Fetal cardiac intervention consists of a novel and evolving technique for the intrauterine treatment of a subset of patients with congenital heart diseases, which aims to improve hemodynamics, reduce secondary damage, and achieve better postnatal outcomes. Nevertheless, the risks and benefits of this therapy remains subject to controversy. This review describes the rationale, selection criteria, and technical features for the most frequently performed fetal cardiac interventions. In addition, we provide a comprehensive overview of the medical literature, exploring the clinical implications of each therapy.
McLaughlinESSchlosserBABorderWL. Fetal diagnostics and fetal intervention. Clin Perinatol. 2016;43(1):23‐38. doi:10.1016/j.clp.2015.11.003
2.
SalaPPrefumoFPastorinoD, et al.Fetal surgery: an overview. Obstet Gynecol Surv. 2014;69(4):218‐228. doi:10.1097/OGX.0000000000000061
3.
Van Der LindeDKoningsEEMSlagerMA, et al.Birth prevalence of congenital heart disease worldwide. J Am Coll Cardiol. 2011;58(21):2241‐2247. doi:10.1016/j.jacc.2011.08.025
4.
DerenOAykanHHOzyuncuO, et al.Fetal cardiac interventions: first-year experience of a tertiary referral center in Turkey. J Obstet Gynaecol Res. 2023;49(6):1525‐1531. doi:10.1111/jog.15649
5.
SuZZhangYCaiX, et al.Improving long-term care and outcomes of congenital heart disease: fulfilling the promise of a healthy life. Lancet Child Adolesc Health. 2023;7(7):502‐518. doi:10.1016/S2352-4642(23)00053-6
6.
Bravo-ValenzuelaNJAraujo JúniorE. Prenatal diagnosis of hypoplastic left heart syndrome: current knowledge. Radiol Bras. 2023;56(5):282‐286. doi:10.1590/0100-3984.2023.0073
7.
FriedmanKGTworetzkyW. Fetal cardiac interventions: where do we stand?Arch Cardiovasc Dis. 2020;113(2):121‐128. doi:10.1016/j.acvd.2019.06.007
8.
SizarovABoudjemlineY. Valve interventions in utero: understanding the timing, indications, and approaches. Can J Cardiol. 2017;33(9):1150‐1158. doi:10.1016/j.cjca.2017.06.009
9.
MaxwellDAllanLTynanMJ. Balloon dilatation of the aortic valve in the fetus: a report of two cases. Br Heart J1991;65(5):256‐258.
10.
Araujo JúniorETonniGChungMRuanoRMartinsWP. Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies. Ultrasound Obstet Gynecol. 2016;48(4):426‐433. doi:10.1002/uog.15867
11.
GardinerHM. In utero intervention for severe congenital heart disease. Best Pract Res Clin Obstet Gynaecol. 2019;58:42‐54. doi:10.1016/j.bpobgyn.2019.01.007
Moon-GradyAJMorrisSABelfortM, et al.International fetal cardiac intervention registry. J Am Coll Cardiol. 2015;66(4):388‐399. doi:10.1016/j.jacc.2015.05.037
15.
KovacevicARoughtonMMellanderM, et alFetal aortic valvuloplasty: investigating institutional bias in surgical decision-making. Ultrasound Obstet Gynecol. 2014;44(5):538‐544. doi:https://doi.org/10.1002/uog.13447
16.
BachaEA. Impact of fetal cardiac intervention on congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14(1):35‐37. doi:https://doi.org/10.1053/j.pcsu.2011.01.003
17.
VogelMMcElhinneyDBWilkins-HaugLE, et al.Aortic stenosis and severe mitral regurgitation in the fetus resulting in giant left atrium and hydrops. J Am Coll Cardiol. 2011;57(3):348‐355. doi:10.1016/j.jacc.2010.08.636
18.
TulzerAArztWTulzerG. Fetal Aortic valvuloplasty may rescue fetuses with critical aortic stenosis and hydrops. Ultrasound Obstet Gynecol. 2021;57:119–125. doi:10.1002/uog.22138
19.
