Update in fetal cardiac intervention

Abstract

The severity of fetal heart disease progresses during gestation and may lead to significant in utero or postnatal morbidity and mortality. Fetal echocardiography allows us to detect heart disease early enough in pregnancy to perform fetal cardiac intervention that may change the natural history of some diseases. The principal aims are the prevention of hydrops due to congenital heart disease, recruitment of hypoplastic ventricles, remodeling of the fetal pulmonary vascular bed, or creation of a two-ventricular circulation after birth without risk to the mother. The initial fetal interventions for valvuloplasty and atrial septostomy showed a high mortality and did not achieve significant change in the final outcome of patients. Nevertheless, some technique modifications have improved the outcome of these patients, making fetal cardiac intervention a promising treatment for congenital heart disease. Conversely, different assessment tools for selection of the correct patient have been studied in some series to improve the success of these procedures and thus the survival odds. We believe that percutaneous procedures with local anesthesia are preferable.

Fetal Echocardiography

“…The evolution of more severe secondary pathology, including a hypoplastic left or right ventricle in the presence of severe semilunar valve obstruction and restriction of the foramen ovale, has prompted the development of invasive procedures to ameliorate the obstruction prenatally. To date, balloon aortic and pulmonary valvuloplasty [59][60][61] and atrial septoplasty and stent placement have been described, with moderate success [62].…”