title: The role of echocardiography in the intraoperative management of the fetus undergoing myelomeningocele repair.
abstract: BACKGROUND
  Fetal surgery for myelomeningocele (MMC) results in better outcomes compared to postnatal treatment. However, risks are present. We describe our experience with intraoperative fetal echocardiography during repair of MMC and report on the management of serious cardiovascular events.
  
  
  METHODS
  The subjects included fetuses with intent to repair MMC from January 2011 to February 2014. The protocol involved continuous echocardiography in a looping, sequential manner of systolic function, heart rate and tricuspid and mitral valve regurgitation.
  
  
  RESULTS
  A total of 101 cases intended fetal MMC repair; 100 completed surgery. Intraoperative ventricular dysfunction was present in 60% (20 mild, 25 moderate, 15 severe). Heart rate <100 bpm was noted in 11 cases. Tricuspid valve regurgitation was present in 35% (26 mild, 7 moderate, 2 severe); mitral valve regurgitation was present in 19% (15 mild, 4 moderate). Serious cardiovascular events were experienced in 7 cases, which affected the conduct of surgery and/or outcome. In 4 of these, medications were given via the umbilical vein and external cardiac compressions were performed. Fetal echocardiography was used to gauge the efficacy of compressions and to guide resuscitation.
  
  
  CONCLUSIONS
  Cardiovascular compromise is common during fetal surgery for MMC. Intraoperative fetal echocardiography is recommended as a growing number of centers contemplate offering this form of novel, but potentially risky, therapy.
authors: Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, Pa., USA.
authors: Jack
authors: J
authors: Rychik
authors: David
authors: D
authors: Cohen
authors: Kha M
authors: KM
authors: Tran
authors: Anita
authors: A
authors: Szwast
authors: Shobha S
authors: SS
authors: Natarajan
authors: Mark P
authors: MP
authors: Johnson
authors: Julie S
authors: JS
authors: Moldenhauer
authors: Nahla
authors: N
authors: Khalek
authors: Juan
authors: J
authors: Martinez-Poyer
authors: Alan W
authors: AW
authors: Flake
authors: Holly L
authors: HL
authors: Hedrick
authors: N Scott
authors: NS
authors: Adzick
mesh_terms: D004452:Echocardiography; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D046128:Fetal Therapies; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D008591:Meningomyelocele / Q000601:surgery*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal