Gardiner H M
Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W120HS, UK.
Heart. 2009 Oct;95(20):1648-52. doi: 10.1136/hrt.2007.138420. Epub 2009 May 13.
Surgery for congenital heart disease is now often performed in the first months of life because mortality is higher and myocardial damage more serious in unoperated children or those undergoing delayed surgery. Fetal cardiac intervention may prove a logical extension and has been proposed for fetuses with critical semilunar valve stenosis or atresia. Early ventricular decompression may halt disease progression, alter the natural history and improve postnatal outcomes either by preserving a two-ventricle circulation or by improving the outlook for single-ventricle candidates because of a healthier myocardium and pulmonary bed. Without intervention, fetuses with a closed interatrial septum may develop circulatory failure resulting in hydrops and intrauterine death, whereas in utero balloon atrial septostomy may stabilise the situation and increase duration of pregnancy.
先天性心脏病手术现在常常在出生后的头几个月进行，因为未经手术治疗的儿童或接受延迟手术的儿童死亡率更高，心肌损伤也更严重。胎儿心脏介入治疗可能是一种合理的扩展，已被提议用于患有严重半月瓣狭窄或闭锁的胎儿。早期心室减压可能会阻止疾病进展，改变自然病程，并通过维持双心室循环或改善单心室候选者的预后（因为心肌和肺床更健康）来改善出生后的结局。如果不进行干预，房间隔闭合的胎儿可能会发生循环衰竭，导致水肿和宫内死亡，而宫内球囊房间隔造口术可能会稳定病情并延长妊娠期。
