Quintero Rubén A, Huhta James, Suh Elsa, Chmait Ramen, Romero Roberto, Angel Jeffrey
Florida Institute for Fetal Diagnosis and Therapy, St. Joseph's Women's Hospital, Tampa, FL, USA.
Am J Obstet Gynecol. 2005 Oct;193(4):1424-8. doi: 10.1016/j.ajog.2005.02.126.
The purpose of this study was to report a novel technique, laser atrial septotomy, for the in utero treatment of hypoplastic left heart syndrome with intact atrial septum.
In utero atrial septotomy by Neodymium-YAG laser photofulguration in a fetus with hypoplastic left heart syndrome (HLHS) and intact atrial septum was performed at 30 4/7 weeks of gestation. Percutaneous fetal cardiocentesis was performed to guide a contact (Neodymium-YAG) laser fiber into the right atrium with the objective of creating an interatrial communication by photofulguration of the septal tissue.
New onset of blood flow from the left to the right atrium was confirmed by color Doppler imaging during the procedure. The neoatrial septal defect remained patent until delivery. A 3400-g neonate was born by spontaneous vaginal delivery at 37 weeks of gestation. A first stage Norwood procedure was performed on the first day of life and surgical correction of an obstructed right pulmonary vein at 3 months. Although pulmonary vascular resistance was normal at cardiac catheterization at 2 months of age, the infant died at 5 months of age from multiple organ failure. An autopsy was declined.
In utero laser atrial septotomy is feasible. Further experience is necessary to determine the risks and benefits of this technique for the treatment of fetuses hypoplastic left heart syndrome with intact atrial septum.
本研究旨在报告一种新型技术——激光房间隔切开术，用于在子宫内治疗房间隔完整的左心发育不全综合征。
在妊娠30又4/7周时，对一名患有左心发育不全综合征（HLHS）且房间隔完整的胎儿进行了经钕钇铝石榴石激光光凝子宫内房间隔切开术。进行经皮胎儿心脏穿刺术，以引导接触式（钕钇铝石榴石）激光光纤进入右心房，目的是通过光凝间隔组织建立房间交通。
术中通过彩色多普勒成像确认了从左心房到右心房有新的血流出现。新的房间隔缺损在分娩前一直保持开放。一名体重3400克的新生儿在妊娠37周时经阴道自然分娩出生。出生第一天进行了第一期诺伍德手术，3个月时对梗阻性右肺静脉进行了手术矫正。尽管在2个月大时心脏导管检查显示肺血管阻力正常，但该婴儿在5个月大时死于多器官衰竭。拒绝进行尸检。
子宫内激光房间隔切开术是可行的。需要进一步的经验来确定该技术治疗房间隔完整的左心发育不全综合征胎儿的风险和益处。
