Fetal Pulmonary Valvuloplasty in Fetuses with Right Ventricular Outflow Tract Obstructive Disease: Experience and Outcom
- PDF / 1,263,304 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 33 Downloads / 179 Views
ORIGINAL ARTICLE
Fetal Pulmonary Valvuloplasty in Fetuses with Right Ventricular Outflow Tract Obstructive Disease: Experience and Outcome of the First Five Cases in China Chengcheng Pang1 · Chengbin Zhou1 · Zhiwei Zhang2 · Yufen Li2 · Xu Zhang1 · Fengzhen Han3 · Yunxia Sun4 · Sheng Wang5 · Jian Zhuang6 · Wei Pan1 Received: 22 July 2020 / Accepted: 8 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The current study was to report our initial experiences of fetal pulmonary valvuloplasty (FPV) for fetuses with pulmonary atresia with intact ventricular septum (PA/IVS) and critical pulmonary stenosis (CPS), including case selection, technical feasibility, and the effects of FPV on utero and postnatal outcome. Two fetuses with PA/IVS and three fetuses with CPS were enrolled between September 2016 and April 2018. All fetuses were with concomitant severe right ventricular dysplasia and growth arrest. Parameters of right cardiac development and hemodynamics, including tricuspid/mitral annulus ratio (TV/MV), right ventricle/left ventricle long-axis ratio (RV/LV), tricuspid valve inflow duration/cardiac cycle ratio (TVI/ CC), degree of tricuspid regurgitation (TR), and blood flow direction of arterial duct and ductus venosus, were evaluated using echocardiogram. FPV was performed trans-abdominally under ultrasound guidance. Echocardiogram was performed post-FPV and every 2–4 weeks thereafter until delivery. The median gestational age at the time of FPV was 28 weeks. From technical perspective, pulmonary balloon valvuloplasty was successfully performed and the opening of pulmonary valve was improved in all fetuses in 2–4 weeks. However, progressive restenosis was observed in four fetuses with gestation advancing, and re-atresia occurred in two PA/IVS fetuses at 36th and 37th weeks’ gestation, respectively. The growth trajectories of TV/MV, RV/LV, and TVI/CC were improved in the 1st week after FPV and then slowed down along with pulmonary valve restenosis. All fetuses were born alive and underwent postnatal interventions, including pulmonary balloon valvuloplasty in three fetuses and surgical procedures in two fetuses. During follow-up, three fetuses turned to be biventricular, one became one and a half ventricular at 1-year old, and one died of neonatal infection. Although pulmonary valve restenosis might occur as gestation advancing, FPV seems to be a safe and feasible procedure to improve the growth trajectories of right heart for fetuses with PA/IVS and CPS. Keywords Fetus · Echocardiography · Pulmonary valve stenosis · Pulmonary atresia · Balloon dilation Abbreviations FPV Fetal pulmonary valvuloplasty PA/IVS Pulmonary atresia with intact ventricular septum (PA/IVS) CPS Critical pulmonary stenosis TV Tricuspid valve MV Mitral valve RV Right ventricle * Jian Zhuang [email protected] * Wei Pan [email protected] Extended author information available on the last page of the article
LV Left ventricle PV Pulmonary valve AV Aortic valve TV/MV Tricuspid/mitral annulus
Data Loading...
