Indications for Fetal Pulmonary Valvuloplasty

Abstract

In parallel to the interventions on the aortic valve, pulmonary valvuloplasty in utero may follow two different indications. The first is to simply ensure fetal survival by reversing fetal hydrops caused by severe right-ventricular decompensation. The second and more ambitious goal is reducing fetal morbidity, by promoting intrauterine growth on ventricular, valvular, and vascular level so as to avoid the development of a functionally univentricular heart. The achievements of these goals depend on an evidence-based selection of suitable candidates, on the level of expertise and cooperation of the team performing the intervention, and on the availability of adequate technical equipment. In light of improving results of postnatal treatment ranging from postnatal dilatation, radio-frequency perforation of atretic valves, and surgical strategies of one-and-a-half heart or univentricular course, only limited types of lesions have the potential to benefit from prenatal interventions.