Fetal interventions for congenital heart disease

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Lindsay R Freud1, Wayne Tworetzky

  • 1aDepartment of Pediatrics, Division of Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York City, New York bDepartment of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Current Opinion in Pediatrics
|February 18, 2016
PubMed

Insights

Percutaneous fetal cardiac intervention (FCI) shows promise for select congenital heart diseases like hypoplastic left heart syndrome. Careful patient selection and postnatal management are crucial for achieving biventricular circulation and improving survival.

Area of Science:

  • Cardiology
  • Fetal Medicine
  • Interventional Cardiology

Background:

  • Congenital heart disease (CHD) affects a significant number of newborns.
  • Fetal cardiac intervention (FCI) is an emerging field aimed at treating CHDs before birth.
  • Ultrasound-guided percutaneous techniques are advancing FCI procedures.

Purpose of the Study:

  • To review the rationale, patient selection criteria, technical aspects, and outcomes of FCI.
  • To discuss the application of FCI for specific structural CHDs.
  • To evaluate the potential of FCI to alter natural disease progression.

Main Methods:

  • Percutaneous, ultrasound-guided procedures performed in utero.
  • Interventions target specific fetal cardiac defects.
  • Focus on techniques for aortic stenosis, pulmonary atresia, and hypoplastic left heart syndrome (HLHS).

Main Results:

  • FCI is primarily used for severe aortic stenosis with evolving HLHS, pulmonary atresia with intact ventricular septum, and HLHS with restricted atrial septum.
  • Successful biventricular circulation has been achieved in a subset of patients undergoing FCI for aortic stenosis and pulmonary atresia.
  • FCI for HLHS with restricted atrial septum is technically feasible but has not yet shown significant survival benefits.

Conclusions:

  • Fetal cardiac intervention is a developing treatment modality for specific CHDs.
  • Careful patient selection and postnatal management are critical for successful outcomes.
  • Further evaluation of short- and long-term outcomes is necessary to establish the full potential of FCI.
Abstract

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