Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Semin Fetal Neonatal Med. 2017 Dec;22(6):399-403. doi: 10.1016/j.siny.2017.08.006. Epub 2017 Sep 1.
Fetal cardiac intervention (FCI) is a relatively new and continually evolving field, and, for select cardiac defects, offers the potential to alter the progression of the disease and improve outcomes. It is a procedure that requires a collaborative effort between maternal-fetal medicine, interventional cardiology and fetal echo/ultrasound specialists, as well as fetal and maternal anesthesiologists, nursing specialists, and social workers. This article reviews the most recently reported data and advances in FCI. Currently, FCI is most frequently performed in fetuses with severe aortic stenosis (AS) with evolving hypoplastic left heart syndrome (eHLHS), established HLHS with intact or highly restrictive atrial septum (IAS), and pulmonary atresia with intact ventricular septum (PA-IVS) with evolving hypoplastic right heart syndrome (eHRHS). The goal of FCI for eHLHS and eHRHS is to promote a postnatal biventricular circulation with, theoretically, the potential for better long-term outcomes. In HLHS with IAS the aim is to improve survival. Contemporary data for FCI demonstrate limited maternal risks and improving technical success. With experience, FCI in severe AS with eHLHS has shown improved rates of biventricular outcome and early survival. Limited data for PA-IVS show promise for improving postnatal biventricular outcomes; however, for HLHS with IAS, FCI has yet to clearly demonstrate improved survival. FCI has an evolving role in the management of congenital heart defects. Ongoing analysis of disease progression, patient selection and postnatal outcomes, in conjuncture with technologic innovations and a multicenter collaborative approach, is essential as the field expands.
胎儿心脏介入治疗（FCI）是一个相对较新且不断发展的领域，对于某些特定的心脏缺陷，它具有改变疾病进程和改善预后的潜力。这是一项需要母体胎儿医学、介入心脏病学和胎儿超声心动图专家，以及胎儿和母体麻醉师、护理专家和社会工作者共同合作的程序。本文回顾了 FCI 最近报道的数据和进展。目前，FCI 最常应用于患有严重主动脉瓣狭窄（AS）伴进行性左心发育不良综合征（eHLHS）、完整或高度限制性房间隔（IAS）的已确诊 HLHS，以及伴进行性右心发育不良综合征（eHRHS）的肺动脉瓣闭锁伴完整室间隔（PA-IVS）的胎儿。FCI 治疗 eHLHS 和 eHRHS 的目的是促进产后双心室循环，理论上具有更好的长期预后的潜力。对于 IAS 的 HLHS，其目标是提高生存率。FCI 的当代数据显示，产妇风险有限，技术成功率提高。随着经验的积累，在严重 AS 伴 eHLHS 中，FCI 已显示出提高双心室结局和早期生存率的趋势。PA-IVS 的有限数据显示出改善产后双心室结局的潜力；然而，对于 IAS 的 HLHS，FCI 尚未明确显示出生存率的提高。FCI 在先天性心脏病的管理中具有不断发展的作用。随着该领域的不断发展，持续分析疾病进展、患者选择和产后结局，以及技术创新和多中心协作方法至关重要。
