Fetal Cardiac Interventions-Polish Experience from "Zero" to the Third World Largest Program

Marzena Debska; Adam Kolesnik; Beata Rebizant; Agnieszka Sekowska; Agnieszka Grzyb; Katarzyna Chaberek; Jacek Witwicki; Romuald Debski; Joanna Dangel

doi:10.3390/jcm9092888

Fetal Cardiac Interventions-Polish Experience from "Zero" to the Third World Largest Program

J Clin Med. 2020 Sep 7;9(9):2888. doi: 10.3390/jcm9092888.

Authors

Marzena Debska^{1

2}, Adam Kolesnik^{3

4

5}, Beata Rebizant¹, Agnieszka Sekowska^{1

6}, Agnieszka Grzyb^{3

7}, Katarzyna Chaberek¹, Jacek Witwicki⁸, Romuald Debski¹, Joanna Dangel³

Affiliations

¹ 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland.
² Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
³ Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland.
⁴ Cardiovascular Interventions Laboratory, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
⁵ Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-004 Warsaw, Poland.
⁶ Pain Clinic, Department of Anesthesiology and Intensive Care, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
⁷ Department of Cardiology, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
⁸ Department of Neonatology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland.

Abstract

This article presents the technical aspects of the Polish fetal cardiac interventions (FCI) program, including preparation of the team and modifications in the technique of the procedure that aim to increase its safety for the mother and the fetus. Over 9 years, 128 FCI in 113 fetuses have been performed: 94 balloon aortic valvuloplasties (fBAV), 14 balloon atrioseptoplasties (fBAS) with stent (BAS+), 5 balloon atrioseptoplasties without stent placement (BAS-), and 15 fetal pulmonary valvuloplasties (fBPS). The technical success rate ranged from 80% (BAS-) to 89% (fBAV), while the procedure-related death rate (defined as death within 72 hours following the procedure) ranged from 7% (fBAV and fBPV) to 20% (BAS). There were 98 live births after all FCI (3 pregnancies continue). Median gestational age at delivery was 39 weeks in our center and 38 weeks in other centers.

Keywords: critical aortic stenosis; fetal cardiac interventions; fetal echocardiography; fetal valvuloplasty; hypoplastic left heart syndrome; pulmonary atresia and intact ventricular septum; technical aspects.