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Ann Thorac Surg 1994;57:1409-1415
© 1994 The Society of Thoracic Surgeons

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Articles

Chronic alterations in cardiac mechanics after fetal closed heart operation

Pediatric Heart Institute, Departments of Surgery, Physiology and Pediatrics, Temple University School of Medicine and St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA

^_* Address reprint requests to Dr Sandhu, Division of Pediatric Cardiology, UHN 60, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97201-3098.

Pulmonary artery banding was performed in 8 fetal sheep at 125 days' gestation to evaluate the feasibility of fetal closed cardiac operation. At 135 days' gestation, the fetuses were delivered and the cardiac mechanics were evaluated using a modified Langendorff isolated heart preparation. Two of the 8 fetuses aborted spontaneously 2 and 7 days after operation. Six fetuses (75%) survived the 10 days after delivery. The left ventricular cardiac mechanics in the banded fetuses (group I) were compared with those in 8 control fetuses (group II). All fetal hearts in both groups displayed a significant volume-pressure relationship. The volume-pressure curve was found to be shifted upward and to the left in the fetal hearts after pulmonary artery banding. The left ventricles subjected to increased in utero preload secondary to pulmonary artery banding were capable of generating greater peak systolic and developed pressures. Because the fetal heart manifests a Starling type of preload reserve, as such, it demonstrates that the possibility exists for subsequent fetal development to be altered by intrauterine intervention.

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