Fetal cardiac interventions: myths and facts.
An early, primary, in utero cardiac abnormality may prevent normal heart development and cause irreversible secondary structural changes. The idea of foetal cardiac intervention stems from this understanding and focuses on antenatal intervention targeting the primary abnormality to allow normal flow and haemodynamics and thus normal heart development. Crucial aspects of foetal vascular access, varying foetal lie and structural complexity make it very hard to set procedural standards. The procedures are complex and are associated with significant maternal and foetal morbidity and mortality. The high risk-benefit ratio clearly explains the investigational nature of such therapies. With the development of minimally invasive techniques and continued animal experiments, foetal interventional therapy may see a low rate of morbidity and mortality, improving the prognosis of newborns with congenital heart disease previously considered incurable.
Centre de référence malformations cardiaques congénitales complexes-M3C, hôpital Necker-Enfants-Malades, cardiologie pédiatrique, assistance publique des hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
Isabelle
I
Van Aerschot
Jonathan
J
Rosenblatt
Younès
Y
Boudjemline
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004452:Echocardiography; D005260:Female; D005313:Fetal Death; D005318:Fetal Heart / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000196:embryology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal