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Valve Interventions in Utero: Understanding the Timing, Indications, and Approaches.

Abstract Efficient use of fetal echocardiography has enabled early detection of congenital heart disease and of its often irreversible complications, such as ventricular hypoplasia in case of severe stenosis of the semilunar valves. Experience of the past 25 years has proved that balloon dilatation of the severely stenotic or atretic valve in fetuses as early as the 23rd week of gestation is technically feasible with a learning curve. Reported results regarding the ultimate biventricular circulation outcome after fetal valve intervention are at best controversial, with the desired improvements in the quality of life and cost-benefits of the postnatal treatment being as yet unconfirmed. Despite acute hemodynamic success with a relatively low rate of fetal complications, the number of suitable candidates for the fetal valve intervention remains low. High valvular tissue plasticity in the fetus and difficulties of assessing the point of no return of the myocardial damage often makes the success of fetal valve intervention short-lived and unpredictable. Hopefully, future refinements of the equipment, imaging, and biodegradable tissue regeneration materials will lead to better results of the fetal valve interventions beyond their technical success.
PMID
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Authors

Mayor MeshTerms

Aortic Valve Stenosis

Keywords
Journal Title the canadian journal of cardiology
Publication Year Start




PMID- 28843326
OWN - NLM
STAT- MEDLINE
DA  - 20170827
DCOM- 20170901
LR  - 20170901
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 33
IP  - 9
DP  - 2017 Sep
TI  - Valve Interventions in Utero: Understanding the Timing, Indications, and
      Approaches.
PG  - 1150-1158
LID - S0828-282X(17)30315-X [pii]
LID - 10.1016/j.cjca.2017.06.009 [doi]
AB  - Efficient use of fetal echocardiography has enabled early detection of congenital
      heart disease and of its often irreversible complications, such as ventricular
      hypoplasia in case of severe stenosis of the semilunar valves. Experience of the 
      past 25 years has proved that balloon dilatation of the severely stenotic or
      atretic valve in fetuses as early as the 23rd week of gestation is technically
      feasible with a learning curve. Reported results regarding the ultimate
      biventricular circulation outcome after fetal valve intervention are at best
      controversial, with the desired improvements in the quality of life and
      cost-benefits of the postnatal treatment being as yet unconfirmed. Despite acute 
      hemodynamic success with a relatively low rate of fetal complications, the number
      of suitable candidates for the fetal valve intervention remains low. High
      valvular tissue plasticity in the fetus and difficulties of assessing the point
      of no return of the myocardial damage often makes the success of fetal valve
      intervention short-lived and unpredictable. Hopefully, future refinements of the 
      equipment, imaging, and biodegradable tissue regeneration materials will lead to 
      better results of the fetal valve interventions beyond their technical success.
CI  - Copyright (c) 2017 Canadian Cardiovascular Society. Published by Elsevier Inc.
      All rights reserved.
FAU - Sizarov, Aleksander
AU  - Sizarov A
AD  - Cardiologie pediatrique, Centre de Reference Malformations Cardiaques
      Congenitales Complexes, Hopital Universitaire Necker Enfants Malades, Assistance 
      Publique des Hopitaux de Paris, Paris, France.
FAU - Boudjemline, Younes
AU  - Boudjemline Y
AD  - Cardiologie pediatrique, Centre de Reference Malformations Cardiaques
      Congenitales Complexes, Hopital Universitaire Necker Enfants Malades, Assistance 
      Publique des Hopitaux de Paris, Paris, France; Universite Paris V Descartes,
      Paris, France. Electronic address: [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170623
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
MH  - Aortic Valve/diagnostic imaging/*surgery
MH  - *Aortic Valve Stenosis/congenital/diagnosis/surgery
MH  - Echocardiography
MH  - Female
MH  - Fetal Heart/diagnostic imaging/*surgery
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Pregnancy
MH  - Ultrasonography, Prenatal
EDAT- 2017/08/28 06:00
MHDA- 2017/09/02 06:00
CRDT- 2017/08/28 06:00
PHST- 2016/12/23 [received]
PHST- 2017/06/16 [revised]
PHST- 2017/06/16 [accepted]
AID - S0828-282X(17)30315-X [pii]
AID - 10.1016/j.cjca.2017.06.009 [doi]
PST - ppublish
SO  - Can J Cardiol. 2017 Sep;33(9):1150-1158. doi: 10.1016/j.cjca.2017.06.009. Epub
      2017 Jun 23.