Foetal cardiac interventions: overview and perspectives in 2012

Abstract

Serial ultrasound studies of human foetuses have shed light on the intrauterine history of most foetal cardiac malformations, rhythm disturbances and extracardiac conditions that may interfere with an adequate cardiac function. Over the course of gestation, altered pressures and flows within the heart from both cardiac and extracardiac origins as well as cardiac arrythmias commonly result in severe cardiac damage or failure in affected foetuses. As these factors detrimentally impact on mortality and morbidity, as well as postnatal treatment options, a growing spectrum of foetal interventions has been developed over the past three decades. Therapeutic approaches vary largely, and there is an important differentiation to be made (Fig. 1): Most interventions aim at improving the foetal cardiac function and increasing the chances of intrauterine survival by addressing extracardiac conditions, commonly twin-to-twin-transfusion syndrome (TTTS), foetal hydrothorax or anaemia. In contrast, direct foetal cardiac interventions in structural cardiac malformations like severe semilunar valve obstruction aim at improving postnatal survival and prognosis in most cases. These potential benefits are bought at the risk of technical failure or adverse outcomes, and assume a life-saving character only when the disease progression prompts a mother’s decision to terminate the pregnancy, or in rare cases of cardiac failure.