title: Fetal Aortic Valvuloplasty: Experience and Results of Two Tertiary Centers in Spain.
abstract: OBJECTIVE
  Fetal aortic valvuloplasty (FAV) may avoid progression of critical aortic stenosis (CAS) to hypoplastic left ventricle, improving the options for biventricular circulation (BVC). We describe the results of FAV in 2 referral centers in Spain.
  
  
  METHODS
  We analyzed all FAVs performed in the period 2007-2015. The selection of candidates, the technique, and postnatal management were made following an agreed protocol. A descriptive analysis of survival, type of circulation after birth, and complications was made, considering all deaths in the first 48 h after FAV as FAV-related.
  
  
  RESULTS
  FAV was performed in 28 fetuses at a median gestational age (GA) of 23 weeks (range, 20-32). FAV was technically successful in 22 (78.6%), of whom 11 were born alive and with intention to treat. Eight (72.7%) resulted in BVC and 3 (27.3%) in univentricular circulation. The rate of FAV-related deaths was 32%. These patients underwent FAV earlier than live-born fetuses (median GA at FAV 22 weeks [range, 20.0-25.0] vs. 24.5 weeks [range, 21.0-32.0], respectively, p = 0.031).
  
  
  CONCLUSIONS
  A significant proportion of fetuses with CAS who undergo technically successful FAV have BVC postnatally. However, FAV implies a high risk of fetal death, which highly depends on the GA at which this intervention is required.
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Galindo
authors.forename: Enery
authors.initials: E
authors.lastname: Gómez-Montes
authors.forename: Olga
authors.initials: O
authors.lastname: Gómez
authors.forename: Mar
authors.initials: M
authors.lastname: Bennasar
authors.forename: Fàtima
authors.initials: F
authors.lastname: Crispi
authors.forename: Ignacio
authors.initials: I
authors.lastname: Herraiz
authors.forename: Alberto
authors.initials: A
authors.lastname: Mendoza
authors.forename: David
authors.initials: D
authors.lastname: Escribano
authors.forename: Enrique
authors.initials: E
authors.lastname: García-Torres
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Carretero
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
authors.forename: Josep María
authors.initials: JM
authors.lastname: Martínez
mesh_terms: D001024:Aortic Valve Stenosis / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000706:statistics & numerical data*; D005260:Female; D046128:Fetal Therapies / Q000706:statistics & numerical data*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D013030:Spain; D062606:Tertiary Care Centers
keywords: Biventricular circulation; Congenital heart disease; Critical aortic stenosis; Fetal echocardiography; Intrauterine valvuloplasty