Fetal Stress Response to Fetal Cardiac Surgery

Lam, Christopher T.; Sharma, Samar; Baker, Richard S.; Hilshorst, Jerri L.; Lombardi, John; Clark, Kenneth E.; Eghtesady, Pirooz

doi:10.1016/j.athoracsur.2008.01.096

Cited by 21 publications

(28 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In animal models, it has been noted that cardiac bypass in the fetus results in significant placental dysfunction, in part related to fetal stress and placental vasoconstriction. 531,532 Open fetal surgery for extracardiac conditions affecting the heart such as resection of pericardial teratoma is possible. 533,534 Innovative open fetal surgical procedures that may be lifesaving to the fetus or may improve postnatal outcomes may be pursued on an investigational basis, but only once the benefits are carefully weighed against the risks to both fetus and mother.…”

mentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

View full text Add to dashboard Cite

show abstract

“…28 Higher maternal PaO 2 did not increase fetal PaO 2 in our study, a phenomenon consistently observed in other fetal sheep studies. [7][8][9] We found no difference in fetal PaO 2 during exposure to two different anesthetic techniques, or in baseline PaO 2 values after approximately 40 h between HD-DES and SIVA techniques, suggesting no carryover effect. However, Jonker et al noted a decrease in fetal PaO 2 and oxygen …”

Section: Anesthetic Techniques For Open Fetal Surgerymentioning

confidence: 69%

“…The chronically instrumented fetal-maternal sheep model is a well-established model for fetal-maternal physiologic and hemodynamic studies. [7][8][9] The first aim of this prospective and controlled sheep study was to compare the maternal and fetal effects of two commonly used fetal anesthetic techniques, HD-DES and SIVA. We hypothesized that compared with HD-DES, the SIVA technique provides more stable maternal-fetal hemodynamic parameters, less fetal acidosis, and less fetal cardiac dysfunction.…”

Section: Perioperative Medicinementioning

confidence: 99%

Anesthetic Techniques for Fetal Surgery

et al. 2013

Self Cite

View full text Add to dashboard Cite

Background: Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal-fetal hemodynamic instability and fetal myocardial depression. The authors' preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal-fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA. Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in random sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed. Maternal electroencephalography was used to guide comparable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echocardiography were recorded. Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6-21.4; P < 0.0001), fetal acidosis (pH 7.11 vs. 7.24 at 150 min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension. There was no statistically significant difference in fetal cardiac function. Conclusion: In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane. Fetal echocardiography did not reflect myocardial dysfunction in this model. WItH advances in prenatal diagnosis and improvements in fetal surgical techniques, fetal surgery has become an accepted alternative treatment option for certain fetal diseases. This was most recently exemplified by the Management of Myelomeningocele Study, a multicenter randomized trial that demonstrated a reduced need

show abstract

“…During CPB, the following typically influence the extent of placental damage: i) Re-distribution of fetal blood flow, ii) placental vascular endothelial dysfunction, iii) humoral factors, iv) perfusion patterns, v) pre-perfusion solution, and vi) low temperatures (25). Synergistic effects of these factors may cause progressive hypoxia, hypercapnia, acidosis and mortality of the fetuses (20,26). Therefore, in CPB, particularly within fetal cardiac arrest models, the placenta is not considered to be a stable oxygenator.…”

Section: Discussionmentioning

confidence: 99%

“…Normothermic fetal cardiac bypass was conducted for 30 min with a mean pump flow rate of 350 ml/kg/min, according to a previously used method (17). Upon termination of bypass, fetal hemodynamic recordings were monitored continuously for 120 min, as described previously (18)(19)(20). Following completion of the studies, the ewes and fetuses were euthanized via an intravenous injection of 50 mg/kg sodium pentobarbital (Shanghai Xinya Pharmaceutical Gaoyou Co., Ltd., Shanghai, China) and then 10 ml of 10% potassium chloride (Yangzhou Zhongbao Pharmaceutical Co., Ltd., Yangzhou, China).…”

Section: Methodsmentioning

confidence: 99%

Assessing the impact of total extracorporeal circulation on hemodynamics in an ovine fetal model

Xiao

Zhuang

Zhou

et al. 2017

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. The present study aimed to evaluate the impact of total extracorporeal circulation on hemodynamics and placental function in an ovine fetal model. Mid-term ovine fetuses (n=6) underwent extracorporeal circulation (30 min), cardioplegic arrest (20 min) and monitoring (120 min). The ascending aorta and umbilical cords of the fetuses were occluded during the bypass and an extracorporeal membrane oxygenator was used as the oxygen source. Biventricular intracardiac pressures, echocardiographic data, blood gas levels and placental function variables were recorded, and statistical analysis was performed using the repeated-measure analysis of variance test. The data indicated that fetal heart rate and blood pressure at 30, 60, 90 and 120 min following the bypass were stable relative to pre-arrest baseline (pre-bypass) values (P>0.05). However, end diastolic pressures in the ovine right ventricles post-bypass were significantly increased at 30, 60, 90 and 120 min relative to pre-bypass pressures (P<0.05). The pulsatility index also increased at 30 min post-bypass relative to the pre-bypass score (0.91±0.06 vs. 0.61±0.14; P=0.007). The mean resistivity index at all time points post-bypass was consistent with the pre-bypass score (P>0.05), while the mean Tei index values for the left and right ventricles post-bypass were significantly higher at all time points relative to pre-bypass values (P<0.05). The pre-bypass fetal blood pH, SaO 2 , base excess and lactate values were maintained during arrest (P>0.05). Fetal hemodynamics and placental function additionally remained stable for up to 2 h upon reperfusion following total extracorporeal circulation and cardioplegic arrest. Collectively these data suggest that the reproducible ovine fetal model may be useful in the evaluation of fetal cardiac surgery.

show abstract

Fetal Stress Response to Fetal Cardiac Surgery

Cited by 21 publications

References 28 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Anesthetic Techniques for Fetal Surgery

Assessing the impact of total extracorporeal circulation on hemodynamics in an ovine fetal model

Contact Info

Product

Resources

About