Galindo A, Gutiérrez-Larraya F, Velasco J M, de la Fuente P
Department of Obstetrics and Gynaecology, Ultrasound and Fetal Physiopathology Unit, Hospital Universitario, Madrid, Spain.
Fetal Diagn Ther. 2006;21(1):100-4. doi: 10.1159/000089058.
Outcome of fetuses with critical pulmonary stenosis (critical PS) or atresia of the pulmonary valve (PA) with intact ventricular septum (IVS) is closely related with right ventricle hypoplasia and its consequent hemodynamics. Fetal echocardiography not only allows early detection of this condition but also monitors its normally unfavorable evolution. These cases may benefit from intrauterine intervention relieving outflow tract obstruction in order to achieve a biventricular circulation. Successful valvuloplasty of the pulmonary valve was performed in a fetus with critical PS-IVS and heart failure at 25 weeks. After the procedure there was a significant improvement in fetal hemodynamics. Follow-up scans at 34 weeks detected a significant restenosis with signs of circulatory failure leading to premature delivery of the baby. An immediate postnatal valvuloplasty successfully completed the ultimate objective of biventricular repair. Fetal pulmonary valvuloplasty is feasible and may change the natural history of the disease in fetuses with critical PS-IVS.
室间隔完整的严重肺动脉狭窄（严重PS）或肺动脉瓣闭锁（PA）胎儿的预后与右心室发育不全及其随之而来的血流动力学密切相关。胎儿超声心动图不仅能早期检测出这种情况，还能监测其通常不利的进展。这些病例可能受益于宫内干预以缓解流出道梗阻，从而实现双心室循环。对一名25周时患有严重PS-IVS并伴有心力衰竭的胎儿成功实施了肺动脉瓣成形术。术后胎儿血流动力学有显著改善。34周时的随访扫描发现有明显的再狭窄，并伴有循环衰竭迹象，导致婴儿早产。出生后立即进行的瓣膜成形术成功完成了双心室修复的最终目标。胎儿肺动脉瓣成形术是可行的，并且可能改变患有严重PS-IVS胎儿的疾病自然史。
