Fetal intervention for critical aortic stenosis: advances, research and postnatal follow-up.
OBJECTIVE
Fetal aortic valvuloplasty is intended to alter the natural history of aortic stenosis evolving to hypoplastic left heart syndrome. The most recently reported data and advances on this procedure were reviewed.


RESULTS
The highlights of the latest experience are the advances in further understanding of the prenatal and postnatal natural history of this disease, and the way in which fetal aortic valvuloplasty impacts on it, the identification of new predictors of biventricular outcome, and the report of postnatal survival of intervened patients. Recently reported short-term and middle-term results are encouraging. Experimental research on procedural aspects is ongoing, with no definite results. Multicenter studies are also ongoing.


CONCLUSIONS
In recent years, there have been advances in the understanding of the prenatal and postnatal process of aortic stenosis evolving to hypoplastic left heart syndrome and the effects of fetal aortic valvuloplasty, as well as the need of adequate postnatal therapeutic strategies for these patients. Procedural aspects are being studied with animal models, but still need far more experience before human application. Long-term results are still to be discovered, and multicenter studies may provide a new perspective. Continuing research is mandatory so that ultimately fetal heart intervention finds its place among the therapeutic resources for congenital heart disease.
Pediatric Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Pablo
P
Marantz
Sofía
S
Grinenco
D000818:Animals; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000517:prevention & control; D007231:Infant, Newborn; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D018579:Patient Selection; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal