Changes in left heart hemodynamics after technically successful in-utero aortic valvuloplasty

Ultrasound Obstet Gynecol. 2007 Oct;30(5):715-20. doi: 10.1002/uog.5132.

Abstract

Objective: Severe aortic stenosis in the mid-gestation fetus can progress to hypoplastic left heart syndrome (HLHS). @ In-utero aortic valvuloplasty is an innovative therapy to promote left ventricular growth and function and potentially to prevent HLHS. This study evaluated the effects of mid-gestation fetal balloon aortic valvuloplasty on subsequent fetal left ventricular function and left heart Doppler characteristics.

Methods: We reviewed fetuses with aortic stenosis that underwent attempted in-utero aortic valvuloplasty between 2000 and 2006. Pre-intervention and the latest post-intervention fetal echocardiograms were analyzed to characterize changes in left heart function and Doppler characteristics in utero.

Results: Forty-two fetuses underwent attempted aortic valvuloplasty during the study period, 12 of which were excluded from analysis secondary to inadequate follow-up data, termination or fetal demise. Study fetuses (n = 30) underwent pre-intervention echocardiography at a median gestational age of 23 weeks, and were followed for a median of 66 +/- 23 days post-intervention. In 26 fetuses, aortic valvuloplasty was technically successful. Among these 26, left heart physiology was abnormal pre-intervention and improved or normalized after intervention in most cases: biphasic mitral inflow was present in 5/25 (20%) cases pre-intervention and in 21/23 (91%) post-intervention (P < 0.001); moderate or severe mitral regurgitation was present in 14/26 (54%) cases pre-intervention and in 5/23 (22%) post-intervention (P = 0.02); bidirectional flow across the patent foramen ovale was present in 0/26 cases pre-intervention and in 6/25 (24%) post-intervention (P = 0.01); antegrade flow in the transverse arch was present in 0/25 cases pre-intervention and in 17/26 (65%) post-intervention (P < 0.001). The left ventricular ejection fraction increased from 19 +/- 10% pre-intervention to 39 +/- 14% post-intervention (P < 0.001). These changes were not observed in control fetuses (n = 18).

Conclusion: Fetal aortic valvuloplasty, when technically successful, improves left ventricular systolic function and left heart Doppler characteristics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / embryology
  • Aortic Valve Stenosis / therapy*
  • Catheterization / methods*
  • Echocardiography, Doppler / methods
  • Female
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Hemodynamics
  • Humans
  • Hypoplastic Left Heart Syndrome / diagnostic imaging
  • Hypoplastic Left Heart Syndrome / embryology
  • Hypoplastic Left Heart Syndrome / prevention & control*
  • Pregnancy
  • Pregnancy Outcome
  • Reproducibility of Results
  • Ultrasonography, Prenatal / methods