Intervention for fetal critical aortic stenosis: first step in a metamorphosis?

Jaeggi, Edgar; Chaturvedi, Rajiv

doi:10.1002/uog.19159

Cited by 3 publications

(2 citation statements)

References 26 publications

(42 reference statements)

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“…The general principle of higher case volume being associated with better clinical outcome [48−50] has been reported in paediatric cardiac surgery [51−64] and for some fetal procedures including intrauterine blood transfusion [65] and laser coagulation in twin-to-twin transfusion syndrome [66,67]. In recent series of FAV there is evidence that BV outcomes are higher in centers with a higher case volume [13,14,68]. To optimize the chance of a BV repair after fetal aortic valve dilation, postnatal cardiac management should be in a center that is motivated to attempt BV repair whenever feasible, rather than one that defaults to a Norwood for all borderline cases.…”

Section: Centralizing Treatmentmentioning

confidence: 99%

An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?

et al. 2020

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Fetal cardiac interventions (FCI) offer the opportunity to rescue a fetus at risk of intrauterine death, or more ambitiously to alter disease progression. Most of these fetuses require multiple additional postnatal procedures, and it is difficult to disentangle the effect of the fetal procedure from that of the postnatal management sequence. The true clinical impact of FCI may only be discernible in large-volume institutions that can commit to a standardized postnatal approach and have sufficient case volume to overcome their FCI learning curve.

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Section: Centralizing Treatmentmentioning

confidence: 99%

An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?

et al. 2020

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“…Prenatal intrauterine intervention in critical CHD has effectively stopped irreversible organ damage and promoted the development of dysplastic cardiac structures, with a postoperative biventricular circulation repair rate of 40% to 70% in critical CHD. [33][34][35][36] Timely intrauterine interventions in a fetus with critical aortic stenosis not only improves cardiac development and ventricular function but also increases the likelihood of postnatal biventricular repair. [37] Valvuloplasty in utero can also be performed as pulmonary valvuloplasty in a fetus, with critical pulmonary stenosis (CPS) or pulmonary atresia with intact ventricular septum (PA/IVS).…”

Section: Introductionmentioning

confidence: 99%

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease: Xinhua Hospital Model

Jiang

Wang

et al. 2023

Cardiology Discovery

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With the growing influence of slow population growth and population aging, China has established the birth policy and issued a series of documents to promote maternal and fetal health and improve the birth rate. With the increase in prevalence of birth defects, timely diagnosis and intervention in utero provide possibilities to reduce unnecessary abortions and offer better prognosis. Congenital heart disease (CHD), as one of the most common congenital birth defects, is the leading cause of mortality in patients aged <5 years, and brings a heavy burden to both the affected families and society. Fetuses with CHD are associated with an increased risk of pregnancy-related complications and premature birth, and children with CHD typically face growth and developmental problems even after the correction of malformation. Therefore, management including diagnosis, treatment, and rehabilitation throughout the fetal period into childhood and even adulthood is essential for children with CHD. Based on the rapid advances in intrauterine and perinatal medicine and an in-depth collaboration among obstetrics and pediatrics, a novel diagnosis and treatment system has been established for the management of CHD in the past 2 decades in Shanghai Xinhua Hospital. This Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease model provides prenatal diagnosis, intrauterine intervention, delivery room service and neonatal therapies, and postintrauterine rehabilitation for children with CHD. We have developed a four-dimensional spatiotemporal image correlation echocardiography and a three-dimensional cardiac virtual endoscopy system for the intrauterine diagnosis of CHD, dramatically raising the diagnostic utility. Our innovative and independent newborn-intervention technique has effectively reduced the re-intervention rate in patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. In 2018, Xinhua Hospital independently performed the case of fetal aortic valvuloplasty in Asia through a multidepartment collaborative effort. All children treated in this system achieved biventricular circulation and a better long-term postoperative outcome. We also have conducted postoperative rehabilitation therapy to promote the development and health of children with CHD. The practice of Xinhua model has reduced unnecessary abortion of CHD fetuses, reduced the mortality rate associated with critical CHD, and improved the mid- and long-term prognosis in CHD, which is essential to promote the fertility level and children’s health. Furthermore, translational medicine platform and the birth cohort Early Life Plan was constructed to explore the origins of major developmental diseases and establish an early intervention model in CHD. This practice of assessment of the intrauterine system has been expanded to other congenital defects in Xinhua Hospital, and sequential treatment of more than 2,000 cases has been completed to date. Based on practice in intrauterine management of CHD and other diseases, the concept of Intrauterine Pediatrics was proposed as a first to emphasize early prevention and intervention of childhood diseases and promote a comprehensive lifecycle service for children. The development and evolution of this system requires further attention not only from researchers but also from the government and global medical communities.

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Biventricular Repair or Single-Ventricle Palliation

Voges

Krupičková

2022

JACC: Advances

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Intervention for fetal critical aortic stenosis: first step in a metamorphosis?

Cited by 3 publications

References 26 publications

An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?

An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease: Xinhua Hospital Model

Biventricular Repair or Single-Ventricle Palliation

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