Document Detail


Fetal Cardiac Catheterization using a Percutaneous Transhepatic Access Technique: Preliminary Experience in a Lamb Model.
MedLine Citation:
PMID:  23180625     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives: Human fetal cardiac intervention has typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy. Methods: In 10 fetal lambs (90-97 days gestation), access to the fetal venous system was by percutaneous puncture with a 5Fr sheath (n = 1) into the umbilical vein or 16G IV-catheter (n = 9) into the hepatic vein. This was followed by cardiac catheterization using a 1.8-2.6Fr tapered coronary catheter. Euthanasia and postmortem examination were planned immediately post-procedure (n = 2), or after normal term-delivery (remaining cases). Results: In 1 case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5Fr sheath, died from umbilical haemorrhage. In 8 cases, access to the fetal hepatic vein was achieved. In 7 of these cases the access catheter was advanced into the IVC, followed by catheterization of the RA (all cases) and 4 cardiac chambers (3 cases). One fetus died during cardiac catheterization (RV perforation) and the other 7 fetuses were alive at the end of the procedure (88% survival). Immediate postmortem (n = 2) detected intraperitoneal bleeding (4 and 20ml respectively), while the postnatal postmortem (n = 5) after uneventful pregnancy revealed no vascular or cardiac trauma. Conclusions: Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Andrew Edwards; Samuel Menahem; Alex Veldman; Dietmar Schranz; Yuen Chan; Ilias Nitsos; Flora Wong
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-23
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia; Perinatal Services, Monash Medical Centre, Melbourne, Australia; Fetal Cardiac Unit, Monash Medical Centre, Melbourne, Australia.
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