The first experience with intrauterine balloon vulvoplasty in aortic stenosis

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Abstract

Background: Outflow tract obstruction of the left ventricle (LV) is one of the causes of a disorder of its growth and development of hypoplastic left heart syndrome (HLHS). This pathological condition fails to support systemic blood flow and requires postnatal correction, by creating univentricular blood circulation, a palliative operation with a poor vital prognosis for the newborn. Intrauterine balloon vulvoplasty is a method of treatment that contributes to the improvement of LV growth, which in turn increases the likelihood of maintaining biventricular circulation after birth.

Case report: The paper describes the authors’ first experience with a cardiac intrauterine intervention in a fetus with critical aortic valve stenosis. It briefly outlines the medical history of a female patient, the time course of changes in ultrasound data, the compliance of ECHO-CG readings to the criteria of the International Fetal Cardiac Intervention Registry, describes the technique of balloon vulvoplasty and presents the early hemodynamic results after intrauterine correction.

Conclusion: The early hemodynamic changes after intrauterine intervention in the fetus with critical aortic valve stenosis confirmed the efficiency of balloon vulvoplasty in this pathology. A further follow-up of neonatal hemodynamic parameters after intrauterine cardiac defect correction is required to assess the long-term results of intrauterine correction.

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About the authors

Mark A. Kurtser

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Lapino Clinical Hospital, “Mother and Child” Group of Companies; MD GROUP Clinical Hospital, “Mother and Child” Group of Companies

Author for correspondence.
Email: malmberg.olga@gmail.com

Academician of the Russian Academy of Sciences, Head of the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia; CEO and Member of the Board of Directors, Mother and Child Group of Companies

Russian Federation, Moscow; Moscow Region; Moscow

Olga L. Malmberg

Lapino Clinical Hospital, “Mother and Child” Group of Companies; MD GROUP Clinical Hospital, “Mother and Child” Group of Companies; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia

Email: malmberg.olga@gmail.com

PhD, Chief Specialist in Ultrasound Diagnostics, Mother and Child Group of Companies; Associate Professor of the Department of Ultrasound Diagnostics, Russian Medical Academy Continuing Professional Education, Ministry of Health of Russia

Russian Federation, Moscow Region; Moscow; Moscow

Ashot M. Grigoryan

Lapino Clinical Hospital, “Mother and Child” Group of Companies

Email: malmberg.olga@gmail.com
ORCID iD: 0000-0001-9226-0130

PhD, Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment

Russian Federation, Moscow Region

Olga A. Samsonova

MD GROUP Clinical Hospital, “Mother and Child” Group of Companies; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia

Email: Usfox79@gmail.com

PhD, ultrasound diagnostics doctor, MD GROUP Clinical Hospital of the Mother and Child Group of Companies; Assistant at the Department of Ultrasound Diagnostics, Pirogov Russian National Research Medical University, Ministry of Health of Russia

Russian Federation, Moscow; Moscow

Boris T. Mkrtychyan

MD GROUP Clinical Hospital, “Mother and Child” Group of Companies

Email: malmberg.olga@gmail.com

PhD, Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment

Russian Federation, Moscow

Maria B. Shamanova

MD GROUP Clinical Hospital, “Mother and Child” Group of Companies

Email: m.shamanova@mcclinics.ru

Deputy Chief Physician, Head of the Miscarriage Department

Russian Federation, Moscow

Tatiana O. Normantovich

MD GROUP Clinical Hospital, “Mother and Child” Group of Companies

Email: t.normantovich@mcclinics.ru

Chief Physician

Russian Federation, Moscow

Anna V. Mamaeva

MD GROUP Clinical Hospital, “Mother and Child” Group of Companies

Email: Doc.mamaeva@yahoo.com

Head of the Department of the Prenatal Diagnosis

Russian Federation, Moscow

Oleg A. Latyshkevich

Center for Family Planning and Reproduction, Moscow City Healthcare Department

Email: malmberg.olga@gmail.com

PhD, Chief Physician

Russian Federation, Moscow

Ekaterina A. Gaponenko

MD GROUP Clinical Hospital, “Mother and Child” Group of Companies; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia

Email: malmberg.olga@gmail.com

ultrasound diagnostics doctor, MD GROUP Clinical Hospital of the Mother and Child Group of Companies; Assistant at the Department of Ultrasound Diagnostics, Pirogov Russian National Research Medical University, Ministry of Health of Russia

Russian Federation, Moscow; Moscow

Ekaterina V. Sysolyatina

Lapino Clinical Hospital, “Mother and Child” Group of Companies

Email: malmberg.olga@gmail.com

PhD, obstetrician-gynecologist

Russian Federation, Moscow Region

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Formation of access to the aortic valve

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3. Fig. 2. Ultrasound of the fetus. Coronary balloon in the projection of the aortic valve

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4. Fig. 3. Ultrasound of the fetus. Ultrasound findings after aortic valve valvuloplasty and removal of the balloon and needle show increased effective aortic valve orifice and absence of fluid in the pericardial cavity

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