title: A percutaneous fetal cardiac catheterization technique for pulmonary valvuloplasty and valvulotomy in a mid-gestation lamb model.
abstract: OBJECTIVE
  We aimed to assess the feasibility of using a percutaneous transhepatic cardiac catheterization technique to perform fetal pulmonary valvuloplasty and valvulotomy under ultrasound guidance at mid-gestation.
  
  
  METHODS
  In 13 mid-gestation fetal lambs without cardiac pathology, percutaneous transhepatic cardiac catheterization was used to position a coronary angioplasty catheter within the pulmonary valve. The balloon was inflated/deflated several times, simulating pulmonary valvuloplasty. In another two fetal lambs, a guidewire tip was positioned against the pulmonary valve, and unipolar diathermy was applied to simulate perforation of an atretic valve.
  
  
  RESULTS
  Percutaneous access followed by right heart catheterization was successful in all cases. One fetus died following right ventricle perforation. Simulated pulmonary valvuloplasty was successful in nine cases using catheters with 6-mm-long balloons but unsuccessful in two cases (both survived) using 12-mm-long balloons. In one case, the catheter could not be inserted as the cannula became dislodged. Diathermy of the pulmonary valve was successful in both attempts.
  
  
  CONCLUSIONS
  We successfully simulated in utero perforation and dilation of the pulmonary valve using percutaneous transhepatic access in fetal lambs. The technique has potential for clinical translation into treatment for human fetuses with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum.
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research-Prince Henry Institute, Melbourne, Australia; Perinatal Services, Monash Medical Centre, Melbourne, Australia; Fetal Cardiac Unit, Monash Medical Centre, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Edwards
authors.forename: Alex
authors.initials: A
authors.lastname: Veldman
authors.forename: Ilias
authors.initials: I
authors.lastname: Nitsos
authors.forename: Yuen
authors.initials: Y
authors.lastname: Chan
authors.forename: Nadine
authors.initials: N
authors.lastname: Brew
authors.forename: Mark
authors.initials: M
authors.lastname: Teoh
authors.forename: Samuel
authors.initials: S
authors.lastname: Menahem
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schranz
authors.forename: Flora Y
authors.initials: FY
authors.lastname: Wong
mesh_terms: D000818:Animals; D063126:Balloon Valvuloplasty / Q000379:methods / Q000662:veterinary; D006328:Cardiac Catheterization / Q000379:methods / Q000662:veterinary; D013504:Cardiovascular Surgical Procedures / Q000379:methods* / Q000662:veterinary; D005240:Feasibility Studies; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods* / Q000662:veterinary; D005865:Gestational Age; D006801:Humans; D023421:Models, Animal; D011247:Pregnancy; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging / Q000601:surgery; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D012756:Sheep; D014463:Ultrasonography