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Update in fetal cardiac intervention
1Department of Pediatrics and Obstetrics/Gynecology, USF Daicoff-Andrews Chair in Perinatal Cardiology, 140 7th Avenue S, CRI-4007, St. Petersburg, FL 33701, USA.
Insights
Fetal cardiac intervention shows promise for treating congenital heart disease, improving outcomes for affected infants. Advances in techniques and patient selection enhance the effectiveness of these early treatments.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Pediatric Cardiology
Background:
- Fetal heart disease can lead to severe in utero and postnatal complications, including hydrops and mortality.
- Early detection via fetal echocardiography enables timely intervention to alter disease progression.
- Congenital heart disease poses significant risks to fetal development and survival.
Purpose of the Study:
- To evaluate the efficacy and evolving techniques of fetal cardiac intervention for congenital heart disease.
- To explore methods for preventing hydrops and promoting proper cardiac circulation in fetuses.
- To identify optimal patient selection criteria for improving procedural success rates.
Main Methods:
- Review of initial fetal interventions (valvuloplasty, atrial septostomy) and their outcomes.
- Analysis of technique modifications and advancements in fetal cardiac intervention.
- Investigation of patient assessment tools for selecting appropriate candidates for intervention.
Main Results:
- Early fetal interventions had high mortality and limited impact on patient outcomes.
- Modifications in techniques have led to improved outcomes in recent cases.
- Development of better patient selection criteria is crucial for enhancing procedural success.
Conclusions:
- Fetal cardiac intervention is a promising treatment for congenital heart disease, with improving outcomes.
- Refined techniques and careful patient selection are key to successful fetal cardiac interventions.
- Percutaneous procedures under local anesthesia are considered preferable for fetal interventions.
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.
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