Fetal Aortic Valvuloplasty: Experience and Results of Two Tertiary Centers in Spain

• Published in: Fetal diagnosis and therapy Vol. 42; no. 4; p. 262
• Main Authors: Galindo, Alberto, Gómez-Montes, Enery, Gómez, Olga, Bennasar, Mar, Crispi, Fàtima, Herraiz, Ignacio, Mendoza, Alberto, Escribano, David, García-Torres, Enrique, Carretero, Juan Manuel, Gratacós, Eduard, Martínez, Josep María
• Format: Journal Article
• Language: English
• Published: Switzerland 01.12.2017
• Subjects: Aortic Valve Stenosis - therapy; Balloon Valvuloplasty - statistics & numerical data; Female; Fetal Therapies - statistics & numerical data; Humans; Hypoplastic Left Heart Syndrome - therapy; Pregnancy; Retrospective Studies; Spain; Tertiary Care Centers; Fetal echocardiography; Critical aortic stenosis; Biventricular circulation; Congenital heart disease; Intrauterine valvuloplasty
• ISSN: 1421-9964
• DOI: 10.1159/000460247

Fetal aortic valvuloplasty (FAV) may avoid progression of critical aortic stenosis (CAS) to hypoplastic left ventricle, improving the options for biventricular circulation (BVC). We describe the results of FAV in 2 referral centers in Spain. We analyzed all FAVs performed in the period 2007-2015. The selection of candidates, the technique, and postnatal management were made following an agreed protocol. A descriptive analysis of survival, type of circulation after birth, and complications was made, considering all deaths in the first 48 h after FAV as FAV-related. FAV was performed in 28 fetuses at a median gestational age (GA) of 23 weeks (range, 20-32). FAV was technically successful in 22 (78.6%), of whom 11 were born alive and with intention to treat. Eight (72.7%) resulted in BVC and 3 (27.3%) in univentricular circulation. The rate of FAV-related deaths was 32%. These patients underwent FAV earlier than live-born fetuses (median GA at FAV 22 weeks [range, 20.0-25.0] vs. 24.5 weeks [range, 21.0-32.0], respectively, p = 0.031). A significant proportion of fetuses with CAS who undergo technically successful FAV have BVC postnatally. However, FAV implies a high risk of fetal death, which highly depends on the GA at which this intervention is required.