title: Transesophageal echocardiography in fetal sheep. A monitoring tool for open and fetoscopic cardiac procedures.
abstract: BACKGROUND
  Cardiac procedures in exteriorized fetuses or assisted by fetoscopy require monitoring capabilities not attended by conventional maternal transabdominal echocardiography.
  
  
  METHODS
  We, therefore, assessed the potential of fetal transesophageal echocardiography (TEE) utilizing an intravascular ultrasound catheter (IVUC) for fetal cardiac monitoring. We inserted a 10-F-10-MHz IVUC into the esophagus in 12 exteriorized fetal sheep and by a fetoscopic approach in 4 fetal sheep. Cardiac events were observed. Heart rate, cardiac rhythm, patency of the foramen ovale and ductus arteriosus, and the width of the branch pulmonary arteries could be assessed in all fetuses. Ventricular contractility could be assessed only in fetuses weighing less than 2.5 kg. Larger fetuses did not allow adequate imaging of the apical portion of the ventricles because of limited tissue penetration of the IVUC. Fetal TEE permitted placing small guide wires in the cardiac atria and left ventricle. Short-lived premature beats following intracardiac manipulations of these wires could be observed by fetal TEE in all cases.
  
  
  RESULTS
  At autopsy, no complications from IVUC insertion were observed in the exteriorized fetuses. Fetoscopic placement of the IVUC resulted in minor perioral skin erosion in two nonexteriorized fetuses.
  
  
  CONCLUSIONS
  In conclusion, fetal TEE can be achieved with minor fetal injury and may provide useful information during open and fetoscopic cardiac procedures. Further improvements in IVUC design will permit the application of this technique to monitor human fetal cardiac procedures.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kohl
authors.forename: E J
authors.initials: EJ
authors.lastname: Stelnicki
authors.forename: K J
authors.initials: KJ
authors.lastname: VanderWall
authors.forename: Z
authors.initials: Z
authors.lastname: Szabo
authors.forename: E
authors.initials: E
authors.lastname: Ko
authors.forename: S W
authors.initials: SW
authors.lastname: Bruch
authors.forename: M R
authors.initials: MR
authors.lastname: Harrison
authors.forename: N H
authors.initials: NH
authors.lastname: Silverman
authors.forename: F L
authors.initials: FL
authors.lastname: Hanley
authors.forename: T M
authors.initials: TM
authors.lastname: Chou
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000601:surgery; D005323:Fetal Monitoring / Q000379:methods* / Q000662:veterinary; D005332:Fetoscopy / Q000379:methods / Q000662:veterinary; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D011247:Pregnancy; D012756:Sheep; D016216:Ultrasonography, Prenatal