title: [Fetal cardiac interventions - are we ready for them?].
abstract: OBJECTIVE
  The aim of the study was to analyze types and methods of intrauterine fetal cardiac interventions performed between June 2011 and December 2013, and to assess the perinatal management of the neonates.
  
  
  METHODS
  The program was developed after analysis of the available literature, practical individual training in Linz, Austria, and simulation of the procedure in a dissecting-room. The rules for anesthesia in pregnant women and their fetuses were developed. The interventions were performed in fetuses with critical cardiac defects, in the operating room, under ultrasonographic control. The protocol was approved by the Local Bioethics Committee at the Centre of Postgraduate Medical Education.
  
  
  METHODS
  We included fetuses with critical aortic stenosis (n=29), critical pulmonary stenosis (n=2), and closed or extremely restricted foramen ovale (n=7). Between June 2011 and December 2013, the team comprised of JD, MD and AK conducted 42 interventions in 35 fetuses, including 32 balloon aortic valvuloplasties (in 29 fetuses), 2 pulmonary valvuloplasties, 4 balloon atrial septostomies and 4 atrial septal stent placement. Three fetuses required both, aortic valvuloplasty and fenestration of the atrial septum.
  
  
  RESULTS
  Out of the 42 procedures, 41 (97%) were technically successful. We recorded 3 cases of fetal demise associated with the intervention. We modulated the protocol of anesthesia given to pregnant women, switching from general to local anesthesia with intravenous sedation. We always provided additional fetal anesthesia with fentanyl and atracurium via the umbilical vein.
  
  
  CONCLUSIONS
  Based on our 2.5-year experience, it seems safe to conclude that all types of fetal cardiac interventions may be successfully conducted at Polish centers. The procedures are safe for the pregnant women and improve fetal status. Most of the neonates treated prenatally were referred in good general condition to a tertiary pediatric cardiology and cardiac surgery center
authors.forename: Marzena
authors.initials: M
authors.lastname: Dębska
authors.forename: Joanna
authors.initials: J
authors.lastname: Szymkiewicz-Dangel
authors.forename: Adam
authors.initials: A
authors.lastname: Koleśnik
authors.forename: Piotr
authors.initials: P
authors.lastname: Kretowicz
authors.forename: Beata
authors.initials: B
authors.lastname: Rebizant
authors.forename: Jacek
authors.initials: J
authors.lastname: Witwicki
authors.forename: Romuald
authors.initials: R
authors.lastname: Dębski
mesh_terms: D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005318:Fetal Heart / Q000000981:diagnostic imaging; D054085:Foramen Ovale / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods