Kalish Brian T, Tworetzky Wayne, Benson Carol B, Wilkins-Haug Louise, Mizrahi-Arnaud Arielle, McElhinney Doff B, Lock James E, Marshall Audrey C
Harvard Medical School, Boston, Massachusetts.
Catheter Cardiovasc Interv. 2014 Jul 1;84(1):77-85. doi: 10.1002/ccd.25098. Epub 2014 Apr 7.
The objective of this study was to describe our single-institution experience with prenatal atrial septal stent placement for fetuses with hypoplastic left heart syndrome and an intact atrial septum (HLHS/IAS).
Infants born with HLHS/IAS are at high risk for neonatal death, despite maximal postnatal therapy. Prenatal atrial septoplasty by static balloon dilation has been effective in decompressing the left atrium (LA) in utero, but several factors have limited the size of septal defects. We attempted to overcome the limitations of balloon septoplasty using transcatheter atrial septal stents.
All records from our institution of fetuses with HLHS/IAS that underwent prenatal atrial septal stent placement were reviewed, including operative notes and echocardiograms.
Nine fetuses between 24 and 31 weeks gestation with HLHS/IAS underwent attempted fetal atrial septal stent placement. A stent was deployed across the atrial septum in five fetuses, with four fetuses demonstrating flow across the stent at the time of intervention. In four cases, stent placement failed due to malposition or embolization, but in three of the four cases, atrial balloon septoplasty at the same in-utero procedure successfully and acutely decompressed the LA. There were no maternal complications. There was one fetal demise. The remaining eight fetuses survived to delivery, but four died in the neonatal period (two of which had been stented).
Ultrasound-guided atrial septal stent placement is feasible in some fetuses with HLHS/IAS. Visualization of the septum and catheter tip is critical to technical success. Additional experience is necessary to determine the clinical impact of this intervention. © 2013 Wiley Periodicals, Inc.
本研究的目的是描述我们在单机构中对患有左心发育不全综合征且房间隔完整（HLHS/IAS）的胎儿进行产前房间隔支架置入的经验。
尽管出生后进行了最大程度的治疗，但患有HLHS/IAS的婴儿仍面临较高的新生儿死亡风险。通过静态球囊扩张进行的产前房间隔造口术在子宫内有效减压左心房（LA），但有几个因素限制了房间隔缺损的大小。我们试图使用经导管房间隔支架克服球囊房间隔造口术的局限性。
回顾了我们机构中所有接受产前房间隔支架置入的HLHS/IAS胎儿的记录，包括手术记录和超声心动图。
9例孕周在24至31周之间的HLHS/IAS胎儿尝试进行胎儿房间隔支架置入。5例胎儿在房间隔上部署了支架，其中4例在干预时显示有血流通过支架。在4例中，由于位置不当或栓塞，支架置入失败，但在这4例中的3例中，在同一子宫内操作中进行的房间隔球囊造口术成功并迅速减压了左心房。没有产妇并发症。有1例胎儿死亡。其余8例胎儿存活至分娩，但4例在新生儿期死亡（其中2例已置入支架）。
超声引导下房间隔支架置入在一些HLHS/IAS胎儿中是可行的。隔膜和导管尖端的可视化对于技术成功至关重要。需要更多经验来确定这种干预的临床影响。©2013威利期刊公司
