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Strainic J, Armstrong A. Fetal Cardiac Intervention: a Review of the Current Literature. CURRENT PEDIATRICS REPORTS 2020. [DOI: 10.1007/s40124-020-00209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yuan SM, Humuruola G. Fetal cardiac interventions: clinical and experimental research. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:99-107. [PMID: 27279868 PMCID: PMC4882381 DOI: 10.5114/aic.2016.59359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022] Open
Abstract
Fetal cardiac interventions for congenital heart diseases may alleviate heart dysfunction, prevent them evolving into hypoplastic left heart syndrome, achieve biventricular outcome and improve fetal survival. Candidates for clinical fetal cardiac interventions are now restricted to cases of critical aortic valve stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an intact ventricular septum and evolving hypoplastic right heart syndrome, and hypoplastic left heart syndrome with an intact or highly restrictive atrial septum as well as fetal heart block. The therapeutic options are advocated as prenatal aortic valvuloplasty, pulmonary valvuloplasty, creation of interatrial communication and fetal cardiac pacing. Experimental research on fetal cardiac intervention involves technical modifications of catheter-based cardiac clinical interventions and open fetal cardiac bypass that cannot be applied in human fetuses for the time being. Clinical fetal cardiac interventions are plausible for midgestation fetuses with the above-mentioned congenital heart defects. The technical success, biventricular outcome and fetal survival are continuously being improved in the conditions of the sophisticated multidisciplinary team, equipment, techniques and postnatal care. Experimental research is laying the foundations and may open new fields for catheter-based clinical techniques. In the present article, the clinical therapeutic options and experimental fetal cardiac interventions are described.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China
| | - Gulimila Humuruola
- People's Hospital of Jimunai, Altay Prefecture, Xinjiang Uygur Autonomous Region, China
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Yuan SM. Fetal cardiac interventions: an update of therapeutic options. Braz J Cardiovasc Surg 2015; 29:388-95. [PMID: 25372914 PMCID: PMC4412330 DOI: 10.5935/1678-9741.20140099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/24/2014] [Indexed: 11/20/2022] Open
Abstract
Objective This article aims to present updated therapeutic options for fetal congenital
heart diseases. Methods Data source for the present study was based on comprehensive literature retrieval
on fetal cardiac interventions in terms of indications, technical approaches and
clinical outcomes. Results About 5% of fetal congenital heart diseases are critical and timely intrauterine
intervention may alleviate heart function. Candidates for fetal cardiac
interventions are limited. These candidates may include critical aortic valve
stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an
intact ventricular septum and evolving hypoplastic right heart syndrome, and
hypoplastic left heart syndrome with an intact or highly restrictive atrial septum
as well as fetal heart block. The advocated option are prenatal aortic
valvuloplasty, pulmonary valvuloplasty, creation of atrial communication and fetal
cardiac pacing. Conclusion Fetal cardiac interventions are feasible at midgestation with gradually improved
technical success and fetal/postnatal survival due mainly to a well-trained
multidisciplinary team, sophisticated equipment and better postnatal care.
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Affiliation(s)
- Shi-Min Yuan
- Teaching Hospital, Fujian Medical University, Putian, China
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Moszura T, Góreczny S, Dryżek P. Hypoplastic left heart syndrome - a review of supportive percutaneous treatment. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:201-8. [PMID: 25489307 PMCID: PMC4252312 DOI: 10.5114/pwki.2014.45148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022] Open
Abstract
Due to the complex anatomical and haemodynamic consequences of hypoplastic left heart syndrome (HLHS), patients with the condition require multistage surgical and supportive interventional treatment. Percutaneous interventions may be required between each stage of surgical palliation, sometimes simultaneously with surgery as hybrid interventions, or after completion of multistage treatment. Recent advances in the field of interventional cardiology, including new devices and techniques, have significantly contributed to improving results of multistage HLHS palliation. Knowledge of the potential interventional options as well as the limitation of percutaneous interventions will enable the creation of safe and effective treatment protocols in this highly challenging group of patients. In this comprehensive review we discuss the types, goals, and potential complications of transcatheter interventions in patients with HLHS.
