Transesophageal echocardiography in fetal sheep. A monitoring tool for open and fetoscopic cardiac procedures.
Transesophageal echocardiography in fetal sheep. A monitoring tool for open and fetoscopic cardiac procedures.
复制标题
胎羊经食管超声心动图检查。
DOI：
10.1007/s004649900169
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Chou,TM
中科院分区：
文献类型：
--
作者：
Kohl,T;Stelnicki,EJ;VanderWall,KJ;Szabo,Z;Ko,E;Bruch,SW;Harrison,MR;Silverman,NH;Hanley,FL;Chou,TM
背景：体外胎儿或胎儿内窥镜辅助的心脏手术需要常规母体经腹超声心动图所不具备的监测能力。方法：因此，我们评估了利用血管内超声导管(IVUC)进行胎儿经食道超声心动图(TEE)监测胎儿心脏的潜力。我们将10-F-10-MHzIVUC置入体外培养的12只胎羊的食道内，并对4只胎羊进行了胎盘镜检查。观察心脏事件发生情况。所有胎儿均可测量心率、心率、卵圆孔和动脉导管的通畅度以及肺动脉分支的宽度。只有体重小于2.5公斤的胎儿才能评估心脏的收缩能力。由于IVUC的组织穿透性有限，较大的胎儿不能充分成像脑室的顶端部分。胎儿TEE允许在心脏心房和左心室放置细小的导丝。在所有病例中，胎儿TEE均可观察到心内操作这些钢丝后出现短暂的早搏。结果：在尸检中，未发现体外置入IVUC的胎儿出现并发症。结论：胎儿TEE可在胎儿损伤较小的情况下完成，可为心内直视手术提供有价值的信息。IVUC设计的进一步改进将允许将这项技术应用于监测人类胎儿心脏手术。
Background:Cardiac procedures in exteriorized fetuses or assisted by fetoscopy require monitoring capabilities not attended by conventional maternal transabdominal echocardiography.Methods:We, therefore, assessed the potential of fetal transesophageal echocardiography (TEE) utilizing an intravascular ultrasound catheter (IVUC) for fetal cardiac monitoring. We inserted a 10-F-10-MHz IVUC into the esophagus in 12 exteriorized fetal sheep and by a fetoscopic approach in 4 fetal sheep. Cardiac events were observed. Heart rate, cardiac rhythm, patency of the foramen ovale and ductus arteriosus, and the width of the branch pulmonary arteries could be assessed in all fetuses. Ventricular contractility could be assessed only in fetuses weighing less than 2.5 kg. Larger fetuses did not allow adequate imaging of the apical portion of the ventricles because of limited tissue penetration of the IVUC. Fetal TEE permitted placing small guide wires in the cardiac atria and left ventricle. Short-lived premature beats following intracardiac manipulations of these wires could be observed by fetal TEE in all cases.Results:At autopsy, no complications from IVUC insertion were observed in the exteriorized fetuses. Fetoscopic placement of the IVUC resulted in minor perioral skin erosion in two nonexteriorized fetuses.Conclusions:In conclusion, fetal TEE can be achieved with minor fetal injury and may provide useful information during open and fetoscopic cardiac procedures. Further improvements in IVUC design will permit the application of this technique to monitor human fetal cardiac procedures.