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Acute cardiovascular effects of fetal surgery in the human.
- Source :
-
Circulation [Circulation] 2004 Sep 21; Vol. 110 (12), pp. 1549-56. Date of Electronic Publication: 2004 Sep 07. - Publication Year :
- 2004
-
Abstract
- Background: Prenatal surgery for congenital anomalies can prevent fetal demise or alter the course of organ development, resulting in a more favorable condition at birth. The indications for fetal surgery continue to expand, yet little is known about the acute sequelae of fetal surgery on the human cardiovascular system.<br />Methods and Results: Echocardiography was used to evaluate the heart before, during, and early after fetal surgery for congenital anomalies, including repair of myelomeningocele (MMC, n=51), resection of intrathoracic masses (ITM, n=15), tracheal occlusion for congenital diaphragmatic hernia (CDH, n=13), and resection of sacrococcygeal teratoma (SCT, n=4). Fetuses with MMC all had normal cardiovascular systems entering into fetal surgery, whereas those with ITM, CDH, and SCT all exhibited secondary cardiovascular sequelae of the anomaly present. At fetal surgery, heart rate increased acutely, and combined cardiac output diminished at the time of fetal incision for all groups including those with MMC, which suggests diminished stroke volume. Ventricular dysfunction and valvular dysfunction were identified in all groups, as was acute constriction of the ductus arteriosus. Fetuses with ITM and SCT had the most significant changes at surgery.<br />Conclusions: Acute cardiovascular changes take place during fetal surgery that are likely a consequence of the physiology of the anomaly and the general effects of surgical stress, tocolytic agents, and anesthesia. Echocardiographic monitoring during fetal surgery is an important adjunct in the management of these patients.
- Subjects :
- Adult
Bradycardia embryology
Bradycardia etiology
Cardiac Output
Congenital Abnormalities diagnostic imaging
Ductus Arteriosus physiopathology
Electrocardiography
Female
Fetal Death epidemiology
Fetal Death etiology
Fetal Heart diagnostic imaging
Fetal Monitoring
Gestational Age
Heart Rate, Fetal
Heart Valve Diseases embryology
Heart Valve Diseases etiology
Hernia, Diaphragmatic embryology
Hernia, Diaphragmatic surgery
Humans
Hydrops Fetalis complications
Hydrops Fetalis physiopathology
Infant, Newborn
Intraoperative Complications etiology
Male
Meningomyelocele embryology
Meningomyelocele surgery
Pregnancy
Retrospective Studies
Sacrum
Spinal Neoplasms embryology
Spinal Neoplasms surgery
Teratoma embryology
Teratoma surgery
Thoracic Neoplasms embryology
Thoracic Neoplasms surgery
Ultrasonography, Prenatal
Ventricular Dysfunction embryology
Ventricular Dysfunction etiology
Congenital Abnormalities embryology
Congenital Abnormalities surgery
Fetal Heart physiopathology
Fetal Therapies adverse effects
Fetal Therapies mortality
Fetal Therapies statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 110
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 15353490
- Full Text :
- https://doi.org/10.1161/01.CIR.0000142294.95388.C4