title: Balloon valvuloplasty for critical aortic stenosis in a fetus: a case report.
abstract: The mortality and morbidity of fetal aortic stenosis (AS) depend on the degree of the hemodynamic effects of the stenosis, and left ventricular (LV) adaptation, development and function during fetal life. In the case of critical AS, the development of hydrops and death in utero are well recognized entities. A 23-week gestation fetus was diagnosed with critical severe AS, cardiomegaly, a dilated LV with very poor contractility, and mitral regurgitation. There was a reversal of flow in the aortic arch through the ductus arteriosis and a reversed a-wave in the ductus venosus on Doppler examination. The fetus had hydrops with ascites, and massive scalp, face and skin edema. Fetal amniocentesis was normal. Aortic valvuloplasty was performed under general anesthesia and echocardiographic guidance. Pericardial effusion was not observed after the procedure. However, LV function could not be ameliorated and continued to diminish. There was no cardiac activity in the fetus two hours after the intervention. Aortic valvuloplasty in utero for AS is technically feasible. Mortality is mainly associated with technical errors, LV function, and the degree of endofibroelastosis in the effected fetuses.
authors.affiliation: Department of Maternal and Fetal Medicine Unit, İstanbul Bakırköy Women and Children Training and Resaarch Hospital, İstanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gül
authors.forename: Arda
authors.initials: A
authors.lastname: Saygılı
authors.forename: Sultan
authors.initials: S
authors.lastname: Kavuncuoğlu
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Ceylan
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000196:embryology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000379:methods*; D001919:Bradycardia / Q000196:embryology / Q000209:etiology*; D004695:Endocardial Fibroelastosis / Q000196:embryology; D017809:Fatal Outcome; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006333:Heart Failure / Q000196:embryology; D006801:Humans; D015160:Hydrops Fetalis; D011247:Pregnancy; D016216:Ultrasonography, Prenatal