Percutaneous fetal cardiac interventions for structural heart disease

Area of Science:

• Cardiology
• Fetal Medicine
• Interventional Cardiology

Background:

• Prenatal diagnosis identifies congenital heart defects (CHDs).
• Some CHDs evolve during gestation, offering a window for intervention.
• Fetal cardiac intervention (FCI) can interrupt disease progression, improving outcomes.

Purpose of the Study:

• Review percutaneous FCI for three specific CHDs.
• Discuss pathophysiology, selection, technique, and outcomes.
• Address complications, anesthesia, and specialized center care.

Main Methods:

• Percutaneous fetal aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome.
• Fetal intervention for hypoplastic left heart syndrome with intact atrial septum.
• Percutaneous fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum.

Main Results:

• Aortic valvuloplasty prevented left ventricular hypoplasia and achieved biventricular circulation in ~33% of cases.
• Relief of atrial restriction may improve survival in hypoplastic left heart syndrome with intact atrial septum.
• Pulmonary valvuloplasty resulted in biventricular circulation in the majority of pulmonary atresia cases.

Conclusions:

• FCI is a viable option for specific evolving CHDs.
• Intervention can improve fetal cardiac development and perinatal outcomes.
• Specialized centers are crucial for managing post-FCI infants.