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Title: | Percutaneous Fetal Cardiac Catheterization Technique for Stenting the Foramen Ovale in a Midgestation Lamb Model. | Authors: | Schranz D.;Menahem S. ;Wong F.Y.;Edwards A.;Veldman A.;Nitsos I.;Chan Y.;Brew N.;Teoh M. | Institution: | (Edwards, Veldman, Nitsos, Brew, Menahem, Wong) Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright St, Clayton, Victoria 3168, Australia (Edwards, Teoh, Menahem) Perinatal Services, Monash Medical Centre, Melbourne, Victoria, Australia (Edwards, Teoh, Menahem) Fetal Cardiac Unit, Monash Medical Centre, Melbourne, Victoria, Australia (Chan) Department of Pathology, Monash Medical Centre, Melbourne, Victoria, Australia (Wong) Monash Newborn, Monash Medical Centre, Melbourne, Victoria, Australia (Veldman, Wong) Department of Paediatrics, Monash University, Melbourne, Victoria, Australia (Veldman, Schranz) Pediatric Heart Center, Justus-Liebig University, Giessen, Germany | Issue Date: | 25-Jul-2015 | Copyright year: | 2015 | Publisher: | Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com) | Place of publication: | United States | Publication information: | Circulation: Cardiovascular Interventions. 8 (3) (no pagination), 2015. Article Number: e001967. Date of Publication: 21 Mar 2015. | Journal: | Circulation: Cardiovascular Interventions | Abstract: | Background - Intact or highly restricted intra-atrial septum can be reliably diagnosed in the human fetus as early as 22 to 24 weeks of gestation. Fetal interventions targeting the atrial septum have used a direct approach through the atrial wall. Here, we report stenting of the foramen ovale with a large, open-cell stent via percutaneous access through the fetal hepatic vein in a sheep model. Methods and Results - In 5 fetal sheep of 109 to 111 days of gestation (term, 147 days), the fetal hepatic vein was punctured percutaneously under ultrasound guidance and a 13.3-cm 14-gauge intravenous catheter was inserted. After catheterization of the inferior vena cava, right atrium, foramen ovale, and left atrium with a guidewire and 1.8F to 2.6F tapered catheter, a self-expandable, 8x12-mm flexible open-cell stent was positioned in an unrestricted foramen ovale. Flow and fetal well-being were documented for 45 minutes after the procedure. Access to the left atrium was achieved in all 5 animals and all survived. In 4 animals, the stent was successfully positioned in the foramen ovale. One fetus was born at term and euthanized on day 3: postmortem examination confirmed the patency of the stent. The other 3 fetuses were well after being monitored by ultrasound for 45 minutes. In 1 animal, the stent dislodged immediately after release obstructing the mitral valve. This fetus developed ascites and was euthanized after 4 days. Conclusions - It is feasible to safely advance a large diameter, self-expandable, open-cell design stent into the fetal atrial septum via a percutaneous access route through the fetal hepatic vein.Copyright © 2015 American Heart Association, Inc. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1161/CIRCINTERVENTIONS.114.001967 | PubMed URL: | 25711341 [http://www.ncbi.nlm.nih.gov/pubmed/?term=25711341] | ISSN: | 1941-7640 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/40941 | Type: | Article | Subjects: | puncture *stent *heart foramen ovale animal experiment animal model article ascites autopsy euthanasia fetal well being fetus monitoring gestational age guide wire *heart catheterization heart left atrium heart right atrium hemopericardium inferior cava vein intravenous catheter liver vein mitral valve regurgitation nonhuman ovine model priority journal *heart catheterization *heart foramen ovale heart left atrium heart right atrium hemopericardium inferior cava vein intravenous catheter liver vein mitral valve regurgitation nonhuman animal model priority journal puncture *stent animal experiment ovine model Article ascites autopsy euthanasia fetal well being fetus monitoring gestational age guide wire |
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