Fetal Cardiac Intervention for Pulmonary Atresia with Intact Ventricular Septum: International Fetal Cardiac Intervention Registry

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Hogan, WJ (Author) Other; Grinenco, S (Author) Other; Armstrong, A (Author) Other; Devlieger, R (Author) Other; Dangel, J (Author) Other; Ferrer, Q (Author) Other; Frommelt, M (Author) Other; Galindo, A (Author) Other; Gardiner, H (Author) Other; Gelehrter, S (Author) Other; Herberg, U (Author) Other; Howley, L (Author) Other; Jaeggi, E (Author) Other; Joana Miranda (Author) FMUP; Morris, SA (Author) Other; Oepkes, D (Author) Other; Pedra, S (Author) Other; Peterson, R (Author) Other; Sholler, G (Author) Other; Simpson, J (Author) Other; Strainic, J (Author) Other; Vigneswarran, TV (Author) Other; Wacker Gussmann, A (Author) Other; Moon Grady, AJ (Author) Other

Journal

Title: Fetal Diagnosis and Therapy

Vol. 47

Pages: 731-739

ISSN: 1015-3837

Publisher: Karger

Indexing

ISI Web of Knowledge - 5 Citations

Scopus - 9 Citations

Other information

Authenticus ID: P-00S-HBC

DOI: 10.1159/000508045

Abstract (EN): Introduction:Invasive fetal cardiac intervention (FCI) for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (PS) has been performed with small single-institution series reporting technical and physiological success. We present the first multicenter experience.Objectives:Describe fetal and maternal characteristics of those being evaluated for FCI, including pregnancy/neonatal outcome data using the International Fetal Cardiac Intervention Registry (IFCIR).Methods:We queried the IFCIR for PAIVS/PS cases evaluated from January 2001 to April 2018 and reviewed maternal/fetal characteristics, procedural details, pregnancy and neonatal outcomes. Data were analyzed using standard descriptive statistics.Results:Of the 84 maternal/fetal dyads in the registry, 58 underwent pulmonary valvuloplasty at a median gestational age of 26.1 (21.9-31.0) weeks. Characteristics of fetuses undergoing FCI varied in terms of tricuspid valve (TV) size, TV regurgitation, and pulmonary valve patency. There were fetal complications in 55% of cases, including 7 deaths and 2 delayed fetal losses. Among those who underwent successful FCI, the absolute measurement of the TV increased by 0.32 (+/- 0.17) mm/week from intervention to birth. Among 60 liveborn with known outcome, there was a higher percentage having a biventricular circulation following successful FCI (87 vs. 43%).Conclusions:Our data suggest a possible benefit to fetal therapy for PAIVS/PS, though rates of technically unsuccessful procedures and procedure-related complications, including fetal loss were substantial. FCI criteria are extremely variable, making direct comparison to nonintervention patients challenging and potentially biased. More uniform FCI criteria for fetuses with PAIVS/PS are needed to avoid unnecessary procedures, expose only fetuses most likely to sustain a benefit, and to enable comparisons to be made with nonintervention patients.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9