Turk Kardiyol Dern Ars. 2013; 41(2): 161-165 | DOI: 10.5543/tkda.2013.38801

Balloon valvuloplasty for critical aortic stenosis in a fetus: a case report

Ahmet Gül¹, Arda Saygılı³, Sultan Kavuncuoğlu², Yavuz Ceylan^1
1Department of Maternal And Fetal Medicine Unit, Istanbul Bakırkoy Women And Children Hospital, Istanbul, Turkey
²Department of Neonatology Unit, Istanbul Bakirkoy Women And Children Hospital, Istanbul
³Department of Pediatric Cardiology Acıbadem Bakırköy Hospital, Bakırköy Istanbul, Turkey

The mortality and morbidity of fetal aortic stenosis (AS) depend on the degree of the hemodynamic effects of the stenosis, and left ventricular (LV) adaptation, development and function during fetal life. In the case of critical AS, the development of hydrops and death in utero are well recognized entities. A 23-week gestation fetus was diagnosed with critical severe AS, cardiomegaly, a dilated LV with very poor contractility, and mitral regurgitation. There was a reversal of flow in the aortic arch through the ductus arteriosis and a reversed a-wave in the ductus venosus on Doppler examination. The fetus had hydrops with ascites, and massive scalp, face and skin edema. Fetal amniocentesis was normal. Aortic valvuloplasty was performed under general anesthesia and echocardiographic guidance. Pericardial effusion was not observed after the procedure. However, LV function could not be ameliorated and continued to diminish. There was no cardiac activity in the fetus two hours after the intervention. Aortic valvuloplasty in utero for AS is technically feasible. Mortality is mainly associated with technical errors, LV function, and the degree of endofibroelastosis in the effected fetuses.

Keywords: Aortic valve/abnormalities, aortic valve stenosis/therapy; balloon valvuloplasty; catheterization/methods; fetus/surgery; gestational age; ultrasonography, prenatal.

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