First reported case of fetal aortic valvuloplasty in Asia
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
AS is defined as an obstruction of the left ventricular outflow caused by aortic valve narrowing. Severe AS may lead to a growth restriction of the left ventricle and aortic root, resulting in the hypoplastic left heart syndrome, which finally requires staged palliation for univentricular circulation after birth. In 1991, the balloon aortic valvuloplasty was first attempted in the fetus for relieving the obstruction of the aortic valve before the evolution to hypoplastic left heart syndrome. Subsequently, several groups have performed fetal aortic valvuloplasty, and on the basis of clinical reports published worldwide, FAV has demonstrated a potential benefit in achieving biventricular circulation. Herein, we report our first experience of FAV in a fetus with severe AS at 29.2 weeks of gestation.

Case report
A 33-year-old multiparous woman was referred to our tertiary center with a suspected AS at 24.1 weeks of gestation. Her past medical history was unremarkable, and she had a normal Quad test. A fetal echocardiography was performed using an UGEO WS80A (Samsung Medison, Seoul, Korea) with a 2-6 MHz transabdominal probe. The four-chamber view of the heart showed a normal-sized LV with good contractility. Although a small amount of mitral regurgitation was present, there was no evidence of endocardial brightening, or left-to-right shunting flow across the foramen ovale. The left ventricular outflow tract view revealed a thickened aortic valve with post-stenotic dilatation of the ascending aorta, and the color Doppler revealed turbulent flow across the aortic valve. The pulsed-wave Doppler showed an increased velocity of >3 m/sec. In the aortic arch view, there was no reversed flow in the transverse aortic arch. No other abnormalities were detected, and the parents did not want to undergo fetal karyotyping.....