Fetal cardiac interventions: Myths and facts

Abstract

An early, primary, in utero cardiac abnormality may prevent normal heart development and cause irreversible secondary structural changes. The idea of foetal cardiac intervention stems from this understanding and focuses on antenatal intervention targeting the primary abnormality to allow normal flow and haemodynamics and thus normal heart development. Crucial aspects of foetal vascular access, varying foetal lie and structural complexity make it very hard to set procedural standards. The procedures are complex and are associated with significant maternal and foetal morbidity and mortality. The high risk-benefit ratio clearly explains the investigational nature of such therapies. With the development of minimally invasive techniques and continued animal experiments, foetal interventional therapy may see a low rate of morbidity and mortality, improving the prognosis of newborns with congenital heart disease previously considered incurable.

“Functionally” Univentricular Hearts: Impact of Pre-Natal Diagnosis

“…The pre-natal cardiac screening can also been useful to detect fetal arrhythmias ( 12 ). Of course, the pre-natal diagnosis of complex congenital heart defect has opened the possibility of investigating potential fetal interventions ( 11 ).…”

Ten Common Questions (and Their Answers) on Medical Futility

“…As such, patients who have such neoplastic diseases might someday die of other age-related diseases, not cancer. In utero surgery for congenital abnormalities [95][96][97][98] Once viewed as experimental and potentially futile, in utero surgery is proving feasible and cost-effective to treat conditions such as myelomeningoceles, cardiac defects, aberrations of the urologic system, and other disease states. With time, more experience, and evidence of favorable outcomes and long-term cost savings, these treatments should progressively become more mainstream.…”

Fetal cardiac interventions: an update of therapeutic options

“…Early diagnosis of treatable CHDs may improve fetal intervention outcomes [ 4 ] , allowing ventricular growth and angiogenesis for fetus with semilunar valve stenosis for successful adaptation to extrauterine life [ 5 ] . Advanced imaging technology and equipment have made an accurate diagnosis of most fetal CHDs possible [ 6 ] . Among them, echocardiography is a reliable means for prenatal diagnosis of a wide spectrum of CHDs [ 3 ] .…”