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Weber, B; Emmert, M Y; Behr, L; Brokopp, C E; Frauenfelder, T; Kretschmar, O; Falk, V; Hoerstrup, S P (2011). Fetal trans-apical stent delivery into the pulmonary artery: prospects for prenatal heart-valve implantation. European Journal of Cardio-Thoracic Surgery, 41(2):398-403.

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Objective: The purpose of this study was to assess the technical feasibility of a fetal trans-apical stent delivery into the pulmonary artery using a novel hybrid-intervention technique as a possible route for prenatal minimally invasive heart-valve-implantation approaches. Methods: Pregnant Pre-Alp sheep between 122 and 128 days' gestation (n=3) underwent a midline laparotomy. The fetus was left in utero or partially externalized and its chest was opened via a left-sided minithoracotomy. The fetal heart was cannulated and a guide wire was introduced through the ductus arteriosus into the aorta. A 14-French delivery system was then mounted onto the guide wire and advanced to the landing zone in the pulmonary artery, where the stent was deployed. The position of the stent was confirmed using echocardiography, angiography as well as computed tomography. Results: The trans-apical implantation was successful in all animals. However, at necropsy in one animal, the stent was found to partly occlude one of the pulmonary valvular leaflets. Bleeding at the antero-apical incision occurred in all animals but could be managed without fetal demise. No fetal cardiopulmonary bypass was performed. In all animals, contrast angiography displayed normal perfusion of the pulmonary vasculature as well as the ductus arteriosus. Conclusions: Our study demonstrates the principal technical feasibility of a prenatal stent delivery into the pulmonary artery using a novel trans-apical hybrid-intervention technique. This approach demonstrates the first step towards possible future minimally invasive prenatal heart-valve-implantation procedures.


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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Center for Medical Research
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Deposited On:11 Nov 2011 11:45
Last Modified:05 Apr 2016 15:05
Publisher DOI:10.1016/j.ejcts.2011.04.041
PubMed ID:21741853

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