Fetal Cardiac Intervention
Pp. 209-224 (16)
Pablo Marantz, Sofía Grinenco and Lucas Otãno
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.
Aortic valve stenosis, Catheterization, Congenital heart defects,
Critical aortic stenosis, Diverticulum, Fetal cardiac intervention, Fetal cardiology,
Fetal echocardiography, Fetal heart, Fetal pulmonary valvuloplasty, Fetal
therapies, Hydrops fetalis, Hypoplastic left heart syndrome, Intrauterine
valvuloplasty, Mitral valve insufficiency, Pericardial effusion, Prenatal diagnosis,
Pulmonary atresia with intact ventricular septum, Stent, Ultrasonography.
Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.