Fetal aortic valvuloplasty as the first step in a complex therapeutic strategy

BackgroundFetal aortic valvuloplasty (FAV) is proposed to prevent hypoplastic left heart syndrome due to fetal critical aortic stenosis. Objective: to report our experience on FAV as the first step in a complex therapeutic strategy.MethodSeries of patients with FAV over an 18-year period.Results27 FAVs were performed in 26 fetuses, with technical success in 82% (22/27) and periprocedural fetal demise in 22% (6/27), decreasing to 15% in the second half-cohort. Loss to follow-up was due to birth or postnatal therapy in other centers (5) and termination of pregnancy (1), A normal-sized LV at birth was observed in 46% (6/13), 4 neonates underwent aortic valvuloplasty and 2 cardiac surgeries, with 5/6 achieving biventricular circulation at 28 days, and 3 transplant-free survival at mid-term follow-up. The 7/13 born with a borderline LV underwent LV rehabilitation strategy, with survival at 28 days in 4/7 and at mid-term in 3: one with biventricular circulation, one with a ventricle-and-a-half repair, and one lost to follow-up.ConclusionFAV was feasible in most cases, with no maternal complications, and biventricular circulation at 28 days in similar to 40% of survivors. After FAV, a diverse range of postnatal cardiac interventions are performed, reflecting the challenging innovation in current cardiovascular therapy. What is already known about this topic?Fetal aortic valvuloplasty is performed to prevent the progression to hypoplastic left heart syndrome in selected fetuses with critical aortic stenosis in a limited number of centers worldwide.What does this study add?This study reports outcomes from fetal aortic valvuloplasty as the first step in a complex therapeutic strategy in a single center in Argentina.