Transhepatic ultrasound-guided cardiac catheterization in the fetal lamb - A new approach for cardiac interventions in fetuses

Article

关键词: LEFT-HEART SYNDROME;    IN-UTERO;    ATRIAL SEPTUM;    ECHOCARDIOGRAPHY;    VALVULOPLASTY;    DIAGNOSIS;    STENOSIS;    DEFECTS;    DISEASE;    INTACT;   

DOI  :  10.1161/01.CIR.0000155253.45773.13

来源: SCIE

【 摘 要 】

Background - Percutaneous transventricular and fetoscopic umbilical catheterization have been applied to animal and human fetuses. These methods have a high rate of failure and complications. Here, we propose an alternative route for anterograde echocardiography-guided cardiac catheterization through a transhepatic approach of the intra-abdominal vessels in the fetal lamb. Methods and Results - After exteriorization of the uterus in 12 pregnant ewes between 118 to 122 days' gestation, a 4F sheath mounted over a 1.2-mm needle was placed into the intra-abdominal portion of the umbilical vein ( n = 2) and into the subdiaphragmatic portion of the inferior vena cava via a transhepatic approach ( n = 10) under ultrasound guidance. In the first 2 animals using a transumbilical approach, it was impossible to reach the heart through the ductus venosus. In the next 10 animals, using a conventional technique, echocardiography-guided catheterization of the 4 chambers was performed in the all fetuses, atrial or ventricular pacing in 6 fetuses, and ballooning of the pulmonary valve in 9 of 10 fetuses. Among the 10 fetuses catheterized through the transhepatic approach, 2 were euthanized immediately after the procedure to evaluate intraperitoneal bleeding ( 23 and 29 mL, respectively), and 3 died after the procedure ( 1 of major bleeding and 2 deaths related to balloon catheter manipulation). Finally, 5 were delivered vaginally after an uneventful pregnancy, and autopsy at day 5 did not show significant liver, vascular, or cardiac injury. Conclusions - Echocardiography-guided fetal cardiac catheterization through a transhepatic approach is feasible and provides an interesting alternative approach for human fetal cardiac interventions.

【 授权许可】

Free