Universität zu Köln

Walter, Adeline ORCID: 0000-0001-8302-3854, Strizek, Brigitte ORCID: 0000-0003-3625-7097, Weber, Eva Christin, Gottschalk, Ingo, Geipel, Annegret, Herberg, Ulrike, Gembruch, Ulrich ORCID: 0000-0001-8284-4669 and Berg, Christoph (2022). Intrauterine Valvuloplasty in Severe Aortic Stenosis-A Ten Years Single Center Experience. J. Clin. Med., 11 (11). BASEL: MDPI. ISSN 2077-0383

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Abstract

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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Walter, Adeline UNSPECIFIED orcid.org/0000-0001-8302-3854 UNSPECIFIED Strizek, Brigitte UNSPECIFIED orcid.org/0000-0003-3625-7097 UNSPECIFIED Weber, Eva Christin UNSPECIFIED UNSPECIFIED UNSPECIFIED Gottschalk, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Geipel, Annegret UNSPECIFIED UNSPECIFIED UNSPECIFIED Herberg, Ulrike UNSPECIFIED UNSPECIFIED UNSPECIFIED Gembruch, Ulrich UNSPECIFIED orcid.org/0000-0001-8284-4669 UNSPECIFIED Berg, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-667948
DOI:	10.3390/jcm11113058
Journal or Publication Title:	J. Clin. Med.
Volume:	11
Number:	11
Date:	2022
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2077-0383
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LEFT-HEART SYNDROME; NATURAL-HISTORY; VALVE; SELECTION; FETUSES Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66794