 in Scotland, and unchanged in Eire and Northern Ireland, if there were no terminations of pregnancy and assuming no further spontaneous fetal deaths ( P =0.28). An initial diagnosis of critical pulmonary stenosis was made in 6 cases, at a mean of 22.3 weeks of gestation with progression to PAIVS by 31.4 weeks. Probability of survival at 1 year was 65% and was the same for live-born infants whether or not a fetal diagnosis had been made. Conclusions —PAIVS is rare, occurring in 1 in 22 000 live births in the United Kingdom and Eire. Termination of pregnancy has resulted in an important reduction in the live-born incidence in mainland Britain.

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Section: Daubeney Et Al August 11 1998 565mentioning

confidence: 99%

Pulmonary Atresia With Intact Ventricular Septum

et al. 1998

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“…As it is challenging to directly study the technical risk in patients prospectively, animal research is the primary alternative. In the literature, Kohl et al [14,20,21] evaluated the feasibility of fetal cardiac access in a sheep model, and Fechner et al [22] investigated the impact of cardiac intervention on the fetal growth of the chicken. However, an animal model for the evaluation of the ultrasound-guided IUBAV has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intrauterine Balloon Aortic Valvuloplasty on Gestational Outcome in a Fetal Goat Model

Hua

Yang²,

Zhou³

et al. 2011

Fetal Diagn Ther

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Objective: Intrauterine balloon aortic valvuloplasty (IUBAV) has been used to correct critical aortic valve stenosis. Evaluation of the intervention-related risk is necessary. The purpose of this study was to establish an experimental goat model for ultrasound-guided IUBAV intervention and investigate the immediate and long-term effects of IUBAV on the fetus, gestational outcome and mother’s safety. Study Design: Fifteen pregnant goats with twin gestation in the 2nd and 3rd trimester were anesthetized to establish the surgical procedure. One fetus of the twins received IUBAV intervention, the other served as a control. The data were collected at three time points: immediately before and after IUBAV, and 24 h after birth. Critical organs including the heart, brain, lung and liver from the fetuses/newborns were collected after IUBAV or 24 h after birth. Results: IUBAV intervention immediately induced a significant decrease of pH and Ca²⁺, as well as an increase of blood glucose and lactic acid levels (p < 0.05). IUBAV also caused an increase in stress hormones (epinephrine 1-fold, norepinephrine 4-fold, and cortisol 1-fold; p < 0.05). Following the operation, all of the mother goats recovered, but in 60% (6/10) preterm delivery occurred. Neither pathological changes in fetal critical organs nor a significant difference in metabolism or growth parameters were detected between IUBAV and control kids. Conclusions: Ultrasound-guided IUBAV intervention induced a strong but transient stress response in the operated fetus, which did not result in irreversible histological changes in the fetus or the mother, but may disrupt the continuation of normal gestation in the long term. Preterm delivery is the major risk in this goat IUBAV model.

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“…To overcome the apparent limitations of the percutaneous ultrasound-guided techniques, various authors have investigated alternative approaches, namely, direct heart or umbilical puncture using fetoscopy derived from endoscopic surgery. 14,15 In this latter technique, one of the 2 umbilical arteries is dissected, which allows for the insertion of a 4F sheath. From this site, it is then possible to perform a retrograde catheterization of the fetal left heart.…”

Section: Access To the Fetal Heartmentioning

confidence: 99%

Transhepatic Ultrasound-Guided Cardiac Catheterization in the Fetal Lamb

et al. 2005

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Background-Percutaneous transventricular and fetoscopic umbilical catheterization have been applied to animal and human fetuses. These methods have a high rate of failure and complications. Here, we propose an alternative route for anterograde echocardiography-guided cardiac catheterization through a transhepatic approach of the intra-abdominal vessels in the fetal lamb. Methods and Results-After exteriorization of the uterus in 12 pregnant ewes between 118 to 122 days' gestation, a 4F sheath mounted over a 1.2-mm needle was placed into the intra-abdominal portion of the umbilical vein (nϭ2) and into the subdiaphragmatic portion of the inferior vena cava via a transhepatic approach (nϭ10) under ultrasound guidance. In the first 2 animals using a transumbilical approach, it was impossible to reach the heart through the ductus venosus.In the next 10 animals, using a conventional technique, echocardiography-guided catheterization of the 4 chambers was performed in the all fetuses, atrial or ventricular pacing in 6 fetuses, and ballooning of the pulmonary valve in 9 of 10 fetuses. Among the 10 fetuses catheterized through the transhepatic approach, 2 were euthanized immediately after the procedure to evaluate intraperitoneal bleeding (23 and 29 mL, respectively), and 3 died after the procedure (1 of major bleeding and 2 deaths related to balloon catheter manipulation). Finally, 5 were delivered vaginally after an uneventful pregnancy, and autopsy at day 5 did not show significant liver, vascular, or cardiac injury. Conclusions-Echocardiography-guided fetal cardiac catheterization through a transhepatic approach is feasible and provides an interesting alternative approach for human fetal cardiac interventions.

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Fetoscopic and Open Transumbilical Fetal Cardiac Catheterization in Sheep

Abstract: This study in fetal sheep demonstrates that fetoscopic and open transumbilical fetal cardiac catheterization are feasible and, guided by fetal transesophageal echocardiography, provide potential alternative approaches for human fetal cardiac intervention.

Cited by 57 publications

References 7 publications

Pulmonary Atresia With Intact Ventricular Septum

Pulmonary Atresia With Intact Ventricular Septum

Impact of Intrauterine Balloon Aortic Valvuloplasty on Gestational Outcome in a Fetal Goat Model

Transhepatic Ultrasound-Guided Cardiac Catheterization in the Fetal Lamb

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