Department of Pediatric Cardiology, West China Second University Hospital, and West China Medical School, Sichuan University, Chengdu, China.
Fetal Diagn Ther. 2011;30(2):100-7. doi: 10.1159/000324503. Epub 2011 Apr 5.
Intrauterine balloon aortic valvuloplasty (IUBAV) has been used to correct critical aortic valve stenosis. Evaluation of the intervention-related risk is necessary. The purpose of this study was to establish an experimental goat model for ultrasound-guided IUBAV intervention and investigate the immediate and long-term effects of IUBAV on the fetus, gestational outcome and mother's safety.
Fifteen pregnant goats with twin gestation in the 2nd and 3rd trimester were anesthetized to establish the surgical procedure. One fetus of the twins received IUBAV intervention, the other served as a control. The data were collected at three time points: immediately before and after IUBAV, and 24 h after birth. Critical organs including the heart, brain, lung and liver from the fetuses/newborns were collected after IUBAV or 24 h after birth.
IUBAV intervention immediately induced a significant decrease of pH and Ca(2+), as well as an increase of blood glucose and lactic acid levels (p < 0.05). IUBAV also caused an increase in stress hormones (epinephrine 1-fold, norepinephrine 4-fold, and cortisol 1-fold; p < 0.05). Following the operation, all of the mother goats recovered, but in 60% (6/10) preterm delivery occurred. Neither pathological changes in fetal critical organs nor a significant difference in metabolism or growth parameters were detected between IUBAV and control kids.
Ultrasound-guided IUBAV intervention induced a strong but transient stress response in the operated fetus, which did not result in irreversible histological changes in the fetus or the mother, but may disrupt the continuation of normal gestation in the long term. Preterm delivery is the major risk in this goat IUBAV model.
宫内球囊主动脉瓣成形术（IUBAV）已被用于矫正严重的主动脉瓣狭窄。评估与干预相关的风险是必要的。本研究的目的是建立一个超声引导的 IUBAV 干预的实验山羊模型，并研究 IUBAV 对胎儿、妊娠结局和母亲安全的即时和长期影响。
对 15 只妊娠中期和晚期的双胎妊娠山羊进行麻醉，以建立手术程序。双胞胎中的一只胎儿接受 IUBAV 干预，另一只作为对照。在三个时间点收集数据：IUBAV 干预前和干预后即刻，以及出生后 24 小时。在 IUBAV 或出生后 24 小时后，从胎儿/新生儿收集包括心脏、大脑、肺和肝脏在内的重要器官。
IUBAV 干预立即导致 pH 值和 Ca(2+)显著下降，血糖和乳酸水平升高（p < 0.05）。IUBAV 还导致应激激素增加（肾上腺素增加 1 倍，去甲肾上腺素增加 4 倍，皮质醇增加 1 倍；p < 0.05）。手术后，所有的母羊都恢复了，但有 60%（6/10）发生早产。在 IUBAV 和对照组的胎儿中，未发现重要器官的病理变化，代谢或生长参数也没有显著差异。
超声引导的 IUBAV 干预会导致操作胎儿产生强烈但短暂的应激反应，但不会导致胎儿或母亲发生不可逆转的组织学变化，但可能会长期破坏正常妊娠的延续。早产是这种山羊 IUBAV 模型的主要风险。
