<span class='italic'>In Utero</span> Intervention for Cardiac Disease

doi:10.1017/9781108564434.016

Chapter 15 - In Utero Intervention for Cardiac Disease

from Structural Heart Disease in the Fetus

Published online by Cambridge University Press: 21 October 2019

Edited by

Anthony Johnson and

Mark D. Kilby: Affiliation:
University of Birmingham
Anthony Johnson: Affiliation:
University of Texas Medical School at Houston
Dick Oepkes: Affiliation:
Leids Universitair Medisch Centrum

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Summary

Unlike other fetal therapies, cardiac interventions have not been tested by randomized controlled trials (RCT), such as the one to determine the optimal management of twin-to-twin transfusion syndrome (TTTS) [1]. Most reports of fetal cardiac interventions have no appropriate control subjects and have resulted in level three evidence at best, so their clinical value and generalizability to the fetal population with obstructive cardiac lesions remain uncertain.

Type: Chapter
Information: Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 146 - 156

DOI: https://doi.org/10.1017/9781108564434.016 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2020

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References

Senat, MV, Deprest, J, Boulvain, M, Paupe, A, Winer, N, Ville, Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004; 351: 136–144.Google Scholar

Szwast, A, Tian, Z, McCann, M, Donaghue, D, Rychik, J. Vasoreactive response to maternal hyperoxygenation in the fetus with hypoplastic left heart syndrome. Circ Cardiovasc Imaging. 2010; 3: 172–8.CrossRef Google Scholar PubMed

Schidlow, DN, Donofrio, MT. Prenatal maternal hyperoxygenation testing and implications for critical care delivery planning among fetuses with congenital heart disease: early experience. Am J Perinatol. 2018; 35: 16–23.Google Scholar PubMed

Kohl, T. Chronic intermittent materno-fetal hyperoxygenation in late gestation may improve on hypoplastic cardiovascular structures associated with cardiac malformations in human fetuses. Pediatr Cardiol. 2010; 31: 250–63.CrossRef Google Scholar PubMed

Zeng, S, Zhou, J, Peng, Q, Deng, W, Zhang, M, Zhao, Y, et al. Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation. Sci Rep. 2016; 6: 39304.Google Scholar

Zeng, S, Zhou, J, Peng, Q, Deng, W, Zang, M, Wang, T, Zhou, Q. Sustained chronic maternal hyperoxygenation increases myocardial deformation in fetuses with a small aortic isthmus at risk for coarctation. J Am Soc Echocardiogr. 2017; 30; 992–1000.CrossRef Google Scholar PubMed

Maxwell, D, Allan, L, Tynan, MJ. Balloon dilatation of the aortic valve in the fetus: a report of two cases. Br Heart J. 1991; 65: 256–8.Google Scholar

Delius, RE, Rademecker, MA, de Leval, MR, Elliott, MJ, Stark, J. Is a high-risk biventricular repair always preferable to conversion to a single ventricle repair? J Thorac Cardiovasc Surg. 1996; 112: 1561–8; discussion 1568–9.Google Scholar

Burch, M, Kaufman, L, Archer, N, Sullivan, I. Persistent pulmonary hypertension late after neonatal aortic valvotomy: a consequence of an expanded surgical cohort. Heart. 2004; 90: 918–920.CrossRef Google Scholar PubMed

Emani, SM, Bacha, EA, McElhinney, DB, Marx, GR, Tworetzky, W, Pigula, FA, del Nido, PJ. Primary left ventricular rehabilitation is effective in maintaining two-ventricle physiology in the borderline left heart. J Thorac Cardiovasc Surg. 2009; 138: 1276–82.Google Scholar

Tulzer, G, Arzt, W, Franklin, RC, Loughna, PV, Mair, R, Gardiner, HM. Pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum. Lancet. 2002; 360: 1567–8.Google Scholar

Tworetzky, W, McElhinney, DB, Marx, GR, Benson, CB, Brusseau, R, Morash, D, et al. In utero valvuloplasty for pulmonary atresia with hypoplastic right ventricle: techniques and outcomes. Pediatrics. 2009; 124; e510–18.Google Scholar

Marshall, AC, van der Velde, ME, Tworetzky, W, Gomez, CA, Wilkins-Haug, L, Benson, CB, et al. Creation of an atrial septal defect in utero for fetuses with hypoplastic left heart syndrome and intact or highly restrictive atrial septum. Circulation. 2004; 110: 253–8.Google Scholar

Rychik, J, Rome, JJ, Collins, MH, DeCampli, WM, Spray, TL. The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome. J Am Coll Cardiol. 1999; 34: 554–60.Google Scholar

Taylor, PV, Scott, JS, Gerlis, LM, Esscher, E, Scott, O. Maternal antibodies against fetal cardiac antigens in congenital complete heart block. N Engl J Med. 1986; 315: 667–72.Google Scholar

Eliasson, H, Sonesson, SE, Sharland, G, Granath, F, Simpson, JM, Carvalho, JS, et al. Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation. 2011; 124: 1919–26.CrossRef Google Scholar PubMed

