Walter Adeline, Strizek Brigitte, Weber Eva Christin, Gottschalk Ingo, Geipel Annegret, Herberg Ulrike, Gembruch Ulrich, Berg Christoph
Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany.
Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany.
J Clin Med. 2022 May 29;11(11):3058. doi: 10.3390/jcm11113058.
Objective: To assess the course and outcome of fetal aortic valvuloplasty (FAV) in fetuses with severe aortic stenosis (SAS) in a single center. Methods: All fetuses with a prenatal diagnosis of SAS with subsequent FAV were retrospectively collected in one tertiary center for fetal medicine over a period of 10 years. In the study, period fetuses with SAS were considered suitable for FAV in the presence of markedly elevated left ventricular pressures (maximum velocity of mitral regurgitation (MR Vmax) >250 cm/s and/or maximum velocity of aortic stenosis (AS Vmax) >250 cm/s), retrograde flow in the transverse aortic arch and a left ventricular length Z-score >−1. Results: In the study period 29 fetuses with AS were treated with 38 FAV. If reinterventions are included 82.7% of fetuses received a technically successful FAV. Procedure related death occurred in three (10.3%) cases, spontaneous fetal death in 2 (6.9%), and termination of pregnancy was performed in 3 cases (10.3%). Among the 21 live births (72.4%), four died in infancy. Among the remaining survivors, 8/17 (47.1%) had a biventricular outcome at the age of one year, 8/17 (47.1%) were univentricular and one infant (5.9%) is biventricular at the age of eight months. Fetuses with biventricular outcome had significantly greater left ventricular (LV) length Z-scores (p = 0.031), and lower tricuspid to mitral valve (TV/MV) ratios (p = 0.003). Conclusions: FAV has a high technical success rate and a low rate of procedure related mortality if performed in experienced hands. The success rate of biventricular circulation at the age of one year is moderate and seems to depend rather on the center’s experience and postnatal surgical strategies than solely on prenatal selection criteria. In the absence of randomized controlled trials, FAV remains an experimental intervention.
在单一中心评估重度主动脉瓣狭窄（SAS）胎儿的胎儿主动脉瓣成形术（FAV）的过程及结局。方法：回顾性收集一家三级胎儿医学中心10年间所有产前诊断为SAS并随后接受FAV的胎儿。在研究期间，存在左心室压力明显升高（二尖瓣反流最大速度（MR Vmax）>250 cm/s和/或主动脉瓣狭窄最大速度（AS Vmax）>250 cm/s）、主动脉弓横部逆行血流且左心室长度Z评分> -1的SAS胎儿被认为适合进行FAV。结果：在研究期间，29例主动脉瓣狭窄胎儿接受了38次FAV治疗。若包括再次干预，82.7%的胎儿接受了技术上成功的FAV。手术相关死亡3例（10.3%），自然胎儿死亡2例（6.9%），3例（10.3%）进行了妊娠终止。在21例活产（72.4%）中，4例在婴儿期死亡。在其余幸存者中，17例中有8例（47.1%）在1岁时为双心室结局，17例中有8例（47.1%）为单心室，1例婴儿（5.9%）在8个月时为双心室。双心室结局的胎儿左心室（LV）长度Z评分显著更高（p = 0.031），三尖瓣与二尖瓣（TV/MV）比值更低（p = 0.003）。结论：如果由经验丰富的人员进行，FAV具有较高的技术成功率和较低的手术相关死亡率。1岁时双心室循环的成功率中等，似乎更多地取决于中心的经验和产后手术策略，而非仅仅取决于产前选择标准。在缺乏随机对照试验的情况下，FAV仍然是一种试验性干预措施。
