Fetal transesophageal echocardiography: clinical introduction as a monitoring tool during cardiac intervention in a human fetus.
Because of insufficient imaging by maternal transabdominal fetal echocardiography (TAE) in a human fetus with aortic atresia, imperforate atrial septum and progressive cardiac failure, we assessed the feasibility of fetal transesophageal echocardiography (TEE) as a monitoring tool during fetal cardiac intervention at 24 + 6 weeks of gestation. Percutaneous fetoscopic intraesophageal deployment of the ultrasound catheter was achieved and did not result in any maternal or fetal complications. Fetal TEE permitted substantially clearer definition of fetal cardiac anatomy and intracardiac device manipulations than conventional maternal TAE. Despite the employment of various devices, no sufficiently large opening could be achieved within the atrial septum. Although the fetus tolerated the procedure remarkably well and satisfactory fetoplacental flow could be documented at the end of the procedure, the fetus died from progressive cardiac failure 3 days after the intervention. Fetoscopic TEE is feasible in the human fetus and permits substantially clearer definition of fetal cardiac anatomy and intracardiac manipulations than conventional maternal TAE. Based on the observation of spontaneous closure of multiple iatrogenic perforations of the atrial septum, specialized devices are required in order to improve the technical success rate of septoplasty methods and hence the survival odds of these high-risk patients.
Kohl
T
T
German Center for Fetal Surgery and Minimally-Invasive Therapy, University Hospital of Bonn, Bonn, Germany. thomas.kohl@ukb.uni-bonn.de
Müller
A
A
Tchatcheva
K
K
Achenbach
S
S
Gembruch
U
U
D000328:Adult; D001024:Aortic Valve Stenosis / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods