Abstract

Congenital heart disease (CHD) is the most common birth defect. Fetal cardiac intervention (FCI) is a novel and evolving field that has enabled us to modify the progression of CHDs and favorably change the postnatal outcomes by altering in utero anatomy and physiology. FCIs are only indicated in specific CHDs; CHDs diagnosed during midgestation that may progress and worsen in utero and cause fetal mortality and neonatal morbidity/mortality may benefit from FCI. These include fetal aortic valvuloplasty in severe aortic stenosis evolving to hypoplastic left heart syndrome (HLHS), fetal pulmonary valvuloplasty in pulmonary atresia with intact ventricular septum, critical pulmonary stenosis, atrial septoplasty and/or atrial stent in established HLHS, and transposition of great vessels with restricted or intact atrial septum. This review focuses on commonly performed interventions, candidate selection criteria, technical details, and outcomes of these procedures, which have been previously reported in the literature. Literature data about FCIs have demonstrated that technical success has improved, FCIs have limited maternal risks, and they do not cause any significant complications. Careful selection of candidates suitable for FCI, a multi-team approach, and performing these interventions in specialized centers and in collaborations will further improve the results.