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Transforming congenital heart disease management: Advances in fetal cardiac interventions
Stephanie Guseh1, Wayne Tworetzky2
1Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Fetal cardiac interventions (FCI) are advancing for congenital heart diseases (CHD). These procedures show promise for conditions like hypoplastic left heart syndrome, improving outcomes with multidisciplinary care and new technologies.
Area of Science:
- Cardiology
- Fetal Medicine
- Pediatric Surgery
Background:
- Congenital heart diseases (CHD) represent a significant burden in pediatric cardiology.
- Fetal cardiac interventions (FCI) offer a potential solution for severe fetal cardiac anomalies.
- Specific conditions like aortic stenosis with evolving hypoplastic left heart syndrome (HLHS) and pulmonary atresia with intact ventricular septum require advanced management.
Purpose of the Study:
- To review advancements in fetal cardiac interventions (FCI) for congenital heart diseases (CHD).
- To examine specific FCI techniques, candidate selection criteria, and outcomes for conditions including HLHS.
- To discuss procedural strategies, clinical decision-making, and the role of multidisciplinary teams in FCI.
Main Methods:
- Comprehensive literature review of transformative advancements in fetal cardiac interventions.
- Analysis of specific FCI techniques and refined criteria for fetal and maternal candidate selection.
- Examination of procedural strategies, clinical decision-making, and outcomes data for various CHD types.
Main Results:
- Significant improvements in technical success and management of procedural complications through multidisciplinary teams.
- Promising, yet varied, outcomes associated with current fetal cardiac intervention procedures.
- Highlighting the importance of considering fetal pathophysiology and risks/benefits of early intervention.
Conclusions:
- Fetal cardiac interventions are evolving, offering new hope for managing complex congenital heart diseases.
- Continuous innovation, multidisciplinary collaboration, and integration of new technologies are crucial for advancing FCI.
- Future research is essential to further enhance FCI success rates and long-term patient outcomes in CHD management.
Abstract:
This review addresses the transformative advancements in fetal cardiac interventions (FCI) for congenital heart diseases (CHD), with a particular focus on aortic stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an intact ventricular septum, and HLHS with an intact atrial septum (HLHS-IAS). We outline the specific FCI techniques employed, the refined criteria for selecting appropriate fetal and maternal candidates, and the promising yet varied outcomes associated with these procedures. Procedural strategies and clinical decision-making are examined as we take into account the fetal pathophysiology and the benefits and risks of early intervention. We highlight the role of multidisciplinary teams in improving technical success and managing immediate procedural complications, which have led to significant improvements in procedural outcomes. Additionally, the review discusses the long-term outcomes, challenges, and future research directions in FCI, emphasizing the necessity for continuous innovation and collaboration across specialties to advance the management of CHD. The integration of new technologies and research findings holds the promise of further enhancing FCI success rates and patient outcomes.
