title: Fetal interventions for congenital heart disease.
abstract: OBJECTIVE
  This article discusses the rationale, patient selection, technical aspects, and outcomes of percutaneous, ultrasound-guided fetal cardiac intervention (FCI) for structural congenital heart disease.
  
  
  RESULTS
  FCI is most commonly performed for three forms of congenital heart disease: severe aortic stenosis with evolving hypoplastic left heart syndrome (HLHS), pulmonary atresia with intact ventricular septum and evolving hypoplastic right heart syndrome, and HLHS with intact or highly restrictive atrial septum. For severe aortic stenosis and pulmonary atresia with intact ventricular septum, the goal of intervention is to alter the natural history such that a biventricular circulation may be achieved postnatally. A growing number of patients have achieved a biventricular circulation; however, patient selection and postnatal management strategy are essential for success. HLHS with intact or highly restrictive atrial septum is one of the most lethal forms of congenital heart disease, and the goal of FCI is to improve survival. Although the creation of an atrial communication in utero is technically feasible and may permit greater stability in the immediate postnatal period, significant improvements in survival have not yet been reported.
  
  
  CONCLUSIONS
  FCI is an evolving form of treatment for congenital heart disease that holds promise for select patients. Critical evaluation of both short and long-term outcomes is warranted.
authors.affiliation: aDepartment of Pediatrics, Division of Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York City, New York bDepartment of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lindsay R
authors.initials: LR
authors.lastname: Freud
authors.forename: Wayne
authors.initials: W
authors.lastname: Tworetzky
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D005315:Fetal Diseases / Q000601:surgery*; D005318:Fetal Heart / Q000601:surgery; D046128:Fetal Therapies / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D018579:Patient Selection; D018633:Pulmonary Atresia / Q000601:surgery