Foetal aortic valvuloplasty: experience of five cases

Abstract

Foetal aortic valvuloplasty seems to be a safe and feasible procedure. It has been reported that it has the potential to prevent progression to hypoplastic left heart syndrome in selected foetuses with severe aortic stenosis. Further investigation regarding physiological and clinical aspects of this disease both prenatally and postnatally will probably allow to improve therapeutic strategies and clinical outcome.

Congenital heart disease, prenatal diagnosis and management

“…Fetal critical aortic stenosis may lead to hypoplastic left heart syndrome (HLHS). [36][37][38][39] The purpose of fetal aortic valvuloplasty is to unblock the ventricular outflow tract in order to improve ventricular function and allow left heart structures to develop (Figure 10). Fetal pulmonary valvuloplasty in critical pulmonary stenosis 39,40 may potentially prevent progression to a single ventricle physiology due to severe hypoplasia of the right ventricle.…”

Fetal interventions for congenital heart disease

“…For severe aortic stenosis with evolving HLHS and PA/IVS with evolving HRHS, FCI is based on the premise that a biventricular circulation yields a better prognosis over the course of the child's life. This notion is controversial; however, the increasing adoption of FCI for these indications by institutions all over the world suggests that many believe this pathway is worthy of pursuit [18,[42][43][44][45][46][47]. The role of FCI for fetuses with HLHS with IAS is less controversial, but results thus far have not demonstrated a significant improvement in survival.…”

Cardiopatías congénitas, diagnóstico y manejo prenatal

“…La estenosis aórtica crítica fetal podría evolucionar a un síndrome de corazón izquierdo hipoplásico (SCIH). [36][37][38][39] La valvuloplastia aórtica fetal tiene como objetivo desobstruir el tracto de salida ventricular para mejorar la función ventricular y permitir el crecimiento de las estructuras cardíacas izquierdas (Figura 10). La valvuloplastia pulmonar fetal en la estenosis pulmonar crítica 39,40 tiene el potencial de evitar la progresión hacia una fisiología univentricular por hipoplasia grave del ventrículo derecho.…”