Literature on Fetal Therapy on Interatrial Septum
Atrial septal restriction during fetal age is widely recognized as a lethal defect mostly in patients with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS) or highly restrictive atrial septum (HRAS). The poor outcome has been attributed to structural abnormalities of the pulmonary venous vasculature with arterialization of pulmonary veins and dilatation of lymphatics due to prenatal left atrial hypertension . This hypothesis has been recently supported by an interesting histopathologic study on changes in alveoloseptal lung parenchyma in fetuses with atrial septal restriction; these authors observed that severe lung disease is already evident in the second trimester, precisely in week 23 . Efforts to decompress the hypertensive left atrium in utero have been made since 2000 to treat neonatal hypoxia and hemodynamic instability, to improve anatomic lung abnormalities and outcome. This chapter is a review of the most significant experiences reported in literature on procedural and clinical results of fetal atrial septostomy procedures in HLHS and IAS/HRAS.
KeywordsPulmonary Vein Hypoplastic Left Heart Syndrome Critical Volume Interatrial Septum Pulmonary Vein Stenosis