FIRST INTERNATIONAL FETAL

SURGERY SYMPOSIUM

STUDENT
KAREN DANIELA BAUTISTA ESQUIVIA

CODE
01210021064

TEACHER
LIDY HIGUERA

PRACTICE
BUCARAMANGA HEART
INSTITUTE

2024
 FIRST INTERNATIONAL FETAL
SURGERY SYMPOSIUM

DOCTOR VICTOR
RAUL
Head of the FCV, opens the event on
advances in fetal surgery in the world, tells
us how proud he is of the work team of his
institution and the effective intervention
within surgical interventions that prevent
long-term damage to the fetus

DOCTOR MERLYN MUÑOZ

The institution to which the doctor belongs aims
to offer all highly complex surgeries in the uterus
aimed at the entire obstetric population. The goal
of these procedures is to stop the progression of
a disease that generates high morbidity and
mortality, in this way correcting the
malformations. such as: Spina bifida,
Diaphragmatic hernia, Pulmonary stenosis, Aortic
valve stenosis, Left heart hypoplasty, Cardiac
arrhythmia

CURRENT APPROACH TO FETAL

AORTIC STENOSIS
First case: Complex fetal heart disease
A 20-year-old pregnant patient comes to the fetal cardiology
clinic for severe aortic stenosis: with a hypoplastic left ventricle,
the specialist sends an obstetric ultrasound showing reverse flow
through the aorta, a transabdominal approach is performed to
perform an aortic valvuloplasty, #19 goat needle is used where
access is made through the thorax and then the left ventricle, the
anmiotic cavity is entered, the baby is punctured through the
thorax to access the left ventricle, the balloon guide is advanced
until reaching he anatomical position of the aorta, the aortic
annulus is related to the balloon.

SURGERY SUCCESS
Cross and inflate the balloon into the
aorta and increase flow through the
aorta

COMPLICATIONS
Difficulty in puncture of the left
ventricle depending on its small or thick
size and unfavorable fetal position.

FETAL AORTIC
VALVULOPLASTY
Maxwell et al performed the first successful aortic
valvuloplasty in 1991. The challenges are patient
selection and inadequate techniques.

For this the objectives are: Improve fetal

hemodynamics, prevent myocardial damage, promote
biventricular circulation.
Criteria for performing surgery: Aortic stenosis with
normal or dilated left ventricle, retrograde flow in the
aortic arch, foramen ovale with shunt from left to right

FETAL TRACHEAL
OCCLUSION
It is a birth defect in which there is a
hole in the diaphragm (the large
muscle that separates the chest
from the abdomen).
 CLINICAL EFFECTS

Hipoplasia Pulmonar
Hipertensión Pulmonar

DIAPHRAGMATIC HERNIA IS
ASSOCIATED WITH OTHER
PATHOLOGIES

Heart disease
Hydronephrosis
CNS defects
Gastrointestinal
Trisomies 13

COMPLICATIONS OF
MONOCHORIAL PREGNANCY
Monochorionic pregnancies refer to those in
which there is a single placenta shared by two
or more fetuses. A common complication in
these types of pregnancies is the feto-fetal
transfusion syndrome which occurs
specifically in monochorionic pregnancies and
can be potentially serious.

STAGING OF TTTS

Stage I: Donor's bladder still visible

Stage II: Donor bladder not visible
Stage Ill:
AEDV/REDV in the umbilical artery
Reverse flow in the venous duct