The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, TX, USA.
Best Pract Res Clin Obstet Gynaecol. 2019 Jul;58:42-54. doi: 10.1016/j.bpobgyn.2019.01.007. Epub 2019 Jan 17.
The aim of foetal cardiac therapy is to treat an abnormality at the developmental stage so that the process of cardiac growth, which is complex and relies on the volume and direction of circulating blood as well as genetic determinants, can continue. In reality, most cardiac interventions are palliative; hence, major abnormalities are still present at birth. Nevertheless, tangible benefits following successful foetal intervention include improved haemodynamics and reduction in secondary damage leading to better postnatal outcomes. In cases of semilunar valve stenosis, or atresia, foetal valvuloplasty aims to achieve a biventricular, rather than univentricular, circulation. Opening and stenting a restrictive atrial foramen may preserve the pulmonary function in cases of hypoplastic left heart syndrome, thereby increasing the chances of successful postnatal surgery. More recent endeavours include percutaneous implantation of a miniaturised pacemaker to treat complete heart block and the promotion of left-sided heart growth by chronic maternal hyperoxygenation. The true clinical benefit of these interventions over natural history remains uncertain because of the paucity of appropriate randomised controlled trials (RCTs). Foetal cardiac therapy must now move from a pioneering approach to one that is supported by evidence, as has been done successfully for other foetal therapies.
胎儿心脏治疗的目的是在发育阶段治疗异常，以便继续进行复杂的心脏生长过程，该过程依赖于循环血量和血流方向以及遗传决定因素。实际上，大多数心脏介入治疗都是姑息性的；因此，大多数主要的异常仍然存在于出生时。然而，成功的胎儿干预后有明显的获益，包括改善血液动力学和减少继发性损伤，从而获得更好的出生后结局。在半月瓣狭窄或闭锁的情况下，胎儿瓣成形术旨在实现双心室而不是单心室循环。在左心发育不全综合征的情况下，打开并支架限制的房间隔可能会保留肺功能，从而增加成功的产后手术的机会。最近的努力包括经皮植入微型起搏器以治疗完全性心脏传导阻滞和通过慢性母亲高氧血症促进左心生长。由于适当的随机对照试验（RCT）很少，这些干预措施相对于自然史的真正临床获益仍不确定。胎儿心脏治疗现在必须从开拓性方法转变为有证据支持的方法，就像其他胎儿治疗一样已经成功地做到了这一点。
