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Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report

BACKGROUND: In patients with hypoplastic left heart syndrome (HLHS) premature closure or restriction of the interatrial communication causes severe cyanosis directly after birth with rapid deterioration in clinical state. An ex-utero intrapartum treatment (EXIT) procedure, extracorporal membrane oxy...

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Autores principales: Tulzer, Andreas, Arzt, Wolfgang, Prandstetter, Christoph, Tulzer, Gerald
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047067/
https://www.ncbi.nlm.nih.gov/pubmed/32128498
http://dx.doi.org/10.1093/ehjcr/ytaa005
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author Tulzer, Andreas
Arzt, Wolfgang
Prandstetter, Christoph
Tulzer, Gerald
author_facet Tulzer, Andreas
Arzt, Wolfgang
Prandstetter, Christoph
Tulzer, Gerald
author_sort Tulzer, Andreas
collection PubMed
description BACKGROUND: In patients with hypoplastic left heart syndrome (HLHS) premature closure or restriction of the interatrial communication causes severe cyanosis directly after birth with rapid deterioration in clinical state. An ex-utero intrapartum treatment (EXIT) procedure, extracorporal membrane oxygenation (ECMO), and emergency interventional cardiac catheterization or cardiac surgery has to be anticipated and prepared. We report the first case performing foetal atrial septum stenting in such a patient directly before birth to enable uncomplicated interatrial shunting postnatally. CASE SUMMARY: A 31-year-old pregnant woman was referred to our centre for further evaluation of the foetus due to HLHS. In the follow-up study before birth severe restriction of the foramen ovale with increased retrograde flow in the pulmonary veins [0.33 ratio antegrade/retrograde time velocity integral (TVI)] was detected. After careful consideration foetal atrial septum stenting was performed at 38 + 3 weeks of gestation. At 39 + 2 weeks of gestation the baby was born by caesarean section followed by an uncomplicated postnatal adaption. On the 7th day of life a Norwood procedure was performed and the baby was discharged on the 63rd postoperative day. DISCUSSION: Evaluation of the interatrial communication in foetuses with HLHS should be done carefully just before birth. In the case of severe restriction or closure of the foramen ovale atrial septum stenting just before birth can be considered as an alternative treatment to an EXIT procedure, ECMO, or emergency atrioseptectomy on bypass. However, a very experienced team of paediatric cardiologists and perinatologists with expertise in foetal cardiac interventions is needed to perform this technical difficult procedure.
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spelling pubmed-70470672020-03-03 Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report Tulzer, Andreas Arzt, Wolfgang Prandstetter, Christoph Tulzer, Gerald Eur Heart J Case Rep Case Reports BACKGROUND: In patients with hypoplastic left heart syndrome (HLHS) premature closure or restriction of the interatrial communication causes severe cyanosis directly after birth with rapid deterioration in clinical state. An ex-utero intrapartum treatment (EXIT) procedure, extracorporal membrane oxygenation (ECMO), and emergency interventional cardiac catheterization or cardiac surgery has to be anticipated and prepared. We report the first case performing foetal atrial septum stenting in such a patient directly before birth to enable uncomplicated interatrial shunting postnatally. CASE SUMMARY: A 31-year-old pregnant woman was referred to our centre for further evaluation of the foetus due to HLHS. In the follow-up study before birth severe restriction of the foramen ovale with increased retrograde flow in the pulmonary veins [0.33 ratio antegrade/retrograde time velocity integral (TVI)] was detected. After careful consideration foetal atrial septum stenting was performed at 38 + 3 weeks of gestation. At 39 + 2 weeks of gestation the baby was born by caesarean section followed by an uncomplicated postnatal adaption. On the 7th day of life a Norwood procedure was performed and the baby was discharged on the 63rd postoperative day. DISCUSSION: Evaluation of the interatrial communication in foetuses with HLHS should be done carefully just before birth. In the case of severe restriction or closure of the foramen ovale atrial septum stenting just before birth can be considered as an alternative treatment to an EXIT procedure, ECMO, or emergency atrioseptectomy on bypass. However, a very experienced team of paediatric cardiologists and perinatologists with expertise in foetal cardiac interventions is needed to perform this technical difficult procedure. Oxford University Press 2020-02-10 /pmc/articles/PMC7047067/ /pubmed/32128498 http://dx.doi.org/10.1093/ehjcr/ytaa005 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Tulzer, Andreas
Arzt, Wolfgang
Prandstetter, Christoph
Tulzer, Gerald
Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
title Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
title_full Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
title_fullStr Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
title_full_unstemmed Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
title_short Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
title_sort atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047067/
https://www.ncbi.nlm.nih.gov/pubmed/32128498
http://dx.doi.org/10.1093/ehjcr/ytaa005
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