Fetal Intervention

Published on 07/06/2015 by admin

Filed under Neonatal - Perinatal Medicine

Last modified 07/06/2015

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32 Fetal Intervention

III. TREATMENT

A. Fetal aortic stenosis

1. Fetal intervention is currently only justifiable for a severe form of aortic stenosis that has a high likelihood of evolving into HLHS or in which heart failure has evolved as a result of the severe LV dysfunction and/or mitral insufficiency.

2. Mild or even moderate forms of fetal aortic stenosis do not usually result in LV hypoplasia or fetal heart failure. The fetus can undergo neonatal balloon aortic valvuloplasty (Figs. 32-1 and 32-2) with satisfactory results and long-term outcomes.

3. The postnatal outcomes for HLHS vary among institutions.

a. The best reported survival ranges from 80% to 90% for the first-stage Norwood surgery and 70% to 80% through the Fontan stage.

b. The long-term survival beyond 20 years of age is unknown.

c. In the context of progressive heart failure or fetal hydrops, the likelihood of survival if the fetus is not at a truly viable age and size for intervention is extremely low.

4. Fetal intervention can be justified if the intent is to prevent progression of severe aortic stenosis to HLHS or fetal hydrops.

a. We select patients we believe will have HLHS at birth but whose LV is still within the normal range at the time of diagnosis.

b. Fetal echocardiography shows features of fetal aortic stenosis with evolving HLHS.

c. Counseling.

       (b) Bradycardia.
       (f) Premature birth.

d. Contraindications to fetal intervention.

    (1) Fetal.
       (a) Anesthesia risk.

e. Fetal cardiac intervention team.

f. Outcomes and follow-up after fetal intervention for aortic stenosis.