Vol 86, No 4 (2015)
ARTICLES
Fetal cardiac interventions – are we ready for them?
Marzena Dębska, Joanna Szymkiewicz-Dangel, Adam Koleśnik, Piotr Kretowicz, Beata Rebizant, Jacek Witwicki, Romuald Dębski
DOI: 10.17772/gp/2074
·
Ginekol Pol 2015;86(4).
Vol 86, No 4 (2015)
ARTICLES
Abstract
Objective: The aim of the study was to analyze types and methods of intrauterine fetal cardiac interventions
performed between June 2011 and December 2013, and to assess the perinatal management of the neonates.
Methods: The program was developed after analysis of the available literature, practical individual training in Linz,
Austria, and simulation of the procedure in a dissecting-room. The rules for anesthesia in pregnant women and their
fetuses were developed. The interventions were performed in fetuses with critical cardiac defects, in the operating
room, under ultrasonographic control. The protocol was approved by the Local Bioethics Committee at the Centre
of Postgraduate Medical Education.
Material: We included fetuses with critical aortic stenosis (n=29), critical pulmonary stenosis (n=2), and closed or
extremely restricted foramen ovale (n=7). Between June 2011 and December 2013, the team comprised of JD,
MD and AK conducted 42 interventions in 35 fetuses, including 32 balloon aortic valvuloplasties (in 29 fetuses), 2
pulmonary valvuloplasties, 4 balloon atrial septostomies and 4 atrial septal stent placement. Three fetuses required
both, aortic valvuloplasty and fenestration of the atrial septum.
Results: Out of the 42 procedures, 41 (97%) were technically successful. We recorded 3 cases of fetal demise
associated with the intervention. We modulated the protocol of anesthesia given to pregnant women, switching
from general to local anesthesia with intravenous sedation. We always provided additional fetal anesthesia with
fentanyl and atracurium via the umbilical vein.
Conclusions: Based on our 2.5-year experience, it seems safe to conclude that all types of fetal cardiac interventions
may be successfully conducted at Polish centers. The procedures are safe for the pregnant women and
improve fetal status. Most of the neonates treated
Abstract
Objective: The aim of the study was to analyze types and methods of intrauterine fetal cardiac interventions
performed between June 2011 and December 2013, and to assess the perinatal management of the neonates.
Methods: The program was developed after analysis of the available literature, practical individual training in Linz,
Austria, and simulation of the procedure in a dissecting-room. The rules for anesthesia in pregnant women and their
fetuses were developed. The interventions were performed in fetuses with critical cardiac defects, in the operating
room, under ultrasonographic control. The protocol was approved by the Local Bioethics Committee at the Centre
of Postgraduate Medical Education.
Material: We included fetuses with critical aortic stenosis (n=29), critical pulmonary stenosis (n=2), and closed or
extremely restricted foramen ovale (n=7). Between June 2011 and December 2013, the team comprised of JD,
MD and AK conducted 42 interventions in 35 fetuses, including 32 balloon aortic valvuloplasties (in 29 fetuses), 2
pulmonary valvuloplasties, 4 balloon atrial septostomies and 4 atrial septal stent placement. Three fetuses required
both, aortic valvuloplasty and fenestration of the atrial septum.
Results: Out of the 42 procedures, 41 (97%) were technically successful. We recorded 3 cases of fetal demise
associated with the intervention. We modulated the protocol of anesthesia given to pregnant women, switching
from general to local anesthesia with intravenous sedation. We always provided additional fetal anesthesia with
fentanyl and atracurium via the umbilical vein.
Conclusions: Based on our 2.5-year experience, it seems safe to conclude that all types of fetal cardiac interventions
may be successfully conducted at Polish centers. The procedures are safe for the pregnant women and
improve fetal status. Most of the neonates treated
Keywords
fetal cardiac interventions / prenatal balloon valvuloplasty /
/ interatrial stent / fetal echocardiography / aortic stenosis /
/ pulmonary stenosis
Title
Fetal cardiac interventions – are we ready for them?
Journal
Ginekologia Polska
Issue
Vol 86, No 4 (2015)
Page views
884
Article views/downloads
2541
DOI
10.17772/gp/2074
Bibliographic record
Ginekol Pol 2015;86(4).
Keywords
fetal cardiac interventions / prenatal balloon valvuloplasty /
/ interatrial stent / fetal echocardiography / aortic stenosis /
/ pulmonary stenosis
Authors
Marzena Dębska
Joanna Szymkiewicz-Dangel
Adam Koleśnik
Piotr Kretowicz
Beata Rebizant
Jacek Witwicki
Romuald Dębski