Fetal cardiac intervention is a highly specialized, technically challenging cardiac intervention that occurs during fetal life. It is reserved for fetuses with complex congenital heart disease. In various high-risk fetuses, it may alleviate ventricular dysfunction and prevent some fetuses from developing progressive ventricular hypoplasia as gestation advances and achieve a biventricular circulation postnatally with improved fetal survival.
Candidates for clinical fetal cardiac interventions are restricted to very specific variants of complex congenital heart disease such as: critical aortic valve stenosis with evolving hypoplastic left heart syndrome (HLHS), pulmonary atresia with an intact ventricular septum (PA/IVS) and evolving hypoplastic right heart syndrome, and HLHS with an intact or highly restrictive atrial septum. The early relief of heart obstructions may promote ventricular and vascular growth and improve postnatal outcomes.
Therapeutic options include: fetal aortic valvuloplasty, pulmonary valvuloplasty or creation of an interatrial communication (via balloon +/- stent placement) in fetuses with HLHS with intact or restrictive atrial septum.
Clinical fetal cardiac interventions are plausible for mid-gestation fetuses with the above-mentioned congenital heart defects. The technical success, biventricular outcome and fetal survival are continuously being improved in the conditions of the sophisticated multidisciplinary team, equipment, techniques and postnatal care.
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