Fetal transesophageal echocardiography:: clinical introduction as a monitoring tool during cardiac intervention in a human fetus
Fetal transesophageal echocardiography:: clinical introduction as a monitoring tool during cardiac intervention in a human fetus
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DOI：
10.1002/uog.2625
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发表时间：
2005-12-01
影响因子：
7.1
通讯作者：
Gembruch, U
中科院分区：
文献类型：
--
作者：
Kohl, T;Müller, A;Gembruch, U
由于经腹胎儿超声心动图（TAE）对主动脉闭锁、房间隔闭锁和进行性心力衰竭的胎儿的成像不足，我们评估了在妊娠24 + 6周的胎儿心脏干预期间，经腹胎儿超声心动图（TEE）作为监测工具的可行性。经皮胎儿镜食道内部署超声导管，没有导致任何母体或胎儿并发症。与传统的母体TAE相比，胎儿TEE可以更清晰地定义胎儿心脏解剖和心内装置操作。尽管使用了各种各样的装置，但房间隔内没有足够大的开口。虽然胎儿对手术的耐受性非常好，并且在手术结束时可以记录到令人满意的胎胎盘流动，但在干预后3天，胎儿死于进行性心力衰竭。胎镜TEE在人类胎儿中是可行的，与传统的母体TAE相比，可以更清晰地定义胎儿心脏解剖和心内操作。根据对房间隔多处医源性穿孔的自发愈合的观察，需要专门的器械来提高房间隔成形术的技术成功率，从而提高这些高危患者的生存几率。版权所有(c) 2005 ISUOG。约翰·威利父子有限公司出版。
Because of insufficient imaging by maternal transabdominal fetal ecbocardiograpby (TAE) in a human fetus with aortic atresia, imperforate atrial septum and progressive cardiac failure, we assessed the feasibility of fetal transesopbageal ecbocardiograpby (TEE) as a monitoring tool during fetal cardiac intervention at 24 + 6 weeks of gestation. Percutaneous fetoscopic intraesophageal deployment of the ultrasound catheter was achieved and did not result in any maternal or fetal complications. Fetal TEE permitted substantially clearer definition of fetal cardiac anatomy and intracardiac device manipulations than conventional maternal TAE. Despite the employment of various devices, no sufficiently large opening could be achieved within the atrial septum. Although the fetus tolerated the procedure remarkably well and satisfactory fetoplacental flow could be documented at the end of the procedure, the fetus died from progressive cardiac failure 3 days after the intervention. Fetoscopic TEE is feasible in the human fetus and permits substantially clearer definition of fetal cardiac anatomy and intracardiac manipulations than conventional maternal TAE. Based on the observation of spontaneous closure of multiple iatrogenic perforations of the atrial septum, specialized devices are required in order to improve the technical success rate of septoplasty methods and hence the survival odds of these high-risk patients. Copyright (c) 2005 ISUOG. Published by John Wiley & Sons, Ltd.