Transesophageal echocardiography in fetal sheep. A monitoring tool for open and fetoscopic cardiac procedures.


Journal Article

BACKGROUND:Cardiac procedures in exteriorized fetuses or assisted by fetoscopy require monitoring capabilities not attended by conventional maternal transabdominal echocardiography. METHODS:We, therefore, assessed the potential of fetal transesophageal echocardiography (TEE) utilizing an intravascular ultrasound catheter (IVUC) for fetal cardiac monitoring. We inserted a 10-F-10-MHz IVUC into the esophagus in 12 exteriorized fetal sheep and by a fetoscopic approach in 4 fetal sheep. Cardiac events were observed. Heart rate, cardiac rhythm, patency of the foramen ovale and ductus arteriosus, and the width of the branch pulmonary arteries could be assessed in all fetuses. Ventricular contractility could be assessed only in fetuses weighing less than 2.5 kg. Larger fetuses did not allow adequate imaging of the apical portion of the ventricles because of limited tissue penetration of the IVUC. Fetal TEE permitted placing small guide wires in the cardiac atria and left ventricle. Short-lived premature beats following intracardiac manipulations of these wires could be observed by fetal TEE in all cases. RESULTS:At autopsy, no complications from IVUC insertion were observed in the exteriorized fetuses. Fetoscopic placement of the IVUC resulted in minor perioral skin erosion in two nonexteriorized fetuses. CONCLUSIONS:In conclusion, fetal TEE can be achieved with minor fetal injury and may provide useful information during open and fetoscopic cardiac procedures. Further improvements in IVUC design will permit the application of this technique to monitor human fetal cardiac procedures.

Full Text

Cited Authors

  • Kohl, T; Stelnicki, EJ; VanderWall, KJ; Szabo, Z; Ko, E; Bruch, SW; Harrison, MR; Silverman, NH; Hanley, FL; Chou, TM

Published Date

  • August 1996

Published In

Volume / Issue

  • 10 / 8

Start / End Page

  • 820 - 824

PubMed ID

  • 8694946

Pubmed Central ID

  • 8694946

Electronic International Standard Serial Number (EISSN)

  • 1432-2218

International Standard Serial Number (ISSN)

  • 0930-2794

Digital Object Identifier (DOI)

  • 10.1007/s004649900169


  • eng