title: Fetal pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum.
abstract: Progressive stenosis of the semilunar valves in utero can be life threatening. We treated two fetuses with complete or almost complete pulmonary atresia and imminent hydrops (increased cardiothoracic ratio, pericardial effusion, holosystolic tricuspid regurgitation extending into diastole, and abnormal venous Dopplers). We dilated the pulmonary valve of two fetuses in utero at 28 and 30 weeks' gestation, through the mothers' abdomens. After the procedure, the fetuses had decreased signs of circulatory failure and gestation continued until near term. In the neonatal period, we did a repeat valvuloplasty with systemic-to-pulmonary arterial shunt. Both children (now aged 18 months and 12 months) now have biventricular circulation. Surgery on selected fetuses with semilunar valve stenosis or atresia, or both, can extend pregnancy and favourably change the postnatal surgical options.
authors.affiliation: Children's Heart Centre Linz, Children's Hospital of Linz, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Tulzer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Arzt
authors.forename: Rodney C G
authors.initials: RC
authors.lastname: Franklin
authors.forename: Pamela V
authors.initials: PV
authors.lastname: Loughna
authors.forename: Rudi
authors.initials: R
authors.lastname: Mair
authors.forename: Helena M
authors.initials: HM
authors.lastname: Gardiner
mesh_terms: D002404:Catheterization; D005315:Fetal Diseases / Q000628:therapy*; D006801:Humans; D018633:Pulmonary Atresia / Q000628:therapy*; D011664:Pulmonary Valve; D011666:Pulmonary Valve Stenosis / Q000628:therapy*; D016896:Treatment Outcome