Fetal interventions

Abstract

With improvement over time in fetal diagnostics and interventional techniques, there has been growing interest in intervening in a variety of cardiac congenital anomalies during pregnancy to improve fetal hemodynamics. Fetal cardiac intervention (FCI) is a rapidly evolving field that includes pharmacologic, catheter-based, and surgical manipulation of a fetus in an effort to improve fetal cardiac status. FCI is considered when the intervention can improve fetal and child status with minimal adverse effects for the mother. Although the majority of congenital heart disease can be diagnosed in-utero, FCI has only been deemed potentially helpful in a small number of lesions: those that include diseases that worsen during mid- to late gestation, are at a high risk for in-utero demise, or carry a risk of significant hemodynamic instability at birth. While FCI covers a range of interventions, this chapter focuses on catheter-based interventions for hypoplastic left heart syndrome (HLHS), which is one of the highest mortality CHD lesions. Two FCIs are available for fetuses with evolving and/or complete HLHS: balloon aortic valvuloplasty and atrial septal dilation/stent placement. The chapter covers both approaches in detail, with illustrations.