Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model

• DOI: 10.1002/uog.12352
• Publication Date: 2012-11-23T11:32:17Z
• Authors: A. Edwards; S. Menahem; A. Veldman; D. Schranz; Y. Chan; I. Nitsos; F. Wong
• Keywords: Cardiac catheterization; Perforation

ABSTRACT Objectives Human fetal cardiac intervention has hitherto typically involved a percutaneous transventricular approach. In lambs, transhepatic approach to access the intra‐abdominal veins after exteriorization of uterus by laparotomy been described. We aimed develop technique for catheterization heart at mid‐gestation that avoids maternal . Methods 10 lambs (90–97 days' gestation), venous system was attempted puncture with 5‐F sheath into umbilical vein ( n = 1) or 16‐gauge IV ‐catheter hepatic 9). This followed using 1.8–2.6‐F tapered coronary catheter. Euthanasia and postmortem examination were performed immediately postprocedure in two cases, normal term delivery remaining cases survived procedure Results one case position precluded procedural attempts, another, fetus, accessed sheath, died from hemorrhage. eight achieved. seven these catheter advanced inferior vena cava, right atrium (all cases) four chambers (three cases). One fetus during owing ventricle perforation, other fetuses alive end (87.5% survival). Immediate euthanasia detected intraperitoneal bleeding (4 mL 20 ), while postnatal following uneventful five revealed no vascular trauma Conclusions Ultrasound‐guided is feasible mid‐gestational sheep. potential translation human circulatory interventions. Copyright © 2013 ISUOG. Published John Wiley & Sons Ltd