Fetoscopy-assisted enables valvuloplasty in a human fetus with disadvantageous intrauterine position — A case report

Background Some fetuses scheduled for balloon valvuloplasty present with unfavorable lies that render a successful procedure unlikely or impossible. In these situations, Foetal posturing previously has been achieved by maternal laparotomy. As a less invasive means, we demonstrate the feasibility of a minimally-invasive fetoscopic approach. Case Percutaneous ultrasound-guided Foetal balloon valvuloplasty for severe aortic valve stenosis was attempted in a human fetus at 29 + 4 weeks of gestation under general maternofetal anesthesia. Unfortunately, prior to the procedure, the fetus had been observed on several occasions remaining in a dorso-anterior cephalic position. Therefore, the left ventricle could not be accessed by the conventional percutaneous ultrasound-guided approach. In order to achieve the desired Foetal lie, fetoscopic assistance was employed: using a standardized fetoscopic setup, a fetoscope and two graspers, the fetus was rotated in dorsoposterior position. After this maneuver, successful balloon valvuloplasty was achieved. Mother and fetus tolerated the procedure well and complications were not observed. Discussion Fetoscopy-assisted Foetal posturing offers itself as an alternative to maternal laparotomy in fetuses presenting with a persisting disadvantageous position at the time of ballon valvuloplasty. Due to the increased risks of preterm rupture of membranes and earlier delivery posed by the fetoscopic approach, this technique may preferably be used in more mature fetuses when Foetal posturing cannot be achieved by other means.