Future Directions of Fetal Interventions in Congenital Heart Disease

Fetal interventions for congenital heart disease have become an important treatment modality with well-established indications, such as aortic stenosis and evolving hypoplastic left heart syndrome (HLHS), HLHS with intact or highly restrictive interatrial septum, and pulmonary atresia or critical pulmonary stenosis with intact ventricular septum and evolving hypoplastic right heart syndrome. Fetal interventions should be performed by a well-trained multidisciplinary team at a referral center with a large number of patients and an institutional commitment to support a fully developed fetal cardiac program. The technique has been standardized with catheters being inserted through needles that are advanced across the maternal abdomen and the fetal heart in anesthetized patients. These procedures may alter the natural history of such diseases, resulting in improved postnatal outcomes measured by better clinical stability, survival, and achievement of a biventricular circulation. Expansion of indications, better imaging and catheter technologies, and introduction of new forms of therapy are expected in the near future.