Amniotic air insufflation during minimally invasive fetoscopic fetal cardiac interventions is safe for the fetal brain in sheep.
BACKGROUND
Amniotic air insufflation during experimental fetoscopic fetal cardiac interventions greatly improves the visualization of intra-amniotic contents. The purpose of this study was to assess any histologically discernible effects from this approach on the fetal brain after short-term studies and long-term survival in sheep.


METHODS
Thirty pregnant ewes between 80 and 110 days of gestation underwent amniotic air insufflation during various fetoscopic fetal cardiac interventions. After 18 short-term and 12 long-term studies, the brains of the operated fetuses and-if available-their unoperated siblings were examined for hemorrhage, embolism, infarctions, inflammatory changes, and abnormal cortical maturation.


RESULTS
Amniotic air insufflation during minimally invasive fetoscopic fetal cardiac interventions did not result in any histologically discernible damage to the brain in short-term and long-term studies in any but 2 sibling sheep. In the 2 affected siblings, a small area of chronic cortical frontal lobe infarction was observed after long-term survival.


CONCLUSIONS
Amniotic air insufflation during minimally invasive percutaneous fetoscopic fetal cardiac interventions is safe for the fetal brain and does not compromise maternal hemodynamics in sheep. These findings encourage further investigation of the role this technique might play during fetoscopic fetal cardiac interventions in humans.
Kohl
Thomas
T
Division of Obstetrics & Prenatal Medicine, University Hospital of Bonn, Bonn, Germany. thokohl@t-online.de
Reckers
Julia
J
Strümper
Danja
D
Grosse Hartlage
Maike
M
Gogarten
Wiebke
W
Gembruch
Ulrich
U
Vogt
Johannes
J
Van Aken
Hugo
H
Scheld
Hans H
HH
Paulus
Werner
W
Rickert
Christian H
CH
D000650:Amnion; D000818:Animals; D001927:Brain Diseases / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005332:Fetoscopy; D007327:Insufflation; D011247:Pregnancy; D012756:Sheep; D013997:Time Factors