Fetal Pulmonary Valvuloplasty For Pa-ivs In Mainland China
Gang Luo, Silin Pan
Qingdao Women and Children's Hospitle, Qingdao, China
Objective To summarize and evaluate the clinical effect of ultrasound-guided fetal pulmonary valvuloplasty (FPV) in the treatment of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum (PA/CPS-IVS). Methods From July 2018 to October 2019, 14 cases of PA/IVS fetuses < 3 cases of CPS/IVS were successfully operated on by FPV in our hospital. The median gestational age was 27 weeks. To summarize and analyze the changes of the morphological and functional parameters, complications and fetal postnatal outcomes. Results All 17 fetuses were successfully operated on by FPV under general anesthesia. Transient bradycardia is common in operation, and adrenaline or atropine was injected for some fetuses. 2 cases sustained fetal bradycardia after FPV, < termination of pregnancy. The remaining 15 fetuses were followed up for 2 weeks. Echocardiography showed that the fetal TV/MV, RV/LV, PV/AV, TID/CC increased from 0.82 (0.44-0.89), 0.55 (0.52-0.83), 0.67 (0.56-1.00), 0.36 (0.26-0.46) to 0.90 (0.80-1.08), 0.84 (0.68-0.88), 0.98 (0.85-0.10), 0.46 (0.37-0.55), the difference was statistically significant (P<0.05). The tricuspid regurgitation was improved by 3.8 m/s (3.2-4.6 m/s) to 3.3 m/s (2.6-4.1m/s) compared with before, < the difference was statistically significant (P<0.05). Ten fetuses were followed up to full-term for cesarean section and delivery. Ten cases with severe pulmonary stenosis were treated in percutaneous balloon pulmonary valvuloplasty (PBPV) or/< PDA stenting after birth. The transpulmonary pressure gradients were 55mmHg , 52mmHg and 44mmHg respectively in 3 cases after birth. The other 2 fetuses were followed up regularly, and the related right ventricular indexes did not deteriorate. Conclusion FPV technology is safe < effective. It can significantly increase the chance of biventricular circulation after birth. < even avoid early intervention. Bradycardia is the main complication after operation.
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