The Children’s Heart Center Linz is Europeans largest Center for prenatal cardiac interventions with almost 200 performed procedures. All Interventions have been performed by me in cooperation with the Institute of Prenatal Medicine of Kepler University Hospital
Here you will receive a detailed counseling:
- if it is necessary and possible to perform a fetal cardiac intervention
- how this procedure is performed
- about the organizational details: appointments, housing, financing etc.
Most frequent indications are: narrow or closed cardiac valves (aortic-, pulmonary valve) narrow or closed foramen ovale (atrial septal communication)
FAQ regarding fetal cardiac interventions (dilation or re-opening of cardiac valves)
How is such an intervention performed?
A long needle is advanced through the maternal abdomen into the amniotic cavity and further through the fetal chest into a cardiac chamber. A cardiac catheter, with a balloon at its tip, is then inserted and, guided by a floppy wire, manipulated across the stenotic (=narrowed) valve. Then this balloon is inflated several times until the valve-opening is improved. The balloon catheter and the needle are removed at the end of the procedure
How is this procedure monitored?
Monitoring is done only by transabdominal ultrasound
What kind of anesthesia is used?
We perform all procedures in general anesthesia.
Does the fetus feel pain?
Due to the general anesthesia, the fetus will receive anesthesia, too via the mother. So we make sure the fetus feels no pain and does not move.
What complications can occur?
1) Bleeding: caused by the small perforation of the myocardium, bleeding might occur in the pericardium leading to a pericardial effusion. In the case of a large effusion, drainage of this effusion with a second needle might become necessary
2) Arrhythmias: this intervention may cause a reflective bradycardia (=slow heartbeat). If this bradycardia persists for a longer time, we have to administer drugs directly to the fetal heart to increase the heart rate again.
3) Intracardiac thrombi: these thrombi, a rare complication, are harmless but they impair vision of ultrasound and may make it impossible to proceed with the procedure. Thrombi usually disappear within 1 or 2 weeks.
Is there risk of fetal death?
Yes, the risk is 5-6%
What are the risks for the mother?
There are the same risks as in any other general anesthesia or amniocentesis. Very rare can occur: premature labor, premature rupture of the membranes or infections. So far, we not seen any of these complications.
What happens after the procedure?
After the procedure we will monitor the fetal heart beats and perform non-stress tests to assess fetal well-being. Discharge usually will be after 2 nights. Further checks will be scheduled at your referring doctor and/or at our center. The optimal date and location of delivery will be discussed with you.
Is my child healthy after such an intervention?
No. Depending on the underlying diagnosis we can improve cardiac function, cardiac growth and fetal circulation, but we cannot completely heal it. After birth it may be necessary to repeat an intervention or to surgically repair or replace valves put shunts etc… but the situation at birth should be much better than without a fetal intervention. Each child, each cardiac defect is different. I will explain exactly what will be the prognosis for your child.