Tulzer Gerald, Arzt Wolfgang, Franklin Rodney C G, Loughna Pamela V, Mair Rudi, Gardiner Helena M
Children's Heart Centre Linz, Children's Hospital of Linz, Austria.
Lancet. 2002 Nov 16;360(9345):1567-8. doi: 10.1016/S0140-6736(02)11531-5.
Progressive stenosis of the semilunar valves in utero can be life threatening. We treated two fetuses with complete or almost complete pulmonary atresia and imminent hydrops (increased cardiothoracic ratio, pericardial effusion, holosystolic tricuspid regurgitation extending into diastole, and abnormal venous Dopplers). We dilated the pulmonary valve of two fetuses in utero at 28 and 30 weeks' gestation, through the mothers' abdomens. After the procedure, the fetuses had decreased signs of circulatory failure and gestation continued until near term. In the neonatal period, we did a repeat valvuloplasty with systemic-to-pulmonary arterial shunt. Both children (now aged 18 months and 12 months) now have biventricular circulation. Surgery on selected fetuses with semilunar valve stenosis or atresia, or both, can extend pregnancy and favourably change the postnatal surgical options.
胎儿期半月瓣进行性狭窄可能危及生命。我们治疗了两名患有完全性或几乎完全性肺动脉闭锁且即将出现水肿（心胸比率增加、心包积液、全收缩期三尖瓣反流延至舒张期以及异常静脉多普勒表现）的胎儿。我们在妊娠28周和30周时通过母亲腹部对两名胎儿的肺动脉瓣进行了宫内扩张。术后，胎儿循环衰竭体征减轻，妊娠持续至接近足月。在新生儿期，我们再次进行了瓣膜成形术并建立了体肺分流。两名儿童（现分别为18个月和12个月大）目前均有双心室循环。对选定的患有半月瓣狭窄或闭锁或两者皆有的胎儿进行手术，可以延长孕期并有利地改变出生后的手术选择。
