Transhepatic ultrasound-guided cardiac catheterization in the fetal lamb: a new approach for cardiac interventions in fetuses.
Circulation
; 111(6): 736-41, 2005 Feb 15.
Article
em En
| MEDLINE
| ID: mdl-15699256
ABSTRACT
BACKGROUND:
Percutaneous transventricular and fetoscopic umbilical catheterization have been applied to animal and human fetuses. These methods have a high rate of failure and complications. Here, we propose an alternative route for anterograde echocardiography-guided cardiac catheterization through a transhepatic approach of the intra-abdominal vessels in the fetal lamb. METHODS ANDRESULTS:
After exteriorization of the uterus in 12 pregnant ewes between 118 to 122 days' gestation, a 4F sheath mounted over a 1.2-mm needle was placed into the intra-abdominal portion of the umbilical vein (n=2) and into the subdiaphragmatic portion of the inferior vena cava via a transhepatic approach (n=10) under ultrasound guidance. In the first 2 animals using a transumbilical approach, it was impossible to reach the heart through the ductus venosus. In the next 10 animals, using a conventional technique, echocardiography-guided catheterization of the 4 chambers was performed in the all fetuses, atrial or ventricular pacing in 6 fetuses, and ballooning of the pulmonary valve in 9 of 10 fetuses. Among the 10 fetuses catheterized through the transhepatic approach, 2 were euthanized immediately after the procedure to evaluate intraperitoneal bleeding (23 and 29 mL, respectively), and 3 died after the procedure (1 of major bleeding and 2 deaths related to balloon catheter manipulation). Finally, 5 were delivered vaginally after an uneventful pregnancy, and autopsy at day 5 did not show significant liver, vascular, or cardiac injury.CONCLUSIONS:
Echocardiography-guided fetal cardiac catheterization through a transhepatic approach is feasible and provides an interesting alternative approach for human fetal cardiac interventions.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cateterismo Cardíaco
/
Coração Fetal
/
Fígado
Tipo de estudo:
Etiology_studies
Limite:
Animals
/
Pregnancy
Idioma:
En
Ano de publicação:
2005
Tipo de documento:
Article