Fetal cardiac surgery—a big challenge in the 21st century

Prenatal diagnosis and treatment planning of congenital heart defects—possibilities and limits

“…Since the early days of prenatal echocardiography diagnosis, innumerable reports have been published about intrauterine progression and increased abortion and stillbirth rates in fetuses with heart defects. [2,5,6,18,25,27,30,32,37,45,46] In the postnatal pediatric cardiological/pediatric cardiac surgery, it would be crucially important in the prenatal situation not only to diagnose cardiac defects as early as possible but also to treat them, thus avoiding secondary irreversible organ damage. [46] However, the corresponding cardiac structures of the fetus are accessible to many diagnostic and therapeutic procedures only at a more advanced gestational age (after the 18th week of pregnancy).…”

“…Because of the rapid miniaturization of many endoscopes and cannula systems, an increasing number of fetal diseases that progress in utero are becoming accessible to prenatal treatment. [1,7,27,30,31,37,39,43,[45][46][47][48] For instance, with the aid of fetoscopically monitored laser coagulation, it is possible to interrupt communicating vascular anastomoses in the placenta in twin-to-twin transfusion syndrome. [7,33,47,48] Experience with more extensive fetoscopic procedures on the fetus such as temporary in utero palliation of diaphragmatic hernias, myelomeningoceles or distal urinary tract obstruction is currently limited to a few centers in the world.…”

“…The natural course of heart defects detected in utero requires further intensive study as stabilization or lack of progression in the prenatal situation can be described for some of these defects with modifi ed outcome analysis so that caution is warranted with any intrauterine procedures that might cause premature birth compared to the lower-risk postnatal operations. [5,6,[12][13][14][25][26][27]30,32,37,42,45,46,48] The possibly favorable prognostic infl uence on the patients of bringing forward the timing of these techniques must be confi rmed in the next few years by well-designed studies. Fetuses with pulmonary valve atresia and postpartum catheter intervention can demonstrate a marked increase in right-ventricular dimensions including the possibility of biventricular palliation.…”

“…Discussion of possible developments in the next few years in the area of intrauterine treatment of certain obstructive heart defects may appear speculative at present. [4][5][6]12,13,18,19,[25][26][27]30,37,45,46] Nevertheless, this article presents an early compressed and critical picture not only of current prenatal diagnostic and counselling possibilities but also of the fi rst in utero case histories.…”

Right atrial hemangioma in the newborn: Utility of fetal imaging

“…Furthermore, as the fields of fetal cardiac intervention and surgery develop other potential options are becoming available, such as fetal cardiac catheterization[7] and/or fetal cardiac surgery. [8]…”