(bright music)
- We perform two different types
of fetal cardiac interventions.
The first is for fetuses who
have a narrowed aortic valve
that look like they may develop
hypoplastic left heart syndrome,
which is a heart problem
where the left-side of the
heart is underdeveloped
and the right-side of the
heart has to do the work
of two ventricles.
That procedure, we open the
aortic valve in the fetus
to try to keep the left-side
of the heart pumping for the body
and the left-side of the
heart growing normally.
The second fetal cardiac
intervention is performed
when a fetus has hypoplastic
left heart syndrome
but does not have a hole
between the top two chambers of the heart.
When that is the case
the blood cannot get out
of the left-side of the heart
and backs up into the lungs
and causes lung damage in the fetus.
In this type of fetal intervention,
we are creating a hole
between the top two chambers
of the heart with a balloon.
In both types of fetal
cardiac intervention,
the procedures are performed
in an operating room
and the first step of the
procedure is to make sure
that the fetus is in a good
position for the procedure.
The obstetrician can manipulate the fetus
through the mother's
abdomen to get the fetus
into a perfect position for the procedure.
After that's done,
general anesthesia is
induced for the mother
and the procedures are all
done under ultrasound guidance.
Next in the procedure,
the fetus is given a medicine for pain
and a medicine to relax the fetus,
and also to make the
fetus not be able to move
for a brief period of
time during the procedure.
And that is done through a needle
through the mother's abdominal wall,
through the uterus, and into
the thigh muscle of the fetus.
Next, the fetal intervention is started
and we take a small
needle that is advanced
through the mother's abdomen,
all under ultrasound guidance,
through the uterine wall, through
the chest wall of the baby
between the ribs and into the heart.
Now, if we are performing a
ballooning of the aortic valve,
that needle is advanced
into the left ventricle
and a wire is then manipulated
across that aortic valve.
And over the wire, we
pass a small catheter
that has a balloon on the tip of it.
We put the balloon across the aortic valve
and inflate the balloon thereby
enlarging the aortic valve.
And then the balloon and wire
and needle are all removed from the heart.
In the fetal intervention
where we create a hole
between the top chambers of the heart,
the needle is advanced through
the mother's abdominal wall,
through the uterus,
into the right atrium of
the heart of the baby,
and through that wall between
the top chambers of the heart
into the left-side of the heart.
We pass a wire out into the
vein coming from the lung,
and then we place a catheter
that has a balloon on the tip of it,
over that wire, placing
the balloon across the wall
between the top chambers of the heart.
We inflate the balloon several times,
and that creates a hole
between the top two chambers of the heart.
The wire, catheter, and
needle are then removed
from the heart and the
procedure is complete.
In some of the procedures,
blood can collect
around the heart of the fetus
that needs to be drained.
We can drain that with a separate needle
under ultrasound guidance, and
then that needle is removed.
And then we do watch the
heart with ultrasound
for 20 to 30 minutes in the operating room
to make sure that blood doesn't
recollect around the heart.
