Matsui Hikoro, Gardiner Helena
Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Queen Charlotte's and Chelsea Hospital, Hammersmith Campus, London W12 ONH, UK.
Semin Fetal Neonatal Med. 2007 Dec;12(6):482-9. doi: 10.1016/j.siny.2007.06.003. Epub 2007 Sep 10.
Fetal cardiac valvuloplasty has been proposed for progressive cardiac disease with a poor prognosis, such as critical aortic stenosis and pulmonary atresia with intact ventricular septum and balloon atrial septostomy for hypoplastic left heart syndrome, or simple transposition of the great arteries with closed or restrictive inter-atrial communication. It is anticipated that early rescue of ventricles or the pulmonary veins from an unfavourable environment may promote healthier ventricular and vascular growth and improve postnatal outcomes. While close collaboration between the fetal medicine specialist and perinatal cardiologist may optimize the chances of technical success, obstacles to progress include the relative rarity of suitable cases and late referral for therapy. In common with other interventions in fetal medicine, there is a learning curve, and it would benefit progress if the procedures were initially concentrated in just a few centres to enable them to develop skills and experience. Following careful evaluation, it may then be desirable to train further centres and roll out best practice models.
对于预后较差的进行性心脏病，如严重主动脉瓣狭窄、室间隔完整的肺动脉闭锁，以及针对左心发育不全综合征的球囊房间隔造口术，或伴有封闭或限制性房间交通的单纯大动脉转位，已提出进行胎儿心脏瓣膜成形术。预计早期将心室或肺静脉从不利环境中解救出来，可能会促进心室和血管更健康地生长，并改善出生后的结局。虽然胎儿医学专家和围产期心脏病专家之间的密切合作可能会优化技术成功的机会，但进展的障碍包括合适病例相对较少以及治疗转诊较晚。与胎儿医学中的其他干预措施一样，存在学习曲线，如果这些手术最初集中在少数几个中心进行，以使它们能够发展技能和经验，将有利于取得进展。经过仔细评估后，可能需要培训更多中心并推广最佳实践模式。
