Abstract：
OBJECTIVE: To present the first-year experience of fetal cardiac interventions (FCIs) in a tertiary referral hospital and to evaluate the outcomes.
METHODS: This retrospective study consisted of four pregnant women who underwent fetal pulmonary or aortic balloon valvuloplasty between November 2020 and June 2021. The procedures were performed with a percutaneous cardiac puncture under the ultrasonography guidance. Gestational age at intervention, procedural success, complications, and perinatal outcomes were evaluated. Procedural complications defined as fetal bradyarrhythmia requiring treatment, pericardial effusion requiring drainage, balloon rupture, and fetal death. The procedure was considered technically successful if the valve was dilated with a balloon catheter. Ultimately successful procedure was defined as the discharge of infants alive with biventricular circulation.
RESULTS: A total of 5 FCIs attempted between 26 + 3 and 28 + 2 gestational weeks. While the procedure was technically successful in 2 cases with pulmonary stenosis, both attempts were unsuccessful in the fetus with pulmonary atresia. Although the procedure was technically successful in the patient with critical aortic stenosis, it ultimately failed. No fetal death occurred in our series and there were no procedure-related significant maternal complications. However, three interventions were complicated by fetal bradycardia and pericardial effusion necessitating treatment, and balloon rupture cropped up in one case.
CONCLUSIONS: FCIs may lead to improving the likelihood of a biventricular outcome for selected fetuses. Careful selection of patients and centralization of experience are essential for obtaining favorable outcomes. Operators should be aware of procedural complications. Improved procedural techniques with a lower complication rate will be achieved through advanced medical technology and special balloon catheters.
METHODS: This retrospective study consisted of four pregnant women who underwent fetal pulmonary or aortic balloon valvuloplasty between November 2020 and June 2021. The procedures were performed with a percutaneous cardiac puncture under the ultrasonography guidance. Gestational age at intervention, procedural success, complications, and perinatal outcomes were evaluated. Procedural complications defined as fetal bradyarrhythmia requiring treatment, pericardial effusion requiring drainage, balloon rupture, and fetal death. The procedure was considered technically successful if the valve was dilated with a balloon catheter. Ultimately successful procedure was defined as the discharge of infants alive with biventricular circulation.
RESULTS: A total of 5 FCIs attempted between 26 + 3 and 28 + 2 gestational weeks. While the procedure was technically successful in 2 cases with pulmonary stenosis, both attempts were unsuccessful in the fetus with pulmonary atresia. Although the procedure was technically successful in the patient with critical aortic stenosis, it ultimately failed. No fetal death occurred in our series and there were no procedure-related significant maternal complications. However, three interventions were complicated by fetal bradycardia and pericardial effusion necessitating treatment, and balloon rupture cropped up in one case.
CONCLUSIONS: FCIs may lead to improving the likelihood of a biventricular outcome for selected fetuses. Careful selection of patients and centralization of experience are essential for obtaining favorable outcomes. Operators should be aware of procedural complications. Improved procedural techniques with a lower complication rate will be achieved through advanced medical technology and special balloon catheters.
摘要：
目的：介绍在三级转诊医院进行胎儿心脏介入治疗（FCI）的第一年经验，并评估结局。
方法：这项回顾性研究包括四名在2020年11月至2021年6月期间接受胎儿肺动脉或主动脉瓣球囊瓣膜成形术的孕妇。该程序是在超声引导下通过经皮心脏穿刺进行的。干预时的妊娠年龄，程序上的成功,并发症,并评估围产期结局。手术并发症定义为胎儿缓慢性心律失常需要治疗，心包积液需要引流,气球破裂，和胎儿死亡。如果用球囊导管扩张瓣膜，则认为该手术在技术上是成功的。最终成功的手术定义为双室循环存活的婴儿出院。
结果：在26+3和28+2孕周之间总共尝试了5个FCI。虽然该手术在2例肺动脉狭窄患者中在技术上是成功的，在有肺动脉闭锁的胎儿中,两次尝试均未成功.尽管该手术在患有严重主动脉瓣狭窄的患者中在技术上是成功的，它最终失败了。在我们的系列中没有发生胎儿死亡，也没有与手术相关的重大母体并发症。然而,三项干预措施并发胎儿心动过缓和心包积液，需要治疗，在一个案例中出现了气球破裂。
结论：FCI可改善选定胎儿的双心室结局。仔细选择患者和集中经验对于获得良好的结果至关重要。操作人员应注意手术并发症。通过先进的医疗技术和特殊的球囊导管，可以实现并发症发生率较低的改进手术技术。
方法：这项回顾性研究包括四名在2020年11月至2021年6月期间接受胎儿肺动脉或主动脉瓣球囊瓣膜成形术的孕妇。该程序是在超声引导下通过经皮心脏穿刺进行的。干预时的妊娠年龄，程序上的成功,并发症,并评估围产期结局。手术并发症定义为胎儿缓慢性心律失常需要治疗，心包积液需要引流,气球破裂，和胎儿死亡。如果用球囊导管扩张瓣膜，则认为该手术在技术上是成功的。最终成功的手术定义为双室循环存活的婴儿出院。
结果：在26+3和28+2孕周之间总共尝试了5个FCI。虽然该手术在2例肺动脉狭窄患者中在技术上是成功的，在有肺动脉闭锁的胎儿中,两次尝试均未成功.尽管该手术在患有严重主动脉瓣狭窄的患者中在技术上是成功的，它最终失败了。在我们的系列中没有发生胎儿死亡，也没有与手术相关的重大母体并发症。然而,三项干预措施并发胎儿心动过缓和心包积液，需要治疗，在一个案例中出现了气球破裂。
结论：FCI可改善选定胎儿的双心室结局。仔细选择患者和集中经验对于获得良好的结果至关重要。操作人员应注意手术并发症。通过先进的医疗技术和特殊的球囊导管，可以实现并发症发生率较低的改进手术技术。
