Fetal Interventions

Abstract

With evolving catheter and imaging technologies and better patient selection, fetal cardiac interventions have become an important treatment modality in the last 10–15 years. They may remodel cardiac morphology and function resulting in improved pre- and postnatal outcomes, including an increased likelihood of achieving a biventricular circulation. Indications for interventions include aortic stenosis and evolving hypoplastic left heart syndrome (HLHS), HLHS with intact or highly restrictive interatrial septum, and pulmonary atresia or critical pulmonary stenosis with intact ventricular septum and evolving hypoplastic right heart syndrome. In utero aortic valvuloplasty results in a biventricular circulation in approximately 1/3 of patients, whereas a biventricular (or 1½) circulation is achieved in most patients who undergo pulmonary valvuloplasty. In utero atrial septostomy is associated with a more stable postnatal course before surgery for HLHS. This chapter will discuss the current indications, techniques, and outcomes of fetal cardiac interventions