Abstract 15508: Animal Model of Fetal Aortic Valvuloplasty: Technical Success Maximized With Combination of Perventricular and Transhepatic Access
Objectives: Fetal aortic valvuloplasty via direct perventricular puncture is reported in humans, complicated by bradycardia and hemopericardium. There are also limitations related to fetal lie. The aim is to develop interventional techniques for successful aortic valve interventions via transhepatic access to potentially avoid the complications of direct cardiac puncture.
Methods: 4 pregnant ewes 110-130 days gestation were placed under general anesthesia. Studies were performed with IACUC approval. Ultrasound revealed the fetal lie, and transhepatic access for aortic valve dilation was attempted.
Results: There were 2 fetal lambs with right side (liver) anterior and 2 with left side (left ventricular apex) anterior respectively. Twin pregnancies were noted in 2 ewes with only 1 lamb (1 right and 1 left side anterior) intervened upon. With fetal position right side anterior, transhepatic access and wire position across the aortic valve was achieved with magnetic navigation. In 1 a balloon was tested over the wire and tracked easily to the aortic valve and was dilated (Figure). In the fetuses with left side anterior, transhepatic approach was not technically successful but perventricular approach was straightforward. One ewe pregnant with twins had respiratory complications unrelated to the procedure and was euthanized. This fetus had failed hepatic access and subsequent perventricular access with no complication. The other 3 fetuses with successful wire course across the aortic valve survived and completed uneventful pregnancies. The twin lamb that did not undergo an intervention suffered no complication.
Conclusion: A combination of transhepatic and perventricular access may increase the technical success of fetal aortic valvuloplasty. With right side anterior the transhepatic technique may avoid direct cardiac puncture associated complications.
- © 2013 by American Heart Association, Inc.