The case for fetal cardiac intervention.

Surgery for congenital heart disease is now often performed in the first months of life because mortality is higher and myocardial damage more serious in unoperated children or those undergoing delayed surgery. Fetal cardiac intervention may prove a logical extension and has been proposed for fetuses with critical semilunar valve stenosis or atresia. Early ventricular decompression may halt disease progression, alter the natural history and improve postnatal outcomes either by preserving a two-ventricle circulation or by improving the outlook for single-ventricle candidates because of a healthier myocardium and pulmonary bed. Without intervention, fetuses with a closed interatrial septum may develop circulatory failure resulting in hydrops and intrauterine death, whereas in utero balloon atrial septostomy may stabilise the situation and increase duration of pregnancy.