title: Use of a pressure guidewire in fetal cardiac intervention for critical aortic stenosis.
abstract: Fetal cardiac intervention for critical aortic stenosis (AS) with evolving hypoplastic left heart syndrome is performed in an attempt to maintain a biventricular circulation postnatally. The procedure has been hindered by technical challenges and poor candidate selection. We report here the novel use of a pressure guidewire during aortic valvuloplasty in a fetus at 21 weeks' gestation with critical AS and evolving hypoplastic left heart syndrome. Use of a pressure guidewire during fetal cardiac intervention offers several potential advantages over existing protocols. This technique augments fetal ultrasound as it relates to operator awareness of catheter and wire position (with continuous monitoring of pressure waveforms), improves on intraprocedural fetal hemodynamic monitoring and responsiveness to resuscitation, and provides a rich new data set of invasive fetal hemodynamics. This data set offers tremendous potential with regards to improving candidate selection and postintervention prognostication. In addition, we provide the first, to our knowledge, characterization of intracardiac pressures in a human fetus with congenital heart disease. Given the realized and potential benefits associated with this technique, use of a pressure guidewire may become standard of care for all fetal cardiac interventions.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA. bryan.goldstein@cchmc.org
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldstein
authors.forename: Carlen G
authors.initials: CG
authors.lastname: Fifer
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Armstrong
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Gelehrter
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Treadwell
authors.forename: Cosmas
authors.initials: C
authors.lastname: van de Ven
authors.forename: Albert P
authors.initials: AP
authors.lastname: Rocchini
mesh_terms: D000328:Adult; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000150:complications / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000209:etiology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011312:Pressure; D014463:Ultrasonography