CASE 8—2016 Percutaneous Fetal Cardiac Intervention for Severe Aortic Stenosis and Evolving Hypoplastic Left-Heart Syndrome

Autor: Scott R. Schulman, Yehuda Ginosar, Mark D. Rollins, Anita J. Moon-Grady, Gerald Tulzer, Sheldon Stohl, Marla B. Ferschl, Brian M. Gilliss
Rok vydání: 2016
Předmět:
Zdroj: Journal of Cardiothoracic and Vascular Anesthesia. 30:1118-1128
ISSN: 1053-0770
Popis: From the Departments of *Anesthesia and Perioperative Care and †Pediatrics, University of California, San Francisco, CA; ‡Department of Pediatric Cardiology, Children’s Heart Center Linz, Kepler University Clinic, Linz, Austria; §Hadassah Hebrew University Medical Center, Jerusalem, Israel; ‖Children’s Hospital of Los Angeles, Los Angeles, CA; and ¶Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. Address reprint requests to Marla B. Ferschl, MD, Department of Anesthesia and Perioperative Care, University of California, San Francisco, Department of Anesthesia, Box 3216, 550 16th St. 5th floor, San Francisco, CA 94143. E-mail: ferschlm@anesthesia.ucsf.edu Published by Elsevier Inc. 1053-0770/2602-0033$36.00/0 http://dx.doi.org/10.1053/j.jvca.2016.03.155 FETAL SURGERY IS AN evolving discipline that aims to improve neonatal outcomes in patients who would otherwise have significant morbidity or mortality without treatment prior to birth. The goal of fetal intervention is to correct a primary defect at an early stage in development in order to halt or reverse subsequent secondary effects of the lesion. Disorders amenable to fetal intervention require both the ability to obtain an early accurate diagnosis and well-understood disease progression. Though a new discipline, the safety and efficacy of fetal surgery for open fetal myelomeningocele were shown in a landmark 2011 article. This study demonstrated improved motor developmental outcomes as well as a decreased need for a ventriculo-peritoneal shunt in children randomized to a fetal myelomeningocele repair v standard postnatal repair. The benefits of fetal intervention also have been evaluated in other congenital anomalies, including chest masses and diaphragmatic hernia, as well as for cardiac lesions. In congenital cardiac disease, a few select lesions may be due to a primary defect that subsequently leads to hemodynamic perturbations that evolve into secondary, more complicated malformations. By intervening during the fetal period rather than waiting until after birth, the goal is to prevent or reduce the impact of these secondary deformities and provide an improved clinical outcome. Three congenital cardiac lesions currently are considered appropriate targets for fetal therapy: (1) aortic stenosis (AS) with evolving hypoplastic left-heart syndrome (eHLHS), (2) hypoplastic left-heart syndrome (HLHS) with intact (or highly restrictive) atrial septum, and (3) pulmonary atresia with intact ventricular septum. Importantly, no prospective trials have demonstrated the efficacy of fetal therapy for these malformations. Of the 3 lesions, aortic balloon dilation for AS is the most commonly performed, and, in fact, several centers throughout the world have experience with percutaneous intervention for this indication. Below, the authors present the case of a percutaneous fetal balloon valvuloplasty of the aortic valve in a fetus with AS.
Databáze: OpenAIRE
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