Controversies of fetal cardiac intervention

被引:21
作者
Pavlovic, Mladen [1 ,2 ]
Acharya, Ganesh [1 ,3 ]
Huhta, James C. [1 ]
机构
[1] Univ S Florida, Coll Med, Dept Pediat, St Petersburg, FL 33701 USA
[2] Univ S Florida, All Childrens Hosp, Childrens Res Inst, St Petersburg, FL 33701 USA
[3] Univ Bern, Dept Pediat, Dept Obstet & Gynecol, Bern, Switzerland
关键词
congenital heart disease; fetal intervention; hypoplastic left heart syndrome; pulmonary atresia;
D O I
10.1016/j.earlhumdev.2008.01.006
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Remarkable advances in ultrasound imaging technology have made it possible to diagnose fetal cardiovascular lesions as early as 12-14 weeks of gestation and to assess their physiological relevance by echocardiography. Moreover, invasive techniques have been developed and refined to relieve significant congenital heart disease (CHD), such as critical aortic and pulmonary stenoses in the pediatric population including neonates. Recognition of the fact that certain CHDs can evolve in utero, and early intervention may improve the outcome by altering the natural history of such conditions has led to the evolution of a new fetal therapy, i.e. fetal cardiac intervention. Two entities, pulmonary valvar atresia and intact ventricular septum (PA/IVS) and hypoplastic left heart syndrome (HLHS), are associated with significant morbidity and mortality even with postnatal surgical therapy. These cases are believed to occur due to restricted blood flow, leading to impaired growth and function of the right or left ventricle. Therefore, several centers started the approach of antenatal intervention with the primary goal of improving the blood flow through the stenotic/atretic valve orifices to allow growth of cardiac structures. Even though centers with a reasonable number of cases seem to have improved the technique and the immediate outcome of fetal interventions, the field is challenged by ethical issues as the intervention puts both the mother and the fetus at risk. Moreover, the perceived benefits of prenatal treatment have to be weighed against steadily improving postnatal surgical and hybrid procedures, which have been shown to reduce morbidity and mortality for these complex heart defects. This review is an attempt to provide a balanced opinion and an update on fetal cardiac intervention. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:149 / 153
页数:5
相关论文
共 27 条
[1]  
Boneva RS, 2001, CIRCULATION, V103, P2376
[2]   Clinical impact of first and early second trimester fetal echocardiography on high risk pregnancies [J].
Carvalho, JS ;
Moscoso, G ;
Tekay, A ;
Campbell, S ;
Thilaganathan, B ;
Shinebourne, EA .
HEART, 2004, 90 (08) :921-926
[3]   Validation and re-evaluation of a discriminant model predicting anatomic suitability for biventricular repair in neonates with aortic stenosis [J].
Colan, SD ;
McElhinney, DB ;
Crawford, EC ;
Keane, JF ;
Lock, JE .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 47 (09) :1858-1865
[4]   Interim mortality in pulmonary atresia with intact ventricular septum [J].
Fenton, KN ;
Pigula, FA ;
Gandhi, SK ;
Russo, L ;
Duncan, KF .
ANNALS OF THORACIC SURGERY, 2004, 78 (06) :1994-1998
[5]   Pulmonary balloon valvuloplasty in a fetus with critical pulmonary stenosis/atresia with intact ventricular septum and heart failure [J].
Galindo, A ;
Gutiérrez-Larraya, F ;
Velasco, JM ;
de la Fuente, P .
FETAL DIAGNOSIS AND THERAPY, 2006, 21 (01) :100-104
[6]   Progression of fetal heart disease and rationale for fetal intracardiac interventions [J].
Gardiner, HM .
SEMINARS IN FETAL & NEONATAL MEDICINE, 2005, 10 (06) :578-585
[7]   Academic outcomes in children with congenital heart disease [J].
Griffin, KJ ;
Elkin, TD ;
Smith, CJ .
CLINICAL PEDIATRICS, 2003, 42 (05) :401-409
[8]  
HOFFMAN JIE, 1990, PEDIATR CLIN N AM, V37, P25
[9]   Advances in fetal cardiac intervention [J].
Huhta, J ;
Quintero, RA ;
Suh, E ;
Bader, R .
CURRENT OPINION IN PEDIATRICS, 2004, 16 (05) :487-493
[10]  
HUHTA JC, 2006, CURR OPIN PEDIATR, V18, P48