Author + information
- Brian Thomas Kalish,
- Wayne Tworetzky,
- Carol B. Benson,
- Louise Wilkins-Haug,
- Arielle Mizrahi-Arnaud,
- Doff B. McElhinney,
- James E. Lock and
- Audrey C. Marshall
Infants born with hypoplastic left heart syndrome and an intact atrial septum (HLHS/IAS) are at high risk for neonatal death, despite maximal postnatal therapy. Prenatal atrial septoplasty by static balloon dilation has been effective in decompressing the left atrium in utero, but several factors have limited the size of septal defects. We attempted to overcome the limitations of balloon septoplasty using transcatheter atrial septal stents.
The records of the Boston Children's Hospital/Brigham and Women's Hospital Fetal Intervention Program were reviewed to identify all fetuses that presented with a diagnosis of HLHS/IAS or severe mitral regurgitation and underwent attempted atrial stent placement.
Nine fetuses between 24 and 31 weeks gestation with HLHS/IAS underwent attempted fetal atrial septal stent placement. A stent was deployed across the atrial septum in five fetuses, with four fetuses demonstrating flow across the stent at the time of intervention. In four cases, stent placement failed due to malposition or embolization, but in three of the four cases, atrial balloon septoplasty at the same in-utero procedure successfully and acutely decompressed the left atrium. There were no maternal complications. There was one fetal demise. The remaining 8 fetuses survived to delivery, but four died in the neonatal period (2 of which had been stented).
Ultrasound-guided atrial septal stent placement is feasible in some fetuses with HLHS/IAS. Visualization of the septum and catheter tip are critical to technical success. Additional experience is necessary to determine the clinical impact of this intervention.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Percutaneous Therapies
Abstract Category: 14. Congenital Cardiology Solutions: Therapy
Presentation Number: 1204-133
- 2013 American College of Cardiology Foundation