Foetoscopy-assisted balloon valvuloplasty in a human foetus with disadvantageous intrauterine position: a case report.
Background
Some foetuses scheduled for balloon valvuloplasty present with unfavourable 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 foetoscopic approach.


Case summary
Percutaneous ultrasound-guided foetal balloon valvuloplasty for severe aortic valve stenosis was attempted in a human foetus at 29 + 4 weeks of gestation under general maternofoetal anaesthesia. Unfortunately, prior to the procedure, the foetus had been observed on several occasions remaining in a dorsoanterior 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, foetoscopic assistance was employed: using a standardized foetoscopic setup, a foetoscope and two graspers, the foetus was rotated in dorsoposterior position. After this manoeuver, successful balloon valvuloplasty was achieved. Mother and foetus tolerated the procedure well and complications were not observed.


Discussion
Foetoscopy-assisted foetal posturing offers itself as an alternative to maternal laparotomy in foetuses presenting with a persisting disadvantageous position at the time of balloon valvuloplasty. Due to the increased risks of preterm rupture of membranes and earlier delivery posed by the foetoscopic approach, this technique may preferably be used in more mature foetuses when foetal posturing cannot be achieved by other means.
['Kohl|Thomas|T|https://orcid.org/0000-0003-3097-2479', 'Akin|Ibrahim|I|', 'Frommberger|Juliane|J|', 'Riehle|Nadja|N|', 'Schranz|Dietmar|D|']
Valvuloplasty Foetus Case report Aortic stenosis Foetal surgery Foetoscopy Intervention Pulmonary atresia