Operative techniques and strategies for minimally invasive fetoscopic fetal cardiac interventions in sheep

Kohl, Thomas; Witteler, Ralf; Strümper, Danja; Gogarten, W.; Asfour, Boulos; Reckers, Julia; Merschhoff, Gregor; Marcus, Abraham; Weyand, Michael; Aken, Hugo Van; Vogt, Johannes; Scheld, Hans H.

doi:10.1007/s004640000129

Cited by 45 publications

(52 citation statements)

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“…In view of the early mortality rate (20-30% within the first 24 h after the procedure) and the constantly improving results of the Norwood procedure at major institutions, some authors feel that prenatal procedures are less justifiable [28,33,44,50,51]. Work is in progress in animal models to improve fetoscopic approaches guided by transesophageal or intraamniotic fetal echocardiography, which improves the imaging when the balloon catheter is inside the fetal heart, but understandably, this approach has not yet been used in the human fetus [27][28][29][30][31][32][33][34]. Further modification and miniaturization of new materials such as cutting balloon catheters combined with future improvement in transcatheter techniques offer promise in reducing the risks (Fig.…”

Section: Fetal Cardiac Interventionmentioning

confidence: 99%

“…The most common noncardiac anomalies for which invasive fetal therapy is currently being considered are myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and malformations of the lungs or the adjacent structures (such as diaphragmatic hernia) [34][35][36][37][38][39][40][41]. It is noteworthy that despite the advances in prenatal diagnosis, studies on prenatal animal model interventions have lagged years behind and still remain limited [26][27][28][29][30][31][33][34][35][36][37][38]. Ongoing evaluation of the efficacy of these still investigational techniques is required so that appropriate selection of fetuses for inutero surgery can be made.…”

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

“…The timing and concepts of intrauterine intervention are now being reconsidered [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Keyhole instruments and catheters and three-dimensional optics and imaging modes make it possible to perform intricate intrauterine procedures with a precision that one could have achieved only through open hysterotomy in the past.…”

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

“…However, some centers are already exploring new minimally invasive therapeutic options with a view to inutero cardiac palliation [26][27][28][29][30][31][32][33]. The upcoming expansion of fetal cardiac interventions to ameliorate critically progressive fetal cardiac lesions intensifies the need to address issues about the adequacy of assessment and patient selection as well as the safety of those who undergo these novel procedures.…”

Section: Introductionmentioning

confidence: 99%

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Interventional fetal balloon valvuloplasty for congenital heart disease—current shortcomings and possible perspectives

et al. 2005

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Fetal cardiac interventions are new and relatively unknown investigational options for modifying congenital heart disease in utero. Techniques for safer access to the fetus must be improved, and selection criteria for patients for whom these procedures are potentially beneficial must be developed. Currently, antenatal cardiac intervention attempts are being made to either prevent or reverse hydrops in fetuses with cardiac valve disease or outflow tract obstruction or to recruit hypoplastic ventricles. Most important are early detection and referral of these fetuses, thereby enabling timely procedures with improved outcomes. However, performing successful fetal cardiac interventions requires multidisciplinary collaboration between obstetricians, pediatric cardiologists, pediatric cardiac surgeons, and anesthesiologists, as each discipline provides specific skills for these critically ill babies.

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Section: Fetal Cardiac Interventionmentioning

confidence: 99%

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interventional fetal balloon valvuloplasty for congenital heart disease—current shortcomings and possible perspectives

et al. 2005

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“…[1][2][3] Because amniotic insufflation precludes conventional maternal transabdominal fetal echocardiography, fetal monitoring and guidance of interventional devices into the fetal heart during these entirely percutaneous procedures has relied on mechanical intravascular ultrasound catheters used as fetal transesophageal echo probes. 4,5 Unfortunately, these catheters carry several limitations that limit their application in the human fetus.…”

mentioning

confidence: 99%

Multimodal Fetal Transesophageal Echocardiography for Fetal Cardiac Intervention in Sheep

Kohl

Westphal²,

Strümper³

et al. 2001

Circulation

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Background-The overall performance of available mechanical intravascular ultrasound catheters for fetal transesophageal echocardiography during fetoscopic fetal cardiac interventions in sheep has been limited by radioelectronic interference, low system frame rates, and low acoustic outputs. Therefore, a more reliable device is desired for human fetoscopic surgical procedures. Methods and Results-We assessed the potential of a newly available 10-French phased-array intravascular ultrasound catheter for multimodal fetal transesophageal echocardiography in 5 fetal sheep between 78 and 98 days of gestation (term, 145 to 150 d). The intravascular ultrasound catheter was easily inserted through the mouth into the esophagus in all 5 sheep fetuses (mean weight, 600 g), and it permitted high-quality 2D imaging of the fetal heart in vertical imaging planes that were validated by MRI. Color Doppler and pulsed Doppler imaging permitted clear assessment of fetal cardiovascular flows and recording of velocity-time integral tracings of the fetal heart and great vessels. The vertical imaging planes were particularly useful to demonstrate interventional material inside the fetal heart and great vessels. Conclusions-Our early experience with the phased-array intravascular ultrasound catheter indicates that multimodal fetal transesophageal echocardiography has now become possible in these smallest of patients. Key Words: fetus Ⅲ echocardiography Ⅲ ultrasonics Ⅲ valvuloplasty Ⅲ surgery Ⅲ catheterization Ⅲ fetoscopy C urrently developed minimally invasive techniques in sheep for fetoscopic fetal cardiac catheterization use gaseous insufflation of the amniotic cavity for optimum fetal visualization and manipulation. 1-3 Because amniotic insufflation precludes conventional maternal transabdominal fetal echocardiography, fetal monitoring and guidance of interventional devices into the fetal heart during these entirely percutaneous procedures has relied on mechanical intravascular ultrasound catheters used as fetal transesophageal echo probes. 4,5 Unfortunately, these catheters carry several limitations that limit their application in the human fetus. The overall image quality suffers unpredictably from radioelectronic interference of the endoscopic equipment, and the low frame rate and low acoustic output of the mechanical catheters result in suboptimal temporal resolution and insufficient depth penetration. Accordingly, satisfactory imaging during experimental fetoscopic fetal cardiac catheterizations has been limited to the catheter near-field. 6 Because the mechanical ultrasound catheters also lack Doppler capabilities, an assessment of fetal hemodynamics was confined to observations of heart rate changes and ductus arteriosus size and oval foramen patency. 5 Because of these limitations, a more reliable device is desired for fetal cardiac intervention in humans. Therefore, we assessed the potential of a novel phased-array intravascular ultrasound catheter for multimodal fetal transesophageal echocardiography in sheep. MethodsWe stu...

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Prenatal Diagnosis and Management of Abnormal Fetal Development in the Third Trimester of Pregnancy

Axt-Fliedner¹,

Wolter²

2015

Genetic Disorders and the Fetus

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Operative techniques and strategies for minimally invasive fetoscopic fetal cardiac interventions in sheep

Abstract: As operative techniques have become more refined, the feasibility of performing fetoscopic fetal cardiac interventions in human fetuses now depends mainly on technical improvements in imaging and interventional catheters, as well as advances in pacemaker equipment.

Cited by 45 publications

References 26 publications

Interventional fetal balloon valvuloplasty for congenital heart disease—current shortcomings and possible perspectives

Interventional fetal balloon valvuloplasty for congenital heart disease—current shortcomings and possible perspectives

Multimodal Fetal Transesophageal Echocardiography for Fetal Cardiac Intervention in Sheep

Prenatal Diagnosis and Management of Abnormal Fetal Development in the Third Trimester of Pregnancy

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