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Affiliation(s)
- Tomasz Moszura
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
- Department of Paediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poland
| | - Sebastian Góreczny
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
| | - Paweł Dryżek
- Department of Cardiology, Polish Mothers Memorial Hospital, Research Institute, Lodz, Poland
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Suzuki S, Kise H, Kaga S, Hoshiai M, Koizumi K, Hasebe Y, Motohashi S, Matsumoto M. Hybrid procedures for an infant with hypoplastic left heart syndrome with intact atrial septum. Gen Thorac Cardiovasc Surg 2013; 63:472-5. [DOI: 10.1007/s11748-013-0304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
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Degenhardt K, Singh MK, Epstein JA. New approaches under development: cardiovascular embryology applied to heart disease. J Clin Invest 2013; 123:71-4. [PMID: 23281412 DOI: 10.1172/jci62884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Despite many innovative advances in cardiology over the past 50 years, heart disease remains a major killer. The steady progress that continues to be made in diagnostics and therapeutics is offset by the cardiovascular consequences of the growing epidemics of obesity and diabetes. Truly innovative approaches on the horizon have been greatly influenced by new insights in cardiovascular development. In particular, research in stem cell biology, the cardiomyocyte lineage, and the interactions of the myocardium and epicardium have opened the door to new approaches for healing the injured heart.
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Affiliation(s)
- Karl Degenhardt
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Zhou K, Wu G, Li Y, Zhao L, Zhou R, Zhu Q, Huang X, Mu D, Hua Y. Protective effects of indomethacin and dexamethasone in a goat model with intrauterine balloon aortic valvuloplasty. J Biomed Sci 2012; 19:74. [PMID: 22889399 PMCID: PMC3438018 DOI: 10.1186/1423-0127-19-74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 07/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrauterine balloon aortic valvuloplasty (IUBAV) has been used for critical aortic stenosis. However, it is necessary to determine the fetal impairments such as preterm birth after this approach and to find a way to prevent or reduce them. METHODS In the present study, we evaluated the therapeutic value of indomethacin (IDM) and dexamethasone (DXS) on reducing the preterm birth rate in experimental goats after IUBAV. RESULTS Our results indicated that the administration of IDM/DXS significantly reduced the rate of premature birth. IDM/DXS treatment led to preservation of myocardial ultrastructure with less damage, and amelioration of the fetal and placental circulation. Furthermore, we found that norepinephrine (NE) level was positively associated with the degree of myocardial damage. IDM/DXS administration led to a significant decrease of operation-induced increase of NE levels, which may be associated with the protective effects of IDM/DXS. Lastly, we found that the administration of IDM/DXS did not induce the risk of ductus arteriosus closure or slow down fetal growth. CONCLUSIONS Our results indicate that IDM/DXS promotes a better gestational outcome at least partially by reducing stress response during and after the operation of IUBAV in the goat model. IDM/DXS may be a useful application in human patients during IUBAV intervention.
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Affiliation(s)
- Kaiyu Zhou
- Department of Pediatric Cardiology, Second University Hospital and West China Medical School, Sichuan University, Chengdu 610041, China
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Hua Y, Yang S, Zhou K, Guo N, Zhu Q, Zhou R, Mu D, Jiang X. Impact of intrauterine balloon aortic valvuloplasty on gestational outcome in a fetal goat model. Fetal Diagn Ther 2011; 30:100-7. [PMID: 21464555 DOI: 10.1159/000324503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intrauterine balloon aortic valvuloplasty (IUBAV) has been used to correct critical aortic valve stenosis. Evaluation of the intervention-related risk is necessary. The purpose of this study was to establish an experimental goat model for ultrasound-guided IUBAV intervention and investigate the immediate and long-term effects of IUBAV on the fetus, gestational outcome and mother's safety. STUDY DESIGN Fifteen pregnant goats with twin gestation in the 2nd and 3rd trimester were anesthetized to establish the surgical procedure. One fetus of the twins received IUBAV intervention, the other served as a control. The data were collected at three time points: immediately before and after IUBAV, and 24 h after birth. Critical organs including the heart, brain, lung and liver from the fetuses/newborns were collected after IUBAV or 24 h after birth. RESULTS IUBAV intervention immediately induced a significant decrease of pH and Ca(2+), as well as an increase of blood glucose and lactic acid levels (p < 0.05). IUBAV also caused an increase in stress hormones (epinephrine 1-fold, norepinephrine 4-fold, and cortisol 1-fold; p < 0.05). Following the operation, all of the mother goats recovered, but in 60% (6/10) preterm delivery occurred. Neither pathological changes in fetal critical organs nor a significant difference in metabolism or growth parameters were detected between IUBAV and control kids. CONCLUSIONS Ultrasound-guided IUBAV intervention induced a strong but transient stress response in the operated fetus, which did not result in irreversible histological changes in the fetus or the mother, but may disrupt the continuation of normal gestation in the long term. Preterm delivery is the major risk in this goat IUBAV model.
