Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta‐analysis of observational studies

Júnior, Edward Araujo; Tonni, Gabriele; Chung, Myung‐Sub; Ruano, Rodrigo; Martins, Wellington de Paula

doi:10.1002/uog.15867

Cited by 21 publications

(25 citation statements)

References 45 publications

(54 reference statements)

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“…It is not our intention to review here this material, largely of a clinical nature – we instead refer the reader to reviews in Achiron & Kivilevitch (), Anilkumar (), Araujo Junior et al . (), Dzialowski et al . () and Homma et al .…”

Section: Cardiovascular Shunts In Ectothermic Vertebrates: Theories mentioning

confidence: 86%

“…The role of central vascular shunts in developing mammals has been considered in great detail, not only with regard to the basic biology of shunting in endotherms, but also because of their importance in human development and the management of pathologies during foetal development. It is not our intention to review here this material, largely of a clinical nature -we instead refer the reader to reviews in Achiron & Kivilevitch (2016), Anilkumar (2013), Araujo Junior et al (2016, Dzialowski et al (2011) andHomma et al (2016). In brief, shunts in the mammalian foetus (and, with a few small differences, in the avian embryo) occur through both intracardiac and external vascular mechanisms and structures.…”

Section: (7) Developmental Context (A) Endothermsmentioning

confidence: 99%

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Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

2019

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This review explores the long‐standing question: ‘Why do cardiovascular shunts occur?’ An historical perspective is provided on previous research into cardiac shunts in vertebrates that continues to shape current views. Cardiac shunts and when they occur is then described for vertebrates. Nearly 20 different functional reasons have been proposed as specific causes of shunts, ranging from energy conservation to improved gas exchange, and including a plethora of functions related to thermoregulation, digestion and haemodynamics. It has even been suggested that shunts are merely an evolutionary or developmental relic. Having considered the various hypotheses involving cardiovascular shunting in vertebrates, this review then takes a non‐traditional approach. Rather than attempting to identify the single ‘correct’ reason for the occurrence of shunts, we advance a more holistic, integrative approach that embraces multiple, non‐exclusive suites of proposed causes for shunts, and indicates how these varied functions might at least co‐exist, if not actually support each other as shunts serve multiple, concurrent physiological functions. It is argued that deposing the ‘monolithic’ view of shunting leads to a more nuanced view of vertebrate cardiovascular systems. This review concludes by suggesting new paradigms for testing the function(s) of shunts, including experimentally placing organ systems into conflict in terms of their perfusion needs, reducing sources of variation in physiological experiments, measuring possible compensatory responses to shunt ablation, moving experiments from the laboratory to the field, and using cladistics‐related approaches in the choice of experimental animals.

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Section: Cardiovascular Shunts In Ectothermic Vertebrates: Theories mentioning

confidence: 86%

Section: (7) Developmental Context (A) Endothermsmentioning

confidence: 99%

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

2019

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“…Termination of pregnancy was not offered in our center due to state laws; however, referral to centers where it is available was an option. Patients were counseled with previously published data of other countries with regard to prognosis and risks of fetal valvuloplasty, as well as the success of postnatal surgery (Norwood or hybrid procedures) . The Hospital's Ethics Committee approved the study protocol, and written parental consent was obtained from all parents involved.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of hypoplastic left heart syndrome and fetal aortic valvuloplasty in a country with suboptimal postnatal management

et al. 2019

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Background: Fetal aortic stenosis (AoS) may progress to hypoplastic left heart syndrome (HLHS) in utero. There are currently no data, prenatal or postnatal, describing survival of fetuses or neonates with AoS or HLHS in a country with suboptimal postnatal management. Study design: Prospective cohort study performed in Mexico, including cases diagnosed with AoS and HLHS within a 6-year period. AoS patients fulfilling previously published criteria for evolving HLHS (eHLHS) were offered fetal aortic valvuloplasty. Outcome variables were perinatal mortality, postnatal management, type of postnatal circulation, and overall survival. Results: Fifty-four patients were included: 16 AoS and 38 HLHS. Eighteen patients had associated anomalies and/or an abnormal karyotype. Seventy-four percent of HLHS received comfort measures, with only three cases reporting an attempt at surgical palliation, and one survivor of the first stage. Fetal aortic valvuloplasty was performed successfully in nine cases of eHLHS. Overall postnatal survival was 44%in AoS with fetal aortic valvuloplasty, and one case (ongoing) in the HLHS group.Conclusions: HLHS in Mexico carries more than a 95% risk of postnatal death, with little or no experience at surgical palliation in most centers. Fetal aortic valvuloplasty in AoS may prevent progression to HLHS and in this small cohort was associated with ≈50% survival.

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“…Fetal interventions may remodel cardiac morphology and function to such an extent that it may favorably alter the in utero natural history, resulting in improved prenatal and postnatal outcomes, including an increased likelihood of achieving biventricular circulation84). However, in a recent meta-analysis study85), fetal aortic valvuloplasty had a live-birth rate of 65% with a neonatal death rate of 16%. In fetal pulmonary valvuloplasty, the live-birth rate was 56% and the neonatal mortality was 33%.…”

Section: Fetal Interventionmentioning

confidence: 99%

Recent advances in pediatric interventional cardiology

Kim

2017

Korean J Pediatr

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During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.

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Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta‐analysis of observational studies

Abstract: Objective To assess perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease (CHD). Methods

Cited by 21 publications

References 45 publications

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

Outcomes of hypoplastic left heart syndrome and fetal aortic valvuloplasty in a country with suboptimal postnatal management

Recent advances in pediatric interventional cardiology

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