KangS LJaeggiERyanG, et al.An overview of contemporary outcomes in fetal cardiac intervention: a case for high volume superspecialization?. Pediatr Cardiol. 2020;41(3):479‐485. doi:https://doi.org/10.1007/s00246-020-02294-2
20.
PatelNDNagotteSIngFFetal. Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty. Catheter Cardiovasc Interv. 2020;96(3):626-632. doi:https://doi.org/10.1002/ccd.28846.
21.
LarajaKSadhwaniATworetzkyW, et al. Neurodevelopmental Outcome in Children after fetal cardiac intervention for aortic stenosis with evolving hypoplastic left heart syndrome. J Pediatr. 2017;184:130–136.e4. doi:https://doi.org/10.1016/j.jpeds.2017.01.034
22.
WanderGVan Der ZandeJAPatelRRJohnsonMRRoos-HesselinkJ. Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications. Expert Rev Cardiovasc Ther. 2023;21(8):587‐599. doi:10.1080/14779072.2023.2237886
23.
RebizantBKolesnikAGrzybA, et al.Fetal Cardiac Intervention-Are They Safe for the Mothers?J Clin Med. 2021;10(4):851. doi:10.3390/jcm10040851
24.
Cantinotti M, McMahon CJ, Marchese P, et al. Echocardiographic parameters for risk prediction in borderline right ventricle: review with special emphasis on pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. J Clin Med. 2023;12(14):4599. doi:10.3390/jcm12144599
25.
HoganWJGrinencoSArmstrongA, et al.Fetal cardiac intervention for pulmonary atresia with intact ventricular septum: International Fetal Cardiac Intervention Registry. Fetal Diagn Ther. 2020;47(10):731‐739. doi:10.1159/000508045
26.
Luo GGaoSSunH, et al.Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results. J Interv Med. 2022;5(4):196-199.
27.
JantzenDWMoon-GradyAJMorrisSA, et al. Hypoplastic Left Heart Syndrome With Intact or Restrictive Atrial Septum: A Report From the International Fetal Cardiac Intervention Registry. Circulation. 2017;136(14):1346–1349.
28.
Rychik J, Rome JJ, Collins MH, DeCampli WM, Spray TL. The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome. J Am Coll Cardiol. 1999;34(2):554–560. doi:10.1016/S0735-1097(99)00225-9
29.
KalishBTTworetzkyWBensonCB, et al.Technical challenges of atrial septal stent placement in fetuses with hypoplastic left heart syndrome and intact atrial septum. Catheter Cardiovasc Interv. 2014;84(1):77‐85. doi:10.1002/ccd.25098
30.
HalderVGhoshSShrimanthYS, et al.Fetal cardiac intervention and fetal cardiac surgery: where are we in 21st century?Am J Cardiovasc Dis. 2021;11(5):642‐646.
31.
SoodVZampiJDRomanoJC. Hypoplastic left heart syndrome with an intact atrial septum. JTCVS Open. 2020;1:51‐56. doi:10.1016/j.xjon.2020.03.001
32.
TulzerAArztWPrandstetterCTulzerG. Atrial septum stenting in a foetus with hypoplastic left heart syndrome and restrictive foramen ovale: an alternative to emergency atrioseptectomy in the newborn—a case report. Eur Heart J Case Rep. 2020;4(1):1‐4. doi:10.1093/ehjcr/ytaa005
33.
MustafaHJAghajaniFJawwadMShahNAbuhamadAKhalilA. Fetal cardiac intervention in hypoplastic left heart syndrome with intact or restrictive atrial septum, systematic review, and meta-analysis. Prenat Diagn. 2023:pd.6420. doi:10.1002/pd.6420
34.
VidaVLBachaEALarrazabalA, et al.Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: surgical experience from a single center. Ann Thorac Surg. 2007;84(2):581‐586. doi:10.1016/j.athoracsur.2007.04.017
35.
ChaturvediRRRyanGSeedMVan ArsdellGJaeggiET. Fetal stenting of the atrial septum: technique and initial results in cardiac lesions with left atrial hypertension. Int J Cardiol. 2013;168(3):2029‐2036. doi:10.1016/j.ijcard.2013.01.173
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