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. 2020 Sep 7;9(9):2888.
doi: 10.3390/jcm9092888.

Fetal Cardiac Interventions-Polish Experience from "Zero" to the Third World Largest Program

Marzena Debska  1   2 , Adam Kolesnik  3   4   5 , Beata Rebizant  1 , Agnieszka Sekowska  1   6 , Agnieszka Grzyb  3   7 , Katarzyna Chaberek  1 , Jacek Witwicki  8 , Romuald Debski  1 , Joanna Dangel  3
Affiliations

Fetal Cardiac Interventions-Polish Experience from "Zero" to the Third World Largest Program

Marzena Debska et al. J Clin Med. .

Abstract

This article presents the technical aspects of the Polish fetal cardiac interventions (FCI) program, including preparation of the team and modifications in the technique of the procedure that aim to increase its safety for the mother and the fetus. Over 9 years, 128 FCI in 113 fetuses have been performed: 94 balloon aortic valvuloplasties (fBAV), 14 balloon atrioseptoplasties (fBAS) with stent (BAS+), 5 balloon atrioseptoplasties without stent placement (BAS-), and 15 fetal pulmonary valvuloplasties (fBPS). The technical success rate ranged from 80% (BAS-) to 89% (fBAV), while the procedure-related death rate (defined as death within 72 hours following the procedure) ranged from 7% (fBAV and fBPV) to 20% (BAS). There were 98 live births after all FCI (3 pregnancies continue). Median gestational age at delivery was 39 weeks in our center and 38 weeks in other centers.

Keywords: critical aortic stenosis; fetal cardiac interventions; fetal echocardiography; fetal valvuloplasty; hypoplastic left heart syndrome; pulmonary atresia and intact ventricular septum; technical aspects.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Training on the cardiac specimen in the dissection room. The catheter was introduced through the apex into the heart of the neonate with critical aortic stenosis. The guidewire with a balloon catheter was introduced through the left ventricular apex and the aortic valve.
Figure 2
Figure 2
Fetal cardiac interventional procedures performed between 2011 and 2020. fBAV: fetal balloon aortic valvuloplasty; fBAS+: stent placement in the interatrial septum; fBAS−: balloon atrioseptoplasty; fBPV: fetal balloon pulmonary valvuloplasty; PR death: procedure-related death. A total of 14 fetuses had more than one procedure (8 fetuses had the same procedure twice, 5 fetuses had two different procedures, and 1 fetus had three different procedures). † two pregnancies continue; * one pregnancy continues. Eight fetuses with critical aortic stenosis were hydropic, and six of them needed opening of the interatrial septum after fBAV.
Figure 3
Figure 3
The technique of performing all cardiac interventional procedures. Antiseptic operating field, transducer covered by antiseptic sleeve. The obstetrician holds the transducer in the right hand and the needle in the left hand.
Figure 4
Figure 4
fBAV—the coronary balloon inflated in the aortic valve. The left ventricular apex was punctured and the needle with the coronary balloon was introduced through the aortic valve.
Figure 5
Figure 5
fBPV—the guidewire was introduced through the needle and placed across the pulmonary valve.
Figure 6
Figure 6
Most common complications during fBAV. Procedures were divided into three parts, with around 30 fBAV in each. From the 32nd procedure, we started to add heparin into the flushing solution and atropine into the umbilical vein. From the 36th procedure, we started to evacuate even a small amount of pericardial effusion.
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