Lopes, LM, Tavares, GM, Damiano, AP, Lopes, MA, Aiello, VD, Schultz, R, Zugaib, M. Perinatal outcome of fetal atrioventricular block: one-hundred-sixteen cases from a single institution. Circulation. 2008; 118: 1268–75.Google Scholar

Jaeggi, ET, Fouron, JC, Silverman, ED, Ryan, G, Smallhorn, J, Hornberger, LK. Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation. 2004; 110: 1542–8.Google Scholar

Carpenter, RJ Jr., Strasburger, JF, Garson, A Jr., Smith, RT, Deter, RL, Engelhardt, HT Jr. Fetal ventricular pacing for hydrops secondary to complete atrioventricular block. J Am Coll Cardiol. 1986; 8: 1434–6.Google Scholar

Walkinshaw, SA, Welch, CR, McCormack, J, Walsh, K. In utero pacing for fetal congenital heart block. Fetal Diagn Ther. 1994; 9: 183–5.Google Scholar

Assad, RS, Zielinsky, P, Kalil, R, Lima, G, Aramayo, A, Santos, A, et al. New lead for in utero pacing for fetal congenital heart block. J Thorac Cardiovasc Surg. 2003; 126: 300–2.CrossRef Google Scholar PubMed

Bar-Cohen, Y, Loeb, GE, Pruetz, JD, Silka, MJ, Guerra, C, Vest, AN, Zhou, L, Chmait, RH. Preclinical testing and optimization of a novel fetal micropacemaker. Heart Rhythm. 2015; 12: 1683–90.Google Scholar

Co-Vu, J, Lopez-Colon, D, Vyas, HV, Weiner, N, DeGroff, C. Maternal hyperoxygenation: a potential therapy for congenital heart disease in the fetuses? A systematic review of the current literature. Echocardiography. 2017; 34: 1822–33.Google Scholar

Kovacevic, A, Öhman, A, Tulzer, G, Herberg, U, Dangel, J, Carvalho, JS, et al. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study. Ultrasound Obstet Gynecol. 2018; 52: 221–9.CrossRef Google Scholar PubMed

Gardiner, HM, Kovacevic, A, Tulzer, G, Sarkola, T, Herberg, U, Dangel, J, et al. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. Ultrasound Obstet Gynecol. 2016; 48: 373–81.CrossRef Google Scholar PubMed

Di Donato, RM, Jonas, RA, Lang, P, Rome, JJ, Mayer, JE Jr., Castaneda, AR. Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg. 1991; 101: 126–37.Google Scholar

Freud, LR, McElhinney, DB, Marshall, AC, Marx, GR, Friedman, KG, del Nido, PJ, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: postnatal outcomes of the first 100 patients. Circulation. 2014; 130: 638–45.Google Scholar

Axt-Fliedner, R, Kreiselmaier, P, Schwarze, A, Krapp, M, Gembruch, U. Development of hypoplastic left heart syndrome after diagnosis of aortic stenosis in the first trimester by early echocardiography. Ultrasound Obstet Gynecol. 2006; 28: 106–9.CrossRef Google Scholar PubMed

Freud, LR, Moon-Grady, A, Escobar-Diaz, MC, Gotteiner, NL, Young, LT, McElhinney, DB, Tworetzky, W. Low rate of prenatal diagnosis among neonates with critical aortic stenosis: insight into the natural history in utero. Ultrasound Obstet Gynecol. 2015; 45: 326–32.Google Scholar

Matsui, H, Gardiner, HM. Fetal intervention for cardiac disease: the cutting edge of perinatal care. Semin Fetal Neonatal Med. 2007; 12: 482–9.Google Scholar

Reich, O, Tax, P, Marek, J, Rázek, V, Gilík, J, Tomek, V, et al. Long term results of percutaneous balloon valvuloplasty of congenital aortic stenosis: independent predictors of outcome. Heart. 2004; 90: 70–76.Google Scholar

McElhinney, DB, Lock, JE, Keane, JF, Moran, AM, Colan, SD. Left heart growth, function, and reintervention after balloon aortic valvuloplasty for neonatal aortic stenosis. Circulation. 2005; 111: 451–8.Google Scholar

Ashburn, DA, McCrindle, BW, Tchervenkov, CI, Jacobs, ML, Lofland, GK, Bove, EL, et al. Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia. J Thorac Cardiovasc Surg. 2003; 125: 1070–82.Google Scholar

Jacobs, JP, O’Brien, SM, Pasquali, SK, Jacobs, ML, Lacour-Gayet, FG, Tchervenkov, CI, et al. Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2011; 92: 2184–91; discussion 2191–2.Google Scholar

Rasiah, SV, Ewer, AK, Miller, P, Wright, JG, Barron, DJ, Brawn, WJ, Kilby, MD. Antenatal perspective of hypoplastic left heart syndrome: 5 years on. Arch Dis Child Fetal Neonatal Ed. 2008; 93: F192–7.CrossRef Google Scholar

