In-utero intervention for severe congenital heart disease.
The concept of fetal therapy is well established for many disorders diagnosed before birth but practical issues regarding its introduction into clinical practice are more difficult. Cardiac malformations are common, with major lesions affecting about 3.5 per thousand pregnancies; however, only a small proportion of these is likely to benefit from an intrauterine intervention. In addition, there are no good animal models of human cardiac disease and our knowledge of the underlying mechanisms is at best sketchy. This combination of factors has resulted in slow progress in developing effective therapies for the intrauterine management of cardiac disease. Recent research and clinical developments have included percutaneous valvuloplasty for severe aortic and pulmonary stenosis, perforation of the closed or restrictive inter-atrial septum and pacing for complete heart block. Progress in these endeavours has been variable but - overall - shows promise for treatment of the human fetus.
Gardiner
Helena M
HM
Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London, W12 ONN, UK. helena.gardiner@imperial.ac.uk
D005315:Fetal Diseases / Q000453:epidemiology / Q000628:therapy*; D005318:Fetal Heart / Q000002:abnormalities / Q000601:surgery; D046128:Fetal Therapies / Q000009:adverse effects / Q000379:methods*; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D018579:Patient Selection; D016896:Treatment Outcome