The role of echocardiography in the intraoperative management of the fetus undergoing myelomeningocele repair.

Abstract:

INTRODUCTION:Fetal surgery for myelomeningocele (MMC) results in better outcomes compared to postnatal treatment. However, risks are present. We describe our experience with intraoperative fetal echocardiography during repair of MMC and report on the management of serious cardiovascular events. MATERIAL AND METHODS:The subjects included fetuses with intent to repair MMC from January 2011 to February 2014. The protocol involved continuous echocardiography in a looping, sequential manner of systolic function, heart rate and tricuspid and mitral valve regurgitation. RESULTS:A total of 101 cases intended fetal MMC repair; 100 completed surgery. Intraoperative ventricular dysfunction was present in 60% (20 mild, 25 moderate, 15 severe). Heart rate <100 bpm was noted in 11 cases. Tricuspid valve regurgitation was present in 35% (26 mild, 7 moderate, 2 severe); mitral valve regurgitation was present in 19% (15 mild, 4 moderate). Serious cardiovascular events were experienced in 7 cases, which affected the conduct of surgery and/or outcome. In 4 of these, medications were given via the umbilical vein and external cardiac compressions were performed. Fetal echocardiography was used to gauge the efficacy of compressions and to guide resuscitation. DISCUSSION:Cardiovascular compromise is common during fetal surgery for MMC. Intraoperative fetal echocardiography is recommended as a growing number of centers contemplate offering this form of novel, but potentially risky, therapy.

journal_name

Fetal Diagn Ther

authors

Rychik J,Cohen D,Tran KM,Szwast A,Natarajan SS,Johnson MP,Moldenhauer JS,Khalek N,Martinez-Poyer J,Flake AW,Hedrick HL,Adzick NS

doi

10.1159/000364863

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

172-8

issue

3

eissn

1015-3837

issn

1421-9964

pii

000364863

journal_volume

37

pub_type

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