HCM City doctors successfully performed second fetal cardiac intervention

Doctors performed the foetal cardiac intervention on January 4. — Photo Courtesy of HCM City’s Department of Health

HÀ NỘI — A second foetal cardiac intervention was successfully performed by doctors from Từ Dũ Hospital and Children’s Hospital No.1 in Hồ Chí Minh City on January 12.

During prenatal examinations, 27-year-old pregnant woman N.P.P.A., from District 3, HCM City, was diagnosed with foetal heart abnormalities at 21 weeks of pregnancy, specifically progressive aortic valve stenosis. She underwent amniocentesis for genetic testing, which showed no abnormalities.

By January 11, the pregnancy had progressed to 29 weeks with severe aortic valve stenosis. After consultations, foetal experts and paediatric cardiologists unanimously concluded that emergency foetal intervention was crucial in this case.

Without intervention or if delayed until after 29 weeks of gestation to dilate the aortic valve, the risk of foetal death would be extremely high.

The foetus faced the possibility of either dying in the womb, with a stillbirth rate exceeding 30 per cent, or progressing to hypoplastic left ventricle syndrome with a 50 per cent risk of a univentricular heart wall (requiring multiple surgeries after birth for temporary return to univentricular circulation or complete treatment with a heart transplant).

Cardiologists determined that foetal cardiovascular intervention at this juncture was appropriate. However, predicting the foetal position for cardiac catheterisation presented challenges due to excess amniotic fluid and frequent foetal position changes.

The surgery started at 9am on January 12.

The surgical team faced the expected challenges, with the foetus frequently changing positions, making it difficult to insert the needle into the left ventricle and onto the aortic valve.

The intervention at Từ Dũ Hospital took 20 minutes to position the needle correctly, and it was then handed over to the heart valve catheterisation team at Children’s Hospital 1 to complete the crucial final step – aortic valvuloplasty.

Post-surgery, the pregnant woman was closely monitored in the operating room for 15 minutes, and the stabilised condition of foetal pericardial effusion was confirmed.

The successful surgery concluded at 11am on the same day, with continuous monitoring of the pregnant woman post-surgery. By 1pm, the foetal pericardial effusion was well controlled, the foetal heart rate was normal, and the mother’s condition was stable.

On January 4, the same expert team from Từ Dũ Hospital and Children’s Hospital 1 achieved a milestone by conducting Việt Nam’s first foetal interventional cardiac catheterisation. This involved pregnant woman L., who, during her first pregnancy, was monitored in Đà Nẵng City. Transferred to Từ Dũ Hospital due to the foetus’s severe heart abnormalities – a birth defect without a pulmonary valve opening and right ventricular hypoplasia – the intervention 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 significant advancement in technical expertise comparable to that of developed countries in the region.

Through the initial two foetal interventional cardiac catheterisations and first-hand observation of the seamless coordination by obstetric and paediatric experts at Từ Dũ and Children’s Hospital 1, the Hồ Chí Minh City Department of Health said several decisive factors contributed to the success of these interventions.

These include accuracy in ultrasound techniques by paediatric cardiologists at Children’s Hospital 1, demonstrating precision in diagnosing foetal congenital heart lesions, serving as the crucial guide for accurate foetal cardiac catheterisation intervention.

Experience and precision in foetal intervention performed by doctors from the two hospitals are also crucial factors.

The Hồ Chí Minh City Department of Health views this success as an initial outcome in the specialised field of foetal congenital heart intervention. — VNS