Fetal Cardiocentesis: A Review of Indications, Risks, Applications and Technique

Abstract

Objectives: To review the indications, applications and technique of fetal cardiocentesis. Methods: Review of published case reports and case series of fetal cardiocentesis utilizing the PubMed search engine of the National Library of Medicine. Results: Case reports and case series demonstrate that fetal cardiocentesis may be an alternative method by which to facilitate prenatal diagnosis, intravascular therapy, multifetal and selective fetal reduction and in utero therapy of congenital heart disease. However, procedure-associated risk is higher than with cordocentesis and may limit use of this procedure. Conclusions: Fetal cardiocentesis may be a reasonable option to obtain fetal intravascular access and facilitate therapeutic interventions when cordocentesis fails or is not feasible. However, expected benefit must clearly outweigh the procedure-associated risk.

Fetal Anemia: Determinants and Perinatal Outcomes according to the Method of Intrauterine Blood Transfusion

“…Cases presenting early in gestation, especially with signs of hydrops may need alternative transfusion approaches due to difficulty with access to the umbilical vein. Some non-IVT methods such as IPT and intracardiac methods have been reported to be used successfully [30, 31]. Based on the reported experience, we would have expected a higher loss rate in the non-IVT group in our study; however, there was no difference in rates of fetal or neonatal loss between groups despite a higher degree of severity in the non-IVT group.…”

Terapia fetal intracardiaca: comunicación de la primera intervención cardiaca fetal exitosa en el Perú, con correlación posnatal al nacimiento y a los 18 meses de vida

“…El acceso intracardiaco para la transfusión intrauterina o muestreo sanguíneo fetal no señala tasas de éxito en las series de casos publicadas, pero sí una tasa de complicaciones de 5,6% a 6,5%. Las complicaciones informadas en este tipo de procedimiento son similares a las descritas anteriormente, además de hemopericardio, daño en las válvulas auriculo-ventriculares, daño auricular, en los grandes vasos, en el sistema de conducción e incluso puede haber trauma pulmonar (15) .…”

“…Antes de reti-rar la aguja, se debe controlar la frecuencia cardíaca fetal y observar el espacio pericárdico, y si no existen complicaciones, retirar la aguja con mucho cuidado. Se sugiere el monitoreo electrónico de la frecuencia cardíaca fetal posterior al procedimiento para excluir evidencia de una condición fetal no tranquilizadora o el inicio de la actividad uterina y evaluación ecográfica de seguimiento dentro de las 24 horas posteriores al procedimiento (15) .…”