Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model

Andrew Edwards, Samuel Menahem, Alex Veldman, Dietmar Schranz, Yuen Chan, Ilias Nitsos, Flora Yuen-Wait Wong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: Human fetal cardiac intervention has typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy. Methods: In 10 fetal lambs (90-97 days gestation), access to the fetal venous system was by percutaneous puncture with a 5Fr sheath (n = 1) into the umbilical vein or 16G IV-catheter (n = 9) into the hepatic vein. This was followed by cardiac catheterization using a 1.8-2.6Fr tapered coronary catheter. Euthanasia and postmortem examination were planned immediately post-procedure (n = 2), or after normal term-delivery (remaining cases). Results: In 1 case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5Fr sheath, died from umbilical haemorrhage. In 8 cases, access to the fetal hepatic vein was achieved. In 7 of these cases the access catheter was advanced into the IVC, followed by catheterization of the RA (all cases) and 4 cardiac chambers (3 cases). One fetus died during cardiac catheterization (RV perforation) and the other 7 fetuses were alive at the end of the procedure (88 survival). Immediate postmortem (n = 2) detected intraperitoneal bleeding (4 and 20ml respectively), while the postnatal postmortem (n = 5) after uneventful pregnancy revealed no vascular or cardiac trauma. Conclusions: Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions.
Original languageEnglish
Pages (from-to)58 - 63
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume42
Issue number1
DOIs
Publication statusPublished - 2013

Cite this

@article{41f09324e3714416b688e4b713eadff0,
title = "Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model",
abstract = "Objectives: Human fetal cardiac intervention has typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy. Methods: In 10 fetal lambs (90-97 days gestation), access to the fetal venous system was by percutaneous puncture with a 5Fr sheath (n = 1) into the umbilical vein or 16G IV-catheter (n = 9) into the hepatic vein. This was followed by cardiac catheterization using a 1.8-2.6Fr tapered coronary catheter. Euthanasia and postmortem examination were planned immediately post-procedure (n = 2), or after normal term-delivery (remaining cases). Results: In 1 case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5Fr sheath, died from umbilical haemorrhage. In 8 cases, access to the fetal hepatic vein was achieved. In 7 of these cases the access catheter was advanced into the IVC, followed by catheterization of the RA (all cases) and 4 cardiac chambers (3 cases). One fetus died during cardiac catheterization (RV perforation) and the other 7 fetuses were alive at the end of the procedure (88 survival). Immediate postmortem (n = 2) detected intraperitoneal bleeding (4 and 20ml respectively), while the postnatal postmortem (n = 5) after uneventful pregnancy revealed no vascular or cardiac trauma. Conclusions: Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions.",
author = "Andrew Edwards and Samuel Menahem and Alex Veldman and Dietmar Schranz and Yuen Chan and Ilias Nitsos and Wong, {Flora Yuen-Wait}",
year = "2013",
doi = "10.1002/uog.12352",
language = "English",
volume = "42",
pages = "58 -- 63",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley & Sons",
number = "1",

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Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model. / Edwards, Andrew; Menahem, Samuel; Veldman, Alex; Schranz, Dietmar; Chan, Yuen; Nitsos, Ilias; Wong, Flora Yuen-Wait.

In: Ultrasound in Obstetrics and Gynecology, Vol. 42, No. 1, 2013, p. 58 - 63.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model

AU - Edwards, Andrew

AU - Menahem, Samuel

AU - Veldman, Alex

AU - Schranz, Dietmar

AU - Chan, Yuen

AU - Nitsos, Ilias

AU - Wong, Flora Yuen-Wait

PY - 2013

Y1 - 2013

N2 - Objectives: Human fetal cardiac intervention has typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy. Methods: In 10 fetal lambs (90-97 days gestation), access to the fetal venous system was by percutaneous puncture with a 5Fr sheath (n = 1) into the umbilical vein or 16G IV-catheter (n = 9) into the hepatic vein. This was followed by cardiac catheterization using a 1.8-2.6Fr tapered coronary catheter. Euthanasia and postmortem examination were planned immediately post-procedure (n = 2), or after normal term-delivery (remaining cases). Results: In 1 case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5Fr sheath, died from umbilical haemorrhage. In 8 cases, access to the fetal hepatic vein was achieved. In 7 of these cases the access catheter was advanced into the IVC, followed by catheterization of the RA (all cases) and 4 cardiac chambers (3 cases). One fetus died during cardiac catheterization (RV perforation) and the other 7 fetuses were alive at the end of the procedure (88 survival). Immediate postmortem (n = 2) detected intraperitoneal bleeding (4 and 20ml respectively), while the postnatal postmortem (n = 5) after uneventful pregnancy revealed no vascular or cardiac trauma. Conclusions: Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions.

AB - Objectives: Human fetal cardiac intervention has typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy. Methods: In 10 fetal lambs (90-97 days gestation), access to the fetal venous system was by percutaneous puncture with a 5Fr sheath (n = 1) into the umbilical vein or 16G IV-catheter (n = 9) into the hepatic vein. This was followed by cardiac catheterization using a 1.8-2.6Fr tapered coronary catheter. Euthanasia and postmortem examination were planned immediately post-procedure (n = 2), or after normal term-delivery (remaining cases). Results: In 1 case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5Fr sheath, died from umbilical haemorrhage. In 8 cases, access to the fetal hepatic vein was achieved. In 7 of these cases the access catheter was advanced into the IVC, followed by catheterization of the RA (all cases) and 4 cardiac chambers (3 cases). One fetus died during cardiac catheterization (RV perforation) and the other 7 fetuses were alive at the end of the procedure (88 survival). Immediate postmortem (n = 2) detected intraperitoneal bleeding (4 and 20ml respectively), while the postnatal postmortem (n = 5) after uneventful pregnancy revealed no vascular or cardiac trauma. Conclusions: Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions.

UR - http://www.ncbi.nlm.nih.gov/pubmed/23180625

U2 - 10.1002/uog.12352

DO - 10.1002/uog.12352

M3 - Article

VL - 42

SP - 58

EP - 63

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 1

ER -