Author + information
- Received November 6, 2018
- Revision received November 21, 2018
- Accepted November 27, 2018
- Published online February 4, 2019.
- Wendy Whiteside, MDa,∗ (, )
- Sarah K. Gelehrter, MDa,
- Carlen G. Fifer, MDa,
- Albert P. Rocchini, MDa,
- Cosmas Van de Ven, MDb,
- Marjorie C. Treadwell, MDb,
- Karena Wu, MDa and
- Jeffrey D. Zampi, MDa
- aDepartment of Pediatrics, Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan
- bDepartment of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Von Voightlander Women’s Hospital, University of Michigan, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Wendy Whiteside, Michigan Medicine Congenital Heart Center, C.S. Mott Children’s Hospital, 1540 East Hospital Drive, Ann Arbor, Michigan 48109-4204.
Hypoplastic left heart syndrome with intact atrial septum is a highly lethal congenital heart defect (1) due to deleterious effect of left atrial (LA) hypertension on lung development. Fetal intervention with LA decompression and atrial septal stent placement can improve neonatal stability and may improve survival (2). Traditionally, fetal LA hypertension severity is assessed using Doppler flow patterns on fetal echocardiography. Using an intraprocedural pressure guidewire provides direct measurement of LA pressures, improving interpretation of noninvasive measures.
A woman at 30 weeks’ gestation carrying a fetus with hypoplastic left heart syndrome with intact atrial septum was referred for fetal atrial septal stent. Fetal echo showed severe LA hypertension with marked flow reversal in dilated pulmonary veins (Figure 1).
The technical aspects of the procedure are previously described (3,4). Once percutaneous access was obtained into the fetal LA, an 0.014-inch PrimeWire Prestige guidewire (Volcano Corporation, San Diego, California) was advanced into the LA. Initial LA pressure was 25 mm Hg (Figure 1). Over this wire, a coronary stent was deployed across the septum. LA pressure decreased immediately to 9 mm Hg, with echocardiography findings of nonrestrictive stent flow and normalization of pulmonary venous Doppler pattern (Figure 1). Favorable Doppler pattern was maintained throughout gestation. Upon term delivery, the baby was stable with saturations in the 70s with a well-positioned stent and underwent planned nonemergent hybrid stage I palliation.
Intracardiac pressure measurements during fetal atrial septal stent placement correlate well with noninvasive measures, providing meaningful information to assess the effectiveness of intervention and may be useful in postnatal prognostication.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 6, 2018.
- Revision received November 21, 2018.
- Accepted November 27, 2018.
- 2019 American College of Cardiology Foundation
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