Daubeney, PE, Wang, D, Delany, DJ, Keeton, BR, Anderson, RH, Slavik, Z, Flather, M, Webber, SA, UK and Ireland Collaborative Study of Pulmonary Atresia with Intact Ventricular Septum. UK and Ireland collaborative study of pulmonary atresia with intact ventricular septum. J Thorac Cardiovasc Surg. 2005; 130: 1071.Google Scholar PubMed

Baba, K, Kotani, Y, Chetan, D, Chaturvedi, RR, Lee, KJ, Benson, LN, et al. Hybrid versus Norwood strategies for single-ventricle palliation. Circulation. 2012; 126 (Suppl. 1): S123–31.CrossRef Google Scholar PubMed

Kovacevic, A, Roughton, M, Mellander, M, Öhman, A, Tulzer, G, Dangel, J, et al. Fetal aortic valvuloplasty: investigating institutional bias in surgical decision-making. Ultrasound Obstet Gynecol. 2014; 44: 538–44.CrossRef Google Scholar PubMed

Arzt, W, Wertaschnigg, D, Veit, I, Klement, F, Gitter, R, Tulzer, G. Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: Experience and results of 24 procedures. Ultrasound Obstet Gynecol. 2011; 37: 689–95.CrossRef Google Scholar PubMed

McElhinney, DB, Marshall, AC, Wilkins-Haug, LE, Brown, DW, Benson, CB, Silva, V, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation. 2009; 120: 1482–90.CrossRef Google Scholar PubMed

Jaeggi, E, Renaud, C, Ryan, G, Chaturvedi, R. Intrauterine therapy for structural congenital heart disease: Contemporary results and Canadian experience. Trends Cardiovasc Med. 2016; 26: 639–46.Google Scholar

Pedra, SR, Peralta, CF, Crema, L, Jatene, IB, da Costa, RN, Pedra, CA. Fetal interventions for congenital heart disease in Brazil. Pediatr Cardiol. 2014; 35: 399–405.Google Scholar

Galindo, A, Gómez-Montes, E, Gómez, O, Bennasar, M, Crispi, F, Herraiz, I, et al. Fetal aortic valvuloplasty: experience and results of two tertiary centers in Spain. Fetal Diagn Ther. 2017; 42: 262–70.Google Scholar

Moon-Grady, AJ, Morris, SA, Belfort, M, Chmait, R, Dangel, J, Devlieger, R, et al. International Fetal Cardiac Intervention Registry: A Worldwide Collaborative Description and Preliminary Outcomes. J Am Coll Cardiol. 2015; 66: 388–99.Google Scholar PubMed

Hunter, LE, Chubb, H, Miller, O, Sharland, G, Simpson, JM. Fetal aortic valve stenosis: a critique of case selection criteria for fetal intervention. Prenat Diagn. 2015; 35: 1176–81.Google Scholar

Roman, KS, Fouron, JC, Nii, M, Smallhorn, JF, Chaturvedi, R, Jaeggi, ET. Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum. Am J Cardiol. 2007; 99: 699–703.Google Scholar

Gardiner, HM, Belmar, C, Tulzer, G, Barlow, A, Pasquini, L, Carvalho, JS, et al. Morphological and functional predictors of eventual circulation in the fetus with pulmonary atresia or critical pulmonary stenosis with intact septum. J Am Coll Cardiol. 2008; 51: 1299–308.CrossRef Google Scholar PubMed

Tulzer, A, Arzt, W, Gitter, R, Prandstetter, C, Grohmann, E, Mair, R, Tulzer, G. Immediate effects and outcomes after in-utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact septum or critical pulmonary stenosis. Ultrasound Obstet Gynecol. 2018; 52: 230–7.Google Scholar

Lara, DA, Morris, SA, Maskatia, SA, Challman, M, Nguyen, M, Feagin, DK, et al. Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia. Ultrasound Obstet Gynecol. 2016; 48: 365–72.CrossRef Google Scholar PubMed

Wohlmuth, C, Wertaschnigg, D, Wieser, I, Arzt, W, Tulzer, G. Tissue Doppler imaging in fetuses with aortic stenosis and evolving hypoplastic left heart syndrome before and after fetal aortic valvuloplasty. Ultrasound Obstet Gynecol. 2016; 47: 608–15.Google Scholar

Tworetzky, W, Wilkins-Haug, L, Jennings, RW, van der Velde, ME, Marshall, AC, Marx, GR, et al. Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique, and results of successful intervention. Circulation. 2004; 110: 2125–31.CrossRef Google Scholar PubMed

Donofrio, MT, Moon-Grady, AJ, Hornberger, LK, Copel, JA, Sklansky, MS, Abuhamad, A, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014; 129: 2183–242.Google Scholar

Jouannic, JM, Boudjemline, Y, Benifla, JL, Bonnet, D. Transhepatic ultrasound-guided cardiac catheterization in the fetal lamb. Circulation. 2005; 111: 736–41.Google Scholar

Kohl, T, Müller, A, Tchatcheva, K, Achenbach, S, Gembruch, U. Fetal transesophageal echocardiography: clinical introduction as a monitoring tool during cardiac intervention in a human fetus. Ultrasound Obstet Gynecol. 2005; 26: 780–5.CrossRef Google Scholar