Fetal aortic valvuloplasty as the first step in a complex therapeutic strategy

Abstract

AbstractBackgroundFetal aortic valvuloplasty (FAV) is proposed to prevent hypoplastic left heart syndrome due to fetal critical aortic stenosis. Objective: to report our experience on FAV as the first step in a complex therapeutic strategy.MethodSeries of patients with FAV over an 18‐year period.Results27 FAVs were performed in 26 fetuses, with technical success in 82% (22/27) and periprocedural fetal demise in 22% (6/27), decreasing to 15% in the second half‐cohort. Loss to follow‐up was due to birth or postnatal therapy in other centers (5) and termination of pregnancy (1), A normal‐sized LV at birth was observed in 46% (6/13), 4 neonates underwent aortic valvuloplasty and 2 cardiac surgeries, with 5/6 achieving biventricular circulation at 28 days, and 3 transplant‐free survival at mid‐term follow‐up. The 7/13 born with a borderline LV underwent LV rehabilitation strategy, with survival at 28 days in 4/7 and at mid‐term in 3: one with biventricular circulation, one with a ventricle‐and‐a‐half repair, and one lost to follow‐up.ConclusionFAV was feasible in most cases, with no maternal complications, and biventricular circulation at 28 days in ∼40% of survivors. After FAV, a diverse range of postnatal cardiac interventions are performed, reflecting the challenging innovation in current cardiovascular therapy.