Intra-amniotic multimodal fetal echocardiography in sheep: a novel imaging approach during fetoscopic interventions and for assessment of high-risk pregnancies in which conventional imaging methods fail.
During fetoscopic interventions, intraesophageal placement of intravascular ultrasound (US) catheters for fetal hemodynamic monitoring may result in esophageal injury in very small fetuses. Moreover, conventional fetal imaging by the transvaginal or transabdominal routes may be impossible in some high-risk pregnancies. The purpose of our study in sheep was to assess the potential of a phased-array intravascular US catheter for intra-amniotic fetal echocardiography. The catheter was percutaneously inserted into the amniotic cavity in seven pregnant ewes at between 78 to 98 days of gestation and permitted high-quality 2-D imaging of the fetal heart and multimodal Doppler assessment of fetal cardiovascular flows. Fetoscopic examination of intra-amniotic contents after intra-amniotic imaging was finished did not display any injury to intra-amniotic contents. The intra-amniotic imaging approach may provide an effective alternative in humans for monitoring during fetoscopic interventions, and to assess fetal anatomy and hemodynamics in high-risk pregnancies when sufficient images cannot be obtained by conventional routes.
Kohl
Thomas
T
Department of Obstetrics & Prenatal Medicine, University of Bonn, Bonn, Germany. thokohl@t-online.de
Hartlage
Maike Grosse
MG
Westphal
Martin
M
Kienitz
Dagmar
D
Aryee
Sebastian
S
Achenbach
Sarah
S
Buller
Tim
T
Kossobutzki
Christina
C
Gogarten
Wiebke
W
Vogt
Johannes
J
Scheld
Hans H
HH
Van Aken
Hugo
H
Gembruch
Ulrich
U
D000653:Amniotic Fluid / Q000000981:diagnostic imaging*; D000818:Animals; D002404:Catheterization / Q000295:instrumentation; D015150:Echocardiography, Doppler / Q000379:methods*; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D023421:Models, Animal; D012756:Sheep; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*