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• W2079409488 abstract "Critical aortic stenosis (AS) occurs in approximately 2% of fetuses with congenital heart disease, and may lead to hypoplastic left heart syndrome (HLHS) or hydrops. In utero ultrasound-guided balloon aortic valvotomy (IUBAV) has been reported, but has been associated with both technical failures and intraoperative mortality. The differential diagnosis of aortic atresia (AA) versus AS may be beyond the resolution of ultrasound in selected cases. We describe intracardiac fetal endoscopy (ICFE) to document AS. A 34 year old, G2 P1, was diagnosed with a fetus with AS at 18 weeks' gestation. Echocardiogram also showed mitral regurgitation, an ascending aorta which measured 1.7 mm which showed no discernible antegrade flow, and a dilated-akinetic left ventricle with an echogenic endocardium. A normal 46, XY karyotype was obtained. The patient gave written informed consent. Under ultrasound guidance and local anesthesia, an 18-gauge needle was inserted percutaneously into the left ventricle. An attempt to negotiate the aortic valve failed twice. The possibility of aortic atresia was contemplated. A 0.8 mm angioscope threaded through the 18-gauge needle confirmed a unicommissural aortic valve with a lumen of approximately 5 mm. A 014” soft-tip wire guide was passed through the lumen of the aortic valve. A 3 mm × 1 cm coronary angioplasty balloon was dilated across the aortic valve, achieving approximately 130% of the aortic valve anulus. Color and pulsed Doppler showed forward and regurgitant flow through the aortic valve. Ventricular function improved significantly post-op. Forward flow through the valve persists after surgery. Minimal scalp edema resolved within 72 hours. Percutaneous ICFE and IUBAV are technically feasible. ICFE may aid in the differential diagnosis of AA versus AS. Further experience is needed to determine the risks and benefits of these procedures in the management of fetuses with AS." @default.
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• W2079409488 date "2004-08-01" @default.
• W2079409488 modified "2023-09-23" @default.
• W2079409488 title "P02.05: Percutaneous fetal aortic valvotomy with intracardiac endoscopy for the treatment of critical aortic valve stenosis" @default.
• W2079409488 doi "https://doi.org/10.1002/uog.1345" @default.
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