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(Circulation. 2000;102:1602.)
© 2000 American Heart Association, Inc.

Brief Rapid Communications

Fetoscopic Direct Fetal Cardiac Access in Sheep

An Important Experimental Milestone Along the Route to Human Fetal Cardiac Intervention

Thomas Kohl, MD; Danja Strümper, MD; Ralf Witteler, MD; Gregor Merschhoff, MS; Rasa Alexiene, MS; Claudia Callenbeck, RN; Boulos Asfour, MD; Julia Reckers, MS; Sebastian Aryee, MS; Christian Vahlhaus, MD; Johannes Vogt, MD; Hugo Van Aken, MD; Hans H. Scheld, MD

From the Departments of Pediatric Cardiology (T.K., G.M., R.A., J.R., S.A., J.V.), Cardiothoracic Surgery (T.K., C.C., B.A., H.H.S.), Anesthesiology (D.S., H.V.A.), Obstetrics and Gynecology (R.W.), and Cardiology (C.V.), University of Münster Medical School, Münster, Germany.

Correspondence to Thomas Kohl, MD, Departments of Pediatric Cardiology and Cardiothoracic Surgery, University of Münster Medical School, Albert Schweitzer Str 33, 48149 Münster, Germany. E-mail tkohl{at}muenster.de

Background—Fetal cardiac interventions by direct ultrasound-guided approaches or open fetal cardiac surgery have been fraught with technical difficulties, as well as with significant maternal and fetal morbidity in humans. Therefore, the purpose of our study in sheep was to assess the feasibility and potential of fetoscopic direct fetal cardiac access.

Methods and Results—In 15 anesthetized pregnant ewes (88 to 109 days of gestation; term, 145 days), 3 to 4 trocars were percutaneously placed in the uterus. Using videofetoscopic equipment, we assessed the feasibility of achieving direct fetal cardiac access. Minimally invasive direct fetal cardiac access by operative fetoscopy was achieved in 10 of the 15 fetal sheep. In 7 fetuses, the approach was successfully tested for fetal cardiac pacing (n=5) or antegrade fetal cardiac catheterization (n=2). Access was not achieved in 5 fetuses because of bleeding complications (n=2) or because the fetoscopic setup could not be established (n=3). All but 2 fetal sheep were alive at the end of the procedure. Acute fetal demise resulted from maternal hypotension or kinking of the fetal inferior caval vein by sternal suspension. Six ewes continued gestation; 3 of these went to term, with a normal fetal outcome. Two ewes died from septicemia 3 and 7 days after the procedure, and 1 ewe aborted 1 month after the procedure.

Conclusions—Minimally invasive direct fetal cardiac access by operative fetoscopy is feasible in fetal sheep. The fetoscopic approach carries important potential for fetal cardiac pacing, antegrade fetal valvuloplasties, and resection of fetal intrapericardial teratomas in human fetuses.

Key Words: fetus • fetoscopy • thoracotomy • stenosis • valves • pacing • valvuloplasty

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