ABSTRACT
Introduction Maxwell, Allan, and Tynan from the United Kingdom were the rst to report a fetal aortic valvoplasty in 1990.1 Since then, fetal cardiac interventions have been performed for some complex congenital heart diseases (CHD) such as aortic stenosis (AS), hypoplastic le heart syndrome (HLHS) with intact or highly restrictive interatrial septum (IAS), and pulmonary atresia (PA) or critical pulmonary stenosis (CPS) with intact ventricular septum (IVS). Considerable technical diculties encountered in the early experiences were mainly due to limitations of imaging, equipment, and fetal lie unsuitability. Optimal patient selection was also challenging. However, with evolving and improving imaging and catheter/balloon technology, and the capability of changing fetal position in utero or performing the procedure through a limited uterine exposure, such procedures were revitalized by the Boston group from 2000 onward and became an integral part of the treatment algorithm for such complex CHD. e hypothesis behind these procedures has been that a prenatal intervention may remodel cardiac morphology and function to such an extent that they may favorably alter the in utero natural history, resulting in improved pre-and postnatal outcomes, including an increased likelihood of achieving a biventricular (BV) circulation. e technique has been standardized and reproduced with few variations among centers.2 In this chapter, we review the indications, techniques, and current results of fetal cardiac interventions.
