Fetal Cardiac Intervention Represents a New Era in Congenital Heart Disease

Anita J. Moon-Grady, MD

Anita J. Moon-Grady, MD

A few decades ago, congenital heart defects weren’t diagnosed until after babies were born. Then, fetal echocardiography allowed for early diagnosis and preparation. More recently, fetal cardiologists have successfully intervened in structural cardiac disease before birth. 

“Just 10 years ago, there was a lot of eyerolling about fetal intervention. It was considered impossible or even unethical,” said Carl L. Backer, MD, from Ann & Robert H. Lurie Children’s Hospital in Chicago. “But today, we’re realizing that fetal cardiologists are changing the natural history of congenital heart disease.”

At a Tuesday session moderated by Dr. Backer, two expert fetal cardiologists will present recent innovations, dramatic case studies, and practical information that every congenital heart surgeon needs to know.

“When a surgeon is consulted on a patient with a fetal diagnosis of aortic stenosis or another structural abnormality, it’s important to consider more than Norwood/Fontan. Fetal intervention is not a cure, but it opens up more options,” said Anita J. Moon-Grady, MD, from the University of California at San Francisco.

Meet the Experts:
Current State of Fetal Cardiac Intervention

11:00 a.m. – 12:00 p.m.
Room 217

The most common fetal procedure is balloon aortic valvuloplasty for severe aortic stenosis. The goal is to prevent the development of hypoplastic left heart syndrome (HLHS). Other fetal techniques include balloon pulmonary valvuloplasty and atrial septoplasty or stent placement. 

Only a handful of medical centers in the US perform fetal cardiac interventions. In Europe and South America, the procedures are more common because Norwood reconstruction is not available. A recent report from the International Fetal Cardiac Intervention Registry concluded that regionalization of treatment is the best path forward. 

“Fetal intervention procedures should not be attempted at every congenital heart surgery center,” said Dr. Backer. 

Parents who travel to regional centers for fetal interventions do so at great risk and expense. After the babies are born, they deserve appropriate follow-up care, so it’s especially important that local surgeons are prepared to evaluate and manage each newborn’s unique condition. 

“Fetal intervention is only the start of a treatment algorithm for the child. Postnatal care is very important for the ultimate outcome. Standard care is not enough. We have to rethink the paradigm,” said Dr. Moon-Grady. 

Wayne Tworetzky, MD, from Boston Children’s Hospital, will describe surgical strategies for babies who have undergone fetal interventions. Many neonates require additional balloon treatments, Ross surgeries, or other procedures to help them develop biventricular circulation. 

“What you see at birth is part of a continuum. The patient’s left ventricular function can get better over time. The disease may still be evolving,” said Dr. Moon-Grady.

These babies represent a new era in congenital heart disease, requiring that surgeons throughout the world learn what to expect when they arrive. And with each passing year, new fetal techniques and technologies are being developed to help these tiny patients survive. 

“Dr. Moon-Grady will enlighten us about a micro-pacemaker trial for fetal heart block, plus an IRB-approved laser treatment for HLHS with intact atrial septum,” said Dr. Backer. “It’s going to be a fascinating session with opportunity for a lively discussion.”