Fetal Aortic Valvuloplasty (FAV)

In the early 1990s, some renowned pediatric cardiologists such as Dr. Lindsay Allan in Europe, Dr. Norman Silverman in the USA, and Dr. Jean Claude Fouron in Canada applied evolving echocardiographic technologies to diagnose congenital heart diseases (CHD) in utero. A novel sub-specialty called fetal cardiology was born. Not only the prenatal diagnosis could be accurately made, but also serial echocardiographic examinations of fetuses with CHD allowed for a better understanding of the natural history of some diseases while still in utero. It was not long when the first fetal transcatheter aortic valvuloplasty was successfully performed in the UK under the leadership of Drs. Allan and Tynan, resulting in the advent of fetal interventional cardiology. Despite some initial resistance of the pediatric cardiology community to embrace such prenatal interventions because of legitimate concerns regarding their efficacy and ethics, the Boston group led by Dr. Tworetzky decided to push forward a strong program in this field in the early 2000s. Since then, their group have published a great deal of good data in fetal cardiac procedures, which helped to establish their role in the management of patients with fetal aortic stenosis (AS) and evolving hypoplastic left heart syndrome (HLHS), pulmonary atresia and intact septum, and HLHS with intact interatrial septum or restrictive atrial septal defect. With evolving catheter and imaging technologies associated with favorable local scenarios, other groups also embarked on similar programs including ours in Brazil led by Dr. Fontes Pedra and the one in Vienna led by Dr. Tulzer. This chapter reviews our experience with fetal aortic valvuloplasty (FAV).