Opinion statement
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.
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References and Recommended Reading
Kadar K: Prognosis for the fetus with congenital heart defects in the era of modern diagnostics and therapeutics [in Hungarian]. Orv Hetil 2004, 145:849–853.
Rychik J: Frontiers in fetal cardiovascular disease. Pediatr Clin North Am 2004, 51:1489–1502, vii.
Tworetzky W, Marshall AC: Balloon valvuloplasty for congenital heart disease in the fetus. Clin Perinatol 2003, 30:541–550.
Bouchard S, Johnson MP, Flake AW, et al: The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg 2002, 37:418–426.
Kohl T, Sharland G, Allan LD, et al: World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction. Am J Cardiol 2000, 85:1230–1233.
Kohl T: Fetal echocardiography: new grounds to explore during fetal cardiac intervention. Pediatr Cardiol 2002, 23:334–346.
Tworetzky W, Wilkins-Haug L, Jennings RW, et al: Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique, and results of successful intervention. Circulation 2004, 110:2125–2131. This is the first large series of balloon dilation of severe aortic stenosis in the fetus.
Carvalho JS, Moscoso G, Tekay A, et al: Clinical impact of first and early second trimester fetal echocardiography on high risk pregnancies. Heart 2004, 90:921–926.
Assad RS, Zielinsky P, Kalil R, et al: New lead for in utero pacing for fetal congenital heart block. J Thorac Cardiovasc Surg 2003, 126:300–302.
Quintero RA, Huhta J, Suh E, et al: In utero cardiac fetal surgery: laser atrial septotomy in the treatment of hypoplastic left heart syndrome with intact atrial septum. Am J Obstet Gynecol 2005, 193:1424–1428.
Huhta J, Quintero RA, Suh E, et al: Advances in fetal cardiac intervention. Curr Opin Pediatr 2004, 16:487–493.
Gardiner HM: Progression of fetal heart disease and rationale for fetal intracardiac interventions. Semin Fetal Neonatal Med 2005, 10:578–585.
McLean KM, Lorts A, Pearl JM: Current treatments for congenital aortic stenosis. Curr Opin Cardiol 2006, 21:200–204.
Tworetzky W, Marshall AC: Fetal interventions for cardiac defects. Pediatr Clin North Am 2004, 51:1503–1513, vii.
Marshall AC, Tworetzky W, Bergersen L, et al: Aortic valvuloplasty in the fetus: technical characteristics of successful balloon dilation. J Pediatr 2005, 147:535–539.
Deng J, Rodeck CH: Current applications of fetal cardiac imaging technology. Curr Opin Obstet Gynecol 2006, 18:177–184.
Kohl T, Muller A, Tchatcheva K, et al: Fetal transesophageal echocardiography: clinical introduction as a monitoring tool during cardiac intervention in a human fetus. Ultrasound Obstet Gynecol 2005, 26:780–785. High quality imaging is necessary for fetal interventional procedures. The safety of this imaging approach will determine whether it can be used routinely.
Makikallio K, McElhinney DB, Levine JC, et al: Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation 2006, 113:1401–1405. Important new information concerning fetal patient selection for aortic stenosis treatment in utero.
Tworetzky W, del Nido PJ, Powell AJ, et al.: Usefulness of magnetic resonance imaging of left ventricular endocardial fibroelastosis in infants after fetal intervention for aortic valve stenosis. Am J Cardiol 2005, 96:1568–1570.
Galindo A, Gutierrez-Larraya F, Velasco JM, et al: Pulmonary balloon valvuloplasty in a fetus with critical pulmonary stenosis/atresia with intact ventricular septum and heart failure. Fetal Diagn Ther 2006, 21:100–104.
Tulzer G, Arzt W, Franklin RC, et al: Fetal pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum. Lancet 2002, 360:1567–1568.
Vlahos AP, Lock JE, McElhinney DB, et al: Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy. Circulation 2004, 109:2326–2330.
Marshall AC, vander Velde ME, Tworetzky W, et al: Creation of an atrial septal defect in utero for fetuses with hypoplastic left heart syndrome and intact or highly restrictive atrial septum. Circulation 2004, 110:253–258.
Quintero RA, Dickinson JE, Morales WJ, et al: Stagebased treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol 2003, 188:1333–1340.
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Viesca, R., Huhta, J.C. Update in fetal cardiac intervention. Curr Treat Options Cardio Med 8, 379–386 (2006). https://doi.org/10.1007/s11936-006-0042-6
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DOI: https://doi.org/10.1007/s11936-006-0042-6