Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures

Arzt, W; Wertaschnigg, Dagmar; Veit, I.; Klement, F.; Gitter, Roland; Tulzer, Gerald

doi:10.1002/uog.8927

Cited by 123 publications

(75 citation statements)

References 14 publications

(1 reference statement)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Certainly, right heart interventions are better tolerated than are left heart ones, and a key advantage was that all procedures were carried out by an experienced team that had already performed a substantial number of left heart interventions16, 17.…”

Section: Discussionmentioning

confidence: 99%

Immediate effects and outcome of in‐utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis

Tulzer

Arzt

Gitter

et al. 2018

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

ObjectiveTo assess the immediate effects of fetal pulmonary valvuloplasty on right ventricular (RV) size and function as well as in‐utero RV growth and postnatal outcome.MethodsPatients with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS) who underwent fetal pulmonary valvuloplasty at our center between October 2000 and July 2017 were included. Echocardiographic data obtained before and after the procedure were analyzed retrospectively (median interval after intervention, 1 (range, 1–3) days) for ventricular and valvular dimensions and ratios, RV filling time (duration of tricuspid valve (TV) inflow/cardiac cycle length), TV velocity time integral (TV‐VTI) × heart rate (HR) and tricuspid regurgitation (TR) velocity. Longitudinal data were collected from only those fetuses followed up in our center. Outcome was assessed using the scoring system as described by Roman et al. for non‐biventricular outcome.ResultsThirty‐five pulmonary valvuloplasties were performed in our institution on 23 fetuses with PAIVS (n = 15) or CPS (n = 8). Median gestational age at intervention was 28 + 4 (range, 23 + 6 to 32 + 1) weeks. No fetal death occurred. Immediately after successful intervention, RV/left ventricular length (RV/LV) ratio (P ≤ 0.0001), TV/mitral valve annular diameter (TV/MV) ratio (P ≤ 0.001), RV filling time (P ≤ 0.00001) and TV‐VTI × HR (P ≤ 0.001) increased significantly and TR velocity (P ≤ 0.001) decreased significantly. In fetuses followed longitudinally to delivery (n = 5), RV/LV and TV/MV ratios improved further or remained constant until birth. Fetuses with unsuccessful intervention (n = 2) became univentricular, all others had either a biventricular (n = 15), one‐and‐a‐half ventricular (n = 3) or still undetermined (n = 3) outcome. Five of nine fetuses with a predicted non‐biventricular outcome, in which the procedure was successful, became biventricular, while two of nine had an undetermined circulation.ConclusionIn selected fetuses with PAIVS or CPS, in‐utero pulmonary valvuloplasty led immediately to larger RV caused by reduced afterload and increased filling, thus improving the likelihood of biventricular outcome even in fetuses with a predicted non‐biventricular circulation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

show abstract

Section: Discussionmentioning

confidence: 99%

Immediate effects and outcome of in‐utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis

Tulzer

Arzt

Gitter

et al. 2018

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

show abstract

“…Higher left ventricular length Z score and higher left ventricular pressure have been independently associated with a higher chance of biventricular outcome after birth, setting left ventricular length Z score \ -2 as an exclusion criteria when selecting candidates for FAV [3,4].…”

Section: Review the Selection Of Patients For Fetal Aortic Valvuloplastymentioning

confidence: 99%

Fetal Valvuloplasty for Critical Aortic Stenosis

2015

View full text Add to dashboard Cite

Fetal aortic valvuloplasty (FAV) aims at modifying the progression of aortic stenosis evolving to hypoplastic left heart syndrome (Donofrio et al. Circulation 129(21):2183-2242. In the last decades, the observation of mid-term outcome of the patients that have been intervened prenatally has allowed further understanding of the disease and the effects of FAV, as well as of postnatal treatment of these patients. FAV is also being studied with animal models, but still with limited results. Given the small number of cases, multicenter studies are ongoing. We present a review of the most recently reported data and central aspects of our experience in the procedure.

show abstract

“…Critical AS and evolving HLHS. [3][4][5][6][7][8][9] a. AS should be the dominant lesion with no additional major cardiac or extracardiac malformations.…”

Section: Relevant Anatomy and Preprocedures Planningmentioning

confidence: 99%

“…Although maternal general anesthesia has been used for fetal interventions, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] we have performed them under maternal conscious sedation and regional spinal blockade conducted by an anesthesiologist.…”

Section: Preparation and Patient Positioningmentioning

confidence: 99%

Future Directions of Fetal Interventions in Congenital Heart Disease

Pedra

Peralta

Pedra

2013

Interventional Cardiology Clinics

View full text Add to dashboard Cite

Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures

Abstract: Objective Valvuloplasty of the fetal aortic valve has the potential to prevent progression of critical aortic stenosis (AS) to hypoplastic left heart syndrome (HLHS

Cited by 123 publications

References 14 publications

Immediate effects and outcome of in‐utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis

Immediate effects and outcome of in‐utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis

Fetal Valvuloplasty for Critical Aortic Stenosis

Future Directions of Fetal Interventions in Congenital Heart Disease

Contact Info

Product

Resources

About