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Minimally Invasive Surgery
Volume 2010, Article ID 674185, 5 pages
Research Article

The Learning Curve for a Fetal Cardiac Intervention Team

1Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
2The Children's Hospital of Pittsburgh of UPMC, 15224, USA
3The Department of Pediatric Cardiology, The Magee-Womens Research Institute, 15213, USA
4The Division of Pediatric Heart Research Cardiovascular Innovation Institute, University of Louisville, KY 40202, USA

Received 24 August 2009; Accepted 18 January 2010

Academic Editor: Casey M. Calkins

Copyright © 2010 Stephen P. Emery et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. Multiple technical difficulties are encountered when a multidisciplinary team of subspecialists begins a minimally-invasive fetal cardiac interventional program. We describe the learning curve. Study Design. Ten pregnant sheep underwent ultrasound-guided balloon valvuloplasty of the aortic valve. Team members and their roles remained constant through the trial. The time between needle insertion and entrance of the left ventricle at the aortic root was recorded. F-test was used to assess significance (P.05). Results. The time required to accurately position the needle tip at the aortic root decreased significantly over the course of the trial, from 12 minutes with the first attempt to one minute with the last (P=.003). Conclusion. A significant learning curve is encountered when a multidisciplinary team begins a minimally-invasive fetal cardiac intervention program. However, technical proficiency can be achieved with practice. Institutions interested in developing such a program should consider practice in an animal model before proceeding to the human fetus.