Fetal aortic valvuloplasty may rescue fetuses with critical aortic stenosis and hydrops

• Published in: Ultrasound in obstetrics & gynecology Vol. 57; no. 1; pp. 119 - 125
• Main Authors: Tulzer, A., Arzt, W., Tulzer, G.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2021; Wiley Subscription Services, Inc
• Subjects: Aorta; Aortic stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - embryology; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty - methods; Cardiac output; Cardiovascular disease; Congenital diseases; congenital heart disease; Congestive heart failure; Coronary vessels; critical aortic stenosis; Echocardiography; Edema; Fatalities; Female; fetal cardiac intervention; Fetal Diseases - surgery; Fetal Heart; Fetoscopy - methods; Fetuses; Gestational Age; Gynecological surgery; Gynecology; Heart failure; Hemodynamics; Humans; hydrops; Hydrops Fetalis - diagnostic imaging; Hydrops Fetalis - surgery; Obstetrics; Pregnancy; Retrospective Studies; Septum; Stenosis; Ultrasonography, Doppler; Ultrasonography, Prenatal; Ultrasound; Ventricle; Ventricular Function; congenital heart disease; fetal cardiac intervention; congestive heart failure; critical aortic stenosis; hydrops
• DOI: 10.1002/uog.22138
• ISSN: 0960-7692; 1469-0705

ABSTRACT Objective Critical aortic stenosis (CAS) with a restrictive interatrial septum may lead to fetal congestive heart failure and hydrops, usually culminating in fetal demise if left untreated. The aim of this study was to assess the effects of fetal aortic valvuloplasty (FAV) on hemodynamics and outcome in these patients. Methods This was a retrospective review of fetuses with CAS and signs of hydrops that underwent FAV in our center between 2000 and 2020. Echocardiograms and patients' charts were analyzed for ventricular and valvular dimensions and for outcome. Results Hydrops was present at the time of intervention in 15 fetuses with CAS that underwent FAV at our center during the study period. All but one patient had at least one technically successful procedure. There were no procedure‐related deaths, but three intrauterine deaths occurred. Twelve subjects were liveborn, of whom two died within 24 h after birth owing to persistent hydrops. Ventricular function improved and hydrops resolved within 3–4 weeks after FAV in 71.4% (10/14) of fetuses with a technically successful intervention. A biventricular outcome was achieved in 50% of the successfully treated patients. Conclusions Fetuses with CAS and hydrops can be successfully treated with FAV. The procedure has the potential to restore sufficient fetal cardiac output, which may lead to resolution of hydrops. Surviving patients seem to be good candidates for a biventricular outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology