Chapter 11

Fetal Cardiac Intervention

Pablo Marantz, Sofía Grinenco and Lucas Otãno

Abstract

Fetal heart interventions have been developed for select cardiac defects in order to alter the natural history of disease and improve patients´ outcomes. Intervention rationale and patient selection criteria, as well as associated risks and procedural technical considerations have been reviewed. Fetal aortic valvuloplasty is performed in fetuses with severe aortic stenosis with evolving hypoplastic left heart syndrome, with improving rates of biventricular outcome and early survival; and in rare cases of fetuses with aortic stenosis with severe mitral insufficiency and restrictive foramen ovale. Fetal atrial septoplasty with atrial septal stent placement in patients with hypoplastic left heart syndrome with intact or highly restrictive atrial septum has not yet demonstrated a decrease in the disease´s associated mortality. There is limited data regarding the results of fetal pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum with evolving hypoplastic right ventricle. Pericardiocentesis for severe pericardial effusion secondary to heart tumors or a cardiac diverticulum or aneurysm continues to be a rare procedure in an exceptional condition. Key aspects regarding selection criteria for intervention and technical and clinical results, require further study in a multicenter collaborative approach.

Total Pages: 209-224 (16)

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