Advances in fetal cardiac intervention

Abstract

Fetal cardiac intervention is in a rapid state of progress now. Attempts are being made to prevent fetal hydrops due to congenital heart defects, to recruit hypoplastic ventricles, to create a two-ventricle circulation after birth, and to remodel the fetal pulmonary vascular bed whose outlet is obstructed. Open heart surgery in the fetus has yet to be done successfully, but interventions for improved cardiac outcomes are now being tested. Their outcomes will depend, in large part, on their successful physiological effects. How to measure these and quantitate the effects of our interventions will require further advances in the understanding of these diseases-both their natural and unnatural courses. New ultrasound techniques and assessment tools to assess fetal cardiac wellness could enhance the limited progress in fetal intervention in the heart so far.

Interventional fetal balloon valvuloplasty for congenital heart disease—current shortcomings and possible perspectives

“…Some cardiac lesions may evolve during pregnancy, so clarification of the implications of fetal cardiac findings may need to be delayed until later in gestation [12,25,26,32,33,[43][44][45][46][47]. There have been many studies on the accuracy of antenatal diagnosis of fetal cardiac malformations, but overall, most of the false negative findings occurred in hearts with multiple lesions at early gestation.…”

“…The most common noncardiac anomalies for which invasive fetal therapy is currently being considered are myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and malformations of the lungs or the adjacent structures (such as diaphragmatic hernia) [34][35][36][37][38][39][40][41]. It is noteworthy that despite the advances in prenatal diagnosis, studies on prenatal animal model interventions have lagged years behind and still remain limited [26][27][28][29][30][31][33][34][35][36][37][38]. Ongoing evaluation of the efficacy of these still investigational techniques is required so that appropriate selection of fetuses for inutero surgery can be made.…”

“…The timing and concepts of intrauterine intervention are now being reconsidered [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Keyhole instruments and catheters and three-dimensional optics and imaging modes make it possible to perform intricate intrauterine procedures with a precision that one could have achieved only through open hysterotomy in the past.…”

“…Despite remarkable advances, the number and type of fetal abnormalities found by ultrasound and classified as ''potentially treatable'' by in-utero interventions are still limited [33][34][35][36]. The most common noncardiac anomalies for which invasive fetal therapy is currently being considered are myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and malformations of the lungs or the adjacent structures (such as diaphragmatic hernia) [34][35][36][37][38][39][40][41].…”

“…However, some centers are already exploring new minimally invasive therapeutic options with a view to inutero cardiac palliation [26][27][28][29][30][31][32][33]. The upcoming expansion of fetal cardiac interventions to ameliorate critically progressive fetal cardiac lesions intensifies the need to address issues about the adequacy of assessment and patient selection as well as the safety of those who undergo these novel procedures.…”