Structural heart disease

doi:10.1017/CBO9780511997778.014

Chapter 9.3 - Structural heart disease

Fetal cardiac interventions

from Section 2 - Fetal disease

Published online by Cambridge University Press: 05 February 2013

Wayne Tworetzky and

Louise E. Wilkins-Haug

Edited by

Mark D. Kilby ,

Anthony Johnson and

Dick Oepkes

Show author details

Mark D. Kilby: Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson: Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes: Affiliation:
Department of Obstetrics, Leiden University Medical Center

Book contents

Get access

Summary

Introduction

This chapter will summarize the current state of trans-catheter fetal cardiac interventions (FCI) for a select group of congenital heart defects (CHDs). A more comprehensive description of the natural history, techniques, and outcomes can be found in the papers referenced. In this chapter we intend to summarize the current approach and highlight limitations and controversies. The field of FCI is fraught with ethical controversies, technical challenges, and imperfect outcomes. Despite this, it is an exciting field with the potential to dramatically alter or improve cardiac function in some patients.

Ethics

Fetal therapies, ranging from transplacental administration of medication to minimally invasive ultrasound or fetoscopic-guided procedures to more invasive open fetal surgery, are commonplace in some centers around the world. Yet despite marvelous innovations in the field, there are few studies that show clear benefit and only a handful of randomized controlled studies have been performed. If it were not for the non-trivial risk to the mother, the healthy patient, fetal therapy for otherwise correctable or even lethal defects would seem to be prudent and warrant the substantial investment in time and personnel. The ethical issues pertaining to non-cardiac defects have been discussed elsewhere and are beyond the scope of this chapter.

Keywords

postnatal therapy fetal cardiac lesion hypoplastic left heart syndrome intact atrial septum structural heart disease fetal cardiac interventions aortic stenosis congenital heart defects

Information

Type: Chapter
Information: Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 123 - 127

DOI: https://doi.org/10.1017/CBO9780511997778.014 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Maxwell, D, Allan, L, Tynan, MJ. Balloon dilatation of the aortic valve in the fetus: a report of two cases. Br Heart J 1991;65(5):256–8.Google Scholar

Kohl, T, Sharland, G, Allan, LD, et al. World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction. Am J Cardiol 2000;85(10):1230–3.Google Scholar

Simpson, JM, Sharland, GK. Natural history and outcome of aortic stenosis diagnosed prenatally. Heart 1997;77(3):205–10.Google Scholar

Mäkikallio, K, McElhinney, DB, Levine, JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation 2006;113(11):1401–5.Google Scholar

Tworetzky, W, Wilkins-Haug, L, Jennings, RW, et al. Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique, and results of successful intervention. Circulation 2004;110(15):2125–31.Google Scholar

McElhinney, DB, Marshall, AC, Wilkins-Haug, LE, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation 2009;120(15):1482–90.Google Scholar

Wilkins-Haug, LE, Tworetzky, W, Benson, CB, et al. Factors affecting technical success of fetal aortic valve dilation. Ultrasound Obstet Gynecol 2006;28(1):47–52.Google Scholar

Marshall, AC, Tworetzky, W, Bergersen, L, et al. Aortic valvuloplasty in the fetus: technical characteristics of successful balloon dilation. J Pediatr 200;147(4):535–9.

Arzt, W, Wertaschnigg, D, Veit, I, et al. Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures. Ultrasound Obstet Gynecol 2011;37(6):689–95.Google Scholar

Mizrahi-Arnaud, A, Tworetzky, W, Bulich, LA, et al. Pathophysiology, management, and outcomes of fetal hemodynamic instability during prenatal cardiac intervention. Pediatr Res 2007;62(3):325–30.Google Scholar

Vlahos, AP, Lock, JE, McElhinney, DB, van der Velde, ME. Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy. Circulation 2004;109(19):2326–30.Google Scholar

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):554–60.Google Scholar

Glatz, JA, Tabbutt, S, Gaynor, JW, et al. Hypoplastic left heart syndrome with atrial level restriction in the era of prenatal diagnosis. Ann Thorac Surg 2007;84(5):1633–8.Google Scholar

Marshall, AC, Levine, J, Morash, D, et al. Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn 2008;28(11):1023–8.Google Scholar

Selamet Tierney, ES, Wald, RM, McElhinney, DB, et al. Changes in left heart hemodynamics after technically successful in-utero aortic valvuloplasty. Ultrasound Obstet Gynecol 2007;30(5):715–20.Google Scholar

Marshall, AC, van der Velde, ME, Tworetzky, W, et al. Creation of an atrial septal defect in utero for fetuses with hypoplastic left heart syndrome and intact or highly restrictive atrial septum. Circulation 2004;110(3):253–8.Google Scholar

Salvin, JW, McElhinney, DB, Colan, SD, et al. Fetal tricuspid valve size and growth as predictors of outcome in pulmonary atresia with intact ventricular septum. Pediatrics 2006;118(2):e415–20.Google Scholar

Roman, KS, Fouron, JC, Nii, M, et al. Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum. Am J Cardiol 2007;99(5):699–703.Google Scholar

Gardiner, HM, Belmar, C, Tulzer, G, et al. Morphologic and functional predictors of eventual circulation in the fetus with pulmonary atresia or critical pulmonary stenosis with intact septum. J Am Coll Cardiol 2008;51(13):1299–308.Google Scholar

Tulzer, G, Arzt, W, Franklin, RC, et al. Fetal pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum. Lancet 2002;360(9345):1567–8.Google Scholar

Tworetzky, W, McElhinney, DB, Marx, GR, et al. In utero valvuloplasty for pulmonary atresia with hypoplastic right ventricle: techniques and outcomes. Pediatrics 2009;124(3):e510–8.Google Scholar

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.