Fetal Cardiac Interventions—Polish Experience from “Zero” to the Third World Largest Program

Figures

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  Figure 1. Training on the cardiac specimen in the dissection room. The catheter was introduced through the apex into the heart of the neonate with critical aortic stenosis. The guidewire with a balloon catheter was introduced through the left ventricular apex and the aortic valve.

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  Figure 2. Fetal cardiac interventional procedures performed between 2011 and 2020. fBAV: fetal balloon aortic valvuloplasty; fBAS+: stent placement in the interatrial septum; fBAS−: balloon atrioseptoplasty; fBPV: fetal balloon pulmonary valvuloplasty; PR death: procedure-related death. A total of 14 fetuses had more than one procedure (8 fetuses had the same procedure twice, 5 fetuses had two different procedures, and 1 fetus had three different procedures). † two pregnancies continue; * one pregnancy continues. Eight fetuses with critical aortic stenosis were hydropic, and six of them needed opening of the interatrial septum after fBAV.

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  Figure 3. The technique of performing all cardiac interventional procedures. Antiseptic operating field, transducer covered by antiseptic sleeve. The obstetrician holds the transducer in the right hand and the needle in the left hand.

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  Figure 4. fBAV—the coronary balloon inflated in the aortic valve. The left ventricular apex was punctured and the needle with the coronary balloon was introduced through the aortic valve.

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  Figure 5. fBPV—the guidewire was introduced through the needle and placed across the pulmonary valve.

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  Figure 6. Most common complications during fBAV. Procedures were divided into three parts, with around 30 fBAV in each. From the 32nd procedure, we started to add heparin into the flushing solution and atropine into the umbilical vein. From the 36th procedure, we started to evacuate even a small amount of pericardial effusion.