title: Impact of intrauterine balloon aortic valvuloplasty on gestational outcome in a fetal goat model.
abstract: OBJECTIVE
  Intrauterine balloon aortic valvuloplasty (IUBAV) has been used to correct critical aortic valve stenosis. Evaluation of the intervention-related risk is necessary. The purpose of this study was to establish an experimental goat model for ultrasound-guided IUBAV intervention and investigate the immediate and long-term effects of IUBAV on the fetus, gestational outcome and mother's safety.
  
  
  METHODS
  Fifteen pregnant goats with twin gestation in the 2nd and 3rd trimester were anesthetized to establish the surgical procedure. One fetus of the twins received IUBAV intervention, the other served as a control. The data were collected at three time points: immediately before and after IUBAV, and 24 h after birth. Critical organs including the heart, brain, lung and liver from the fetuses/newborns were collected after IUBAV or 24 h after birth.
  
  
  RESULTS
  IUBAV intervention immediately induced a significant decrease of pH and Ca(2+), as well as an increase of blood glucose and lactic acid levels (p < 0.05). IUBAV also caused an increase in stress hormones (epinephrine 1-fold, norepinephrine 4-fold, and cortisol 1-fold; p < 0.05). Following the operation, all of the mother goats recovered, but in 60% (6/10) preterm delivery occurred. Neither pathological changes in fetal critical organs nor a significant difference in metabolism or growth parameters were detected between IUBAV and control kids.
  
  
  CONCLUSIONS
  Ultrasound-guided IUBAV intervention induced a strong but transient stress response in the operated fetus, which did not result in irreversible histological changes in the fetus or the mother, but may disrupt the continuation of normal gestation in the long term. Preterm delivery is the major risk in this goat IUBAV model.
authors.affiliation: Department of Pediatric Cardiology, West China Second University Hospital, and West China Medical School, Sichuan University, Chengdu, China. nathan_hua@163.com
authors.forename: Yimin
authors.initials: Y
authors.lastname: Hua
authors.forename: Sen
authors.initials: S
authors.lastname: Yang
authors.forename: Kaiyu
authors.initials: K
authors.lastname: Zhou
authors.forename: Nan
authors.initials: N
authors.lastname: Guo
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhu
authors.forename: Rong
authors.initials: R
authors.lastname: Zhou
authors.forename: Dezhi
authors.initials: D
authors.lastname: Mu
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Jiang
mesh_terms: D000818:Animals; D001011:Aorta / Q000196:embryology / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D005332:Fetoscopy / Q000009:adverse effects*; D006041:Goats; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology; D018570:Risk Assessment; D013312:Stress, Physiological