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Affiliation(s)
- Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, and West China Medical School, Sichuan University, Chengdu, China.
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Boudjemline Y, Rosenblatt J, de La Villeon G, Bénifla JL, Bonnet D, Jouannic JM. Development of a new lead for in utero fetal pacing. Prenat Diagn 2010; 30:122-6. [PMID: 20020429 DOI: 10.1002/pd.2422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The results from preliminary studies on fetal pacing preclude an application to the human fetus. The purpose of this study was to evaluate the feasibility of acute fetal cardiac pacing following ultrasound-guided epicardial anchorage of a new pacing lead dedicated to the fetal heart. METHODS In 12 pregnant ewes, a needle was placed in contact with cardiac chambers under echo-guidance. Using the lumen of the needle, a 3-Fr pacing lead was advanced and fixed on the cardiac wall using a built-in screw. Pacing was attempted using an external pacing system. RESULTS Lead insertion was successful in all but one. In the first fetus, the needle was advanced too far into the right ventricle leading to pericardial bleeding. The fetal heart rate was overdriven in all at 220/ min. After assessment, pacing lead was unscrewed and retrieved without any complication. Pregnancy was electively interrupted in six animals. The other six fetuses were delivered vaginally after uneventful pregnancy and autopsy at day 3 did not show any significant injury. CONCLUSIONS Transcutaneous echo-guided fetal acute pacing is feasible using a specially designed lead. Additional refinement of both the equipments and the operative technique are needed before considering permanent pacing in the human fetus.
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Affiliation(s)
- Younes Boudjemline
- Service de Cardiologie Pédiatrie, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, and Faculté de Médecine Necker-Enfants Malades, Université Paris V, Paris, France
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Indications and outcomes of intrauterine surgery for fetal malformations. Curr Opin Obstet Gynecol 2010; 22:159-65. [DOI: 10.1097/gco.0b013e3283374ab5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Children with severe congenital malformations, such as single-ventricle anomalies, have a daunting prognosis. Heart transplantation would be a therapeutic option but is restricted due to a lack of suitable donor organs and, even in case of successful heart transplantation, lifelong immune suppression would frequently be associated with a number of serious side effects. As an alternative to heart transplantation and classical cardiac reconstructive surgery, tissue-engineered myocardium might become available to augment hypomorphic hearts and/or provide new muscle material for complex myocardial reconstruction. These potential applications of tissue engineered myocardium will, however, impose major challenges to cardiac tissue engineers as well as heart surgeons. This review will provide an overview of available cardiac tissue-engineering technologies, discuss limitations, and speculate on a potential application of tissue-engineered heart muscle in pediatric heart surgery.
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Medrano López C, Guía Torrent JM, Rueda Núñez F, Moruno Tirado A. [Update on pediatric cardiology and congenital heart disease]. Rev Esp Cardiol 2009; 62 Suppl 1:39-52. [PMID: 19174049 DOI: 10.1016/s0300-8932(09)70040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.
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Affiliation(s)
- Constancio Medrano López
- Cardiología Pediátrica, Hospital Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España.
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