title: Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model.
abstract: OBJECTIVE
  Human fetal cardiac intervention has hitherto typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy.
  
  
  METHODS
  In 10 fetal lambs (90-97 days' gestation), access to the fetal venous system was attempted by percutaneous puncture with a 5-F sheath into the umbilical vein (n = 1) or a 16-gauge IV-catheter into the hepatic vein (n = 9). This was followed by cardiac catheterization using a 1.8-2.6-F tapered coronary catheter. Euthanasia and postmortem examination were performed immediately postprocedure in two cases, or after normal term delivery in the remaining cases that survived the procedure.
  
  
  RESULTS
  In one case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5-F sheath, died from umbilical hemorrhage. In eight cases, access to the fetal hepatic vein was achieved. In seven of these cases, the access catheter was advanced into the inferior vena cava, followed by catheterization of the right atrium (all cases) and four cardiac chambers (three cases). One fetus died during cardiac catheterization owing to right ventricle perforation, and the other seven fetuses were alive at the end of the procedure (87.5% survival). Immediate postmortem after euthanasia in two of the fetuses that survived the procedure detected intraperitoneal bleeding (4 mL and 20 mL), while postnatal postmortem examination following uneventful delivery at term in the remaining five fetuses revealed no vascular or cardiac trauma.
  
  
  CONCLUSIONS
  Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions.
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Edwards
authors.forename: S
authors.initials: S
authors.lastname: Menahem
authors.forename: A
authors.initials: A
authors.lastname: Veldman
authors.forename: D
authors.initials: D
authors.lastname: Schranz
authors.forename: Y
authors.initials: Y
authors.lastname: Chan
authors.forename: I
authors.initials: I
authors.lastname: Nitsos
authors.forename: F
authors.initials: F
authors.lastname: Wong
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005318:Fetal Heart / Q000473:pathology* / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000473:pathology*; D006503:Hepatic Veins; D011247:Pregnancy; D034561:Sheep, Domestic; D014471:Umbilical Veins