Acute Cardiovascular Effects of Fetal Surgery in the Human

Rychik, Jack; Tian, Zhenjun; Cohen, Meryl S.; Ewing, Stanford; Cohen, David E.; Howell, Lori J.; Wilson, R. Douglas; Johnson, Mark P.; Hedrick, Holly L.; Flake, Alan W.; Crombleholme, Timothy M.; Adzick, N. Scott

doi:10.1161/01.cir.0000142294.95388.c4

Cited by 95 publications

(71 citation statements)

References 38 publications

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“…536 Intraoperative changes with a decrease in cardiac output, decrease in ventricular function, and development of AV valve regurgitation were common. 537 Maternal anesthesia, the interplay between maternal-placental-fetal hemodynamics, and the stressors of open fetal surgery all likely played a role but are still not completely understood. 538 These observations provide caution and highlight the importance of careful fetal echocardiographic surveillance during and after any invasive fetal procedure.…”

Section: Cardiovascular Changes During Fetal Surgerymentioning

confidence: 99%

“…537 In congenital cystic adenomatoid malformations, surgical mass resection and acute relief of cardiac tamponade may result in acute mismatch in volume with filling impairment and ventricular dysfunction. In sacrococcygeal teratomas, removal of the tumor leads to an acute reduction in preload and sudden imposition of increased afterload after the elimination of the lowvascular-resistance circuit provided by the mass.…”

Section: Cardiovascular Impact After Fetal Surgical Interventionmentioning

confidence: 99%

“…The sudden imposition of decreased preload and increased afterload on an already stressed heart may lead to ventricular mass-to-volume mismatch, ventricular dysfunction, and death. 537 …”

Section: Cardiovascular Impact After Fetal Surgical Interventionmentioning

confidence: 99%

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Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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1,020

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Cardiovascular Changes During Fetal Surgerymentioning

confidence: 99%

Section: Cardiovascular Impact After Fetal Surgical Interventionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

1,020

543

View full text Add to dashboard Cite

show abstract

“…Fetal monitoring during the procedure is possible with fetal pulse oximetry and near-infrared spectroscopy for fetal oxygenation monitoring, fetal echocardiography, a fetal scalp electrode for heart rate monitoring and fetal umbilical blood sampling for fetal blood gases and acid base status [80,81,82]. …”

Section: Fetal Anesthetic Aspects Of Fetal Surgerymentioning

confidence: 99%

Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures

Velde

Buck

2012

Fetal Diagn Ther

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For many prenatally diagnosed conditions, treatment is possible before birth. These fetal procedures can range from minimal invasive punctions to full open fetal surgery. Providing anesthesia for these procedures is a challenge, where care has to be taken for both mother and fetus. There are specific physiologic changes that occur with pregnancy that have an impact on the anesthetic management of the mother. When providing maternal anesthesia, there is also an impact on the fetus, with concerns for potential negative side effects of the anesthetic regimen used. The question whether the fetus is capable of feeling pain is difficult to answer, but there are indications that nociceptive stimuli have a physiologic reaction. This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment. The extent to which a fetus is influenced by the maternal anesthesia depends on the type of anesthesia, with different needs for extra fetal anesthesia or analgesia. When providing fetal anesthesia, the potential negative consequences have to be balanced against the intended benefits of blocking the physiologic fetal responses to nociceptive stimulation.

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“…4 Fetal myocardial depression may also result from the high doses of volatile anesthetic. 5 ideal surgical conditions as defined by a relaxed uterus often come at the expense of stable maternal and fetal hemodynamics.…”

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confidence: 99%