Journal of Clinical Pediatrics >
Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases
Received date: 2022-10-11
Online published: 2024-01-05
Objective To explore the feasibility and short-term efficacy of fetal cardiac intervention (FCI) for critical congenital heart disease. Methods The clinical data of all the fetuses who underwent FCI in the intrauterine diagnosis and treatment center from August 2018 to May 2022 were included, including basic information from perinatal to postnatal, FCI surgical information, fetal echocardiogram information, etc., and the fetuses were followed up until 3 months after birth to analyze the feasibility, effectiveness and safety of FCI technology. Results Seven fetuses were included, 5 of whom underwent FCI surgery with a 100% success rate (5/5), including 2 cases of critical aortic stenosis (CAS) and 3 cases of pulmonary atresia with intact ventricular septum (PA/IVS). The median gestational age at the time of FCI surgery was 29+2(28+6-32+4) weeks. The echocardiographic indexes of 5 fetuses after FCI were significantly improved. All five fetuses were full-term, with a median gestational age of 39+2(38-39+4) weeks. After birth, aortic valvuloplasty was performed in 2 patients with CAS and percutaneous balloon dilatation of pulmonary valve was performed in 3 patients with PA/IVS. One case of CAS with cardiac insufficiency died in the neonatal period, and the other 4 cases had good prognosis during follow-up. Conclusion FCI is a safe and effective technique that is expected to improve the prognosis of critical congenital heart disease.
Leiyi CAI , Liqing ZHAO , Lei WANG , Xianting JIAO , Yongjun ZHANG , Yurong WU , Hong ZHU , Hongping XIA , Kun SUN , Sun CHEN . Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases[J]. Journal of Clinical Pediatrics, 2024 , 42(1) : 35 -39 . DOI: 10.12372/jcp.2024.22e1355
[1] | Rosano A, Botto L D, Botting B, et al. Infant mortality and congenital anomalies from 1950 to 1994: an international perspective[J]. Journal of Epidemiology and Community Health, 2000, 54(9): 660-666. |
[2] | Zhang X, Sun Y, Zhu J, et al. Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study[J]. BMC Pediatr, 2020, 20(1): 416. |
[3] | Arzt W, Tulzer G, Aigner M, et al. Invasive intrauterine treatment of pulmonary atresia/intact ventricular septum with heart failure[J]. Ultrasound Obstet Gynecol, 2003, 21(2): 186-188. |
[4] | Tworetzky W, Marshall AC. Fetal interventions for cardiac defects[J]. Pediatr Clin North Am, 2004, 51(6): 1503-1513. |
[5] | Freud LR, Tworetzky W. Fetal interventions for congenital heart disease[J]. Curr Opin Pediatr, 2016, 28(2): 156-162. |
[6] | Friedman KG, Tworetzky W. Fetal cardiac interventions: Where do we stand?[J]. Arch Cardiovasc Dis, 2020, 113(2): 121-128. |
[7] | McElhinney DB, Marshall AC, Wilkins-Haug LE, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome[J]. Circulation, 2009, 120(15): 1482-1490. |
[8] | Hogan WJ, Grinenco S, Armstrong A, et al. Fetal cardiac intervention for pulmonary atresia with intact ventricular septum: international fetal cardiac intervention registry[J]. Fetal Diagn Ther, 2020: 1-9. |
[9] | Tworetzky W, McElhinney DB, Marx GR, et al. In utero valvuloplasty for pulmonary atresia with hypoplastic right ventricle: techniques and outcomes[J]. Pediatrics, 2009, 124(3): e510-e518. |
[10] | Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association[J]. Circulation, 2014, 129(21): 2183-2242. |
[11] | International Society of Ultrasound in Obstetrics and Gynecology, Carvalho JS, Allan LD, et al. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart[J]. Ultrasound Obstet Gynecol, 2013, 41(3): 348-359. |
[12] | Maxwell D, Allan L, Tynan MJ. Balloon dilatation of the aortic valve in the fetus: a report of two cases[J]. Br Heart J, 1991, 65(5): 256-258. |
[13] | Tulzer A, Arzt W, Tulzer G. Fetal aortic valvuloplasty may rescue fetuses with critical aortic stenosis and hydrops[J]. Ultrasound Obstet Gynecol, 2021, 57(1): 119-125. |
[14] | Araujo Júnior E, Tonni G, Chung M, et al. Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies[J]. Ultrasound Obstet Gynecol, 2016, 48(4): 426-433. |
[15] | Salvin JW, McElhinney DB, Colan SD, et al. Fetal tricuspid valve size and growth as predictors of outcome in pulmonary atresia with intact ventricular septum[J]. Pediatrics, 2006, 118(2): e415-e420. |
[16] | 赵莉晴, 陈笋, 武育蓉, 等. 经皮心导管微导丝肺动脉瓣打孔并球囊扩张治疗新生儿室间隔完整型肺动脉瓣闭锁效果分析[J]. 中华儿科杂志, 2020, 58(2): 96-100. |
[17] | McElhinney DB, Tworetzky W, Lock JE. Current status of fetal cardiac intervention[J]. Circulation, 2010, 121(10): 1256-1263. |
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