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The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
A percutaneous fetal cardiac catheterization technique for pulmonary valvuloplasty and valvulotomy in a mid-gestation
Andrew Edwards1, Alex Veldman, Ilias Nitsos
1The Ritchie Centre, Monash Institute of Medical Research-Prince Henry Institute, Melbourne, Australia; Perinatal Services, Monash Medical Centre, Melbourne, Australia; Fetal Cardiac Unit, Monash Medical Centre, Melbourne, Australia.
Objective:
We aimed to assess the feasibility of using a percutaneous transhepatic cardiac catheterization technique to perform fetal pulmonary valvuloplasty and valvulotomy under ultrasound guidance at mid-gestation.
Method:
In 13 mid-gestation fetal lambs without cardiac pathology, percutaneous transhepatic cardiac catheterization was used to position a coronary angioplasty catheter within the pulmonary valve. The balloon was inflated/deflated several times, simulating pulmonary valvuloplasty. In another two fetal lambs, a guidewire tip was positioned against the pulmonary valve, and unipolar diathermy was applied to simulate perforation of an atretic valve.
Results:
Percutaneous access followed by right heart catheterization was successful in all cases. One fetus died following right ventricle perforation. Simulated pulmonary valvuloplasty was successful in nine cases using catheters with 6-mm-long balloons but unsuccessful in two cases (both survived) using 12-mm-long balloons. In one case, the catheter could not be inserted as the cannula became dislodged. Diathermy of the pulmonary valve was successful in both attempts.
Conclusion:
We successfully simulated in utero perforation and dilation of the pulmonary valve using percutaneous transhepatic access in fetal lambs. The technique has potential for clinical translation into treatment for human fetuses with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum.
