Aortic valvuloplasty in the fetus: technical characteristics of successful balloon dilation.
OBJECTIVE
To describe technical aspects of successful fetal aortic valvuloplasty, with particular attention to balloon size.


METHODS
We retrospectively reviewed all procedural records and echocardiograms pertaining to 26 attempts at fetal aortic valve dilation performed at a single center over a period of 4 years. We assessed the effect of valvuloplasty as determined by echocardiographic appearance at the time of intervention and in follow-up.


RESULTS
In 20 of 26 fetuses who had technically successful aortic valve dilation (median balloon:annulus ratio=1.1), all had improved antegrade flow and 12 had at least mild regurgitation after dilation. Use of an oversized balloon was associated with the onset of moderate or severe aortic regurgitation, seen in 5 fetuses. This aortic regurgitation was well tolerated and improved through the remainder of gestation.


CONCLUSIONS
These data imply that fetal aortic valves can be dilated safely with larger balloons than are commonly used for postnatal dilation. The observation of spontaneous improvement in postdilation aortic regurgitation further suggests that fetal valve tissue behaves uniquely.
Marshall
Audrey C
AC
Department of Cardiology and Department of Surgery, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Tworetzky
Wayne
W
Bergersen
Lisa
L
McElhinney
Doff B
DB
Benson
Carol B
CB
Jennings
Russell W
RW
Wilkins-Haug
Louise E
LE
Marx
Gerald R
GR
Lock
James E
JE
D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005315:Fetal Diseases / Q000628:therapy*; D005318:Fetal Heart / Q000000981:diagnostic imaging; D046128:Fetal Therapies / Q000295:instrumentation / Q000379:methods; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography