Overview of fetal cardiac interventions
Articles,  Blog

Overview of fetal cardiac interventions


(bright music) – We perform two different types of fetal cardiac interventions. The first is for fetuses who
have a narrowed aortic valve that look like they may develop hypoplastic left heart syndrome,
which is a heart problem where the left-side of the
heart is underdeveloped and the right-side of the
heart has to do the work of two ventricles. That procedure, we open the
aortic valve in the fetus to try to keep the left-side of the heart pumping for the body and the left-side of the
heart growing normally. The second fetal cardiac
intervention is performed when a fetus has hypoplastic
left heart syndrome but does not have a hole between the top two chambers of the heart. When that is the case
the blood cannot get out of the left-side of the heart
and backs up into the lungs and causes lung damage in the fetus. In this type of fetal intervention,
we are creating a hole between the top two chambers
of the heart with a balloon. In both types of fetal
cardiac intervention, the procedures are performed
in an operating room and the first step of the
procedure is to make sure that the fetus is in a good
position for the procedure. The obstetrician can manipulate the fetus through the mother’s
abdomen to get the fetus into a perfect position for the procedure. After that’s done, general anesthesia is
induced for the mother and the procedures are all
done under ultrasound guidance. Next in the procedure, the fetus is given a medicine for pain and a medicine to relax the fetus, and also to make the
fetus not be able to move for a brief period of
time during the procedure. And that is done through a needle through the mother’s abdominal wall, through the uterus, and into
the thigh muscle of the fetus. Next, the fetal intervention is started and we take a small
needle that is advanced through the mother’s abdomen,
all under ultrasound guidance, through the uterine wall, through
the chest wall of the baby between the ribs and into the heart. Now, if we are performing a
ballooning of the aortic valve, that needle is advanced
into the left ventricle and a wire is then manipulated
across that aortic valve. And over the wire, we
pass a small catheter that has a balloon on the tip of it. We put the balloon across the aortic valve and inflate the balloon thereby
enlarging the aortic valve. And then the balloon and wire and needle are all removed from the heart. In the fetal intervention
where we create a hole between the top chambers of the heart, the needle is advanced through
the mother’s abdominal wall, through the uterus, into the right atrium of
the heart of the baby, and through that wall between
the top chambers of the heart into the left-side of the heart. We pass a wire out into the
vein coming from the lung, and then we place a catheter that has a balloon on the tip of it, over that wire, placing
the balloon across the wall between the top chambers of the heart. We inflate the balloon several times, and that creates a hole between the top two chambers of the heart. The wire, catheter, and
needle are then removed from the heart and the
procedure is complete. In some of the procedures,
blood can collect around the heart of the fetus
that needs to be drained. We can drain that with a separate needle under ultrasound guidance, and
then that needle is removed. And then we do watch the
heart with ultrasound for 20 to 30 minutes in the operating room to make sure that blood doesn’t
recollect around the heart.

One Comment

Leave a Reply

Your email address will not be published. Required fields are marked *