Doctors performed the foetal cardiac intervention on January 4. (Photo Courtesy of HCM City's Department of Health) During prenatal examinations, 27-year-old pregnant woman, N.P.P.A., fromDistrict 3, HCM City, was diagnosed with foetal heart abnormalities at 21 weeksof pregnancy, specifically progressive aortic valve stenosis. She underwentamniocentesis for genetic testing, which showed no abnormalities.
By January 11, the pregnancy had progressed to 29 weeks with severe aorticvalve stenosis. After consultations, foetal experts and paediatriccardiologists unanimously concluded that emergency foetal intervention wascrucial in this case.
Without intervention or if delayed until after 29 weeks of gestation to dilatethe aortic valve, the risk of foetal death would be extremely high.
The foetus faced the possibility of either dying in the womb, with a stillbirthrate exceeding 30%, or progressing to hypoplastic left ventricle syndrome witha 50% risk of a univentricular heart wall (requiring multiple surgeries afterbirth for temporary return to univentricular circulation or complete treatmentwith a heart transplant).
Cardiologists determined that foetal cardiovascular interventionat this juncture was appropriate. However, predicting the foetal position forcardiac catheterisation presented challenges due to excess amniotic fluid andfrequent foetal position changes.
The surgery started at 9am on January 12.
The surgical team faced the expected challenges, with the foetusfrequently changing positions, making it difficult to insert the needle intothe left ventricle and onto the aortic valve.
The intervention at Tu Du Hospital took 20 minutes to position theneedle correctly, and it was then handed over to the heart valvecatheterisation team at Children's Hospital 1 to complete the crucial finalstep – aortic valvuloplasty.
Post-surgery, the pregnant woman was closely monitored in theoperating room for 15 minutes, and the stabilised condition of foetalpericardial effusion was confirmed.
The successful surgery concluded at 11am on the same day, with continuousmonitoring of the pregnant woman post-surgery. By 1pm, the foetal pericardialeffusion was well controlled, the foetal heart rate was normal, and themother's condition was stable.
Earlier on January 4, the same expert team from Tu Du Hospital andChildren's Hospital 1 achieved a milestone by conducting Vietnam’s firstfoetal interventional cardiac catheterisation. This involved a pregnant womanwho, during her first pregnancy, was monitored in Da Nang city. Transferred toTu Du Hospital due to the foetus's severe heart abnormalities – a birth defectwithout a pulmonary valve opening and right ventricular hypoplasia – theintervention successfully addressed the issues.
Subsequent examinations showed good flow through the foetal pulmonary valve,with no pericardial effusion.
Both interventions were executed with absolute precision, marking a significantadvancement in technical expertise comparable to that of developed countries inthe region.
Through the initial two foetal interventional cardiac catheterisations andfirst-hand observation of the seamless coordination by obstetric and paediatricexperts at Tu Du and Children's Hospital 1, the Ho Chi Minh City Department ofHealth said several decisive factors contributed to the success of theseinterventions.
These include accuracy in ultrasound techniques by paediatric cardiologists atChildren's Hospital 1, demonstrating precision in diagnosing foetal congenitalheart lesions, serving as the crucial guide for accurate foetal cardiaccatheterisation intervention.
Experience and precision in foetal intervention performed by doctors from thetwo hospitals are also crucial factors.
The Ho Chi Minh City Department of Health views this success as an initialoutcome in the specialised field of foetal congenital heart intervention./.
VNA
