Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 May;96(5):1276-1287. doi: 10.1016/j.mayocp.2020.08.029.
Over the past 40 years, the medical and surgical management of congenital heart disease has advanced considerably. However, substantial room for improvement remains for certain lesions that have high rates of morbidity and mortality. Although most congenital cardiac conditions are well tolerated during fetal development, certain abnormalities progress in severity over the course of gestation and impair the development of other organs, such as the lungs or airways. It follows that intervention during gestation could potentially slow or reverse elements of disease progression and improve prognosis for certain congenital heart defects. In this review, we detail specific congenital cardiac lesions that may benefit from fetal intervention, some of which already have documented improved outcomes with fetal interventions, and the state-of-the-science in each of these areas. This review includes the most relevant studies from a PubMed database search from 1970 to the present using key words such as fetal cardiac, fetal intervention, fetal surgery, and EXIT procedure. Fetal intervention in congenital cardiac surgery is an exciting frontier that promises further improvement in congenital heart disease outcomes. When fetuses who can benefit from fetal intervention are identified and appropriately referred to centers of excellence in this area, patient care will improve.
在过去的 40 年中，先天性心脏病的医学和外科治疗已经取得了很大的进展。然而，对于某些发病率和死亡率较高的病变，仍有很大的改进空间。尽管大多数先天性心脏疾病在胎儿发育过程中能够很好地耐受，但某些异常情况会随着妊娠的进行而逐渐加重，并损害其他器官（如肺或气道）的发育。因此，妊娠期间的干预可能会潜在地减缓或逆转疾病进展的某些方面，并改善某些先天性心脏缺陷的预后。在这篇综述中，我们详细介绍了可能受益于胎儿干预的特定先天性心脏病变，其中一些病变已经通过胎儿干预获得了有记录的改善结果，以及这些领域的最新技术水平。这篇综述包括了从 1970 年至今使用关键词如胎儿心脏、胎儿干预、胎儿手术和EXIT 程序在 PubMed 数据库中搜索到的最相关的研究。先天性心脏病胎儿干预是一个令人兴奋的前沿领域，有望进一步改善先天性心脏病的预后。当确定可以从胎儿干预中受益的胎儿并将其适当地转介到该领域的卓越中心时，患者的护理将得到改善。
