Fetal Cardiac Interventions

Team approach is essential to the success of an interventional cardiac program. The parents should be counseled jointly by the fetal medicine team and the cardiologist, and the risk of fetal demise during the procedure or after it made explicit. In cases in which pulmonary venous Doppler abnormalities exist, the parents need to understand that the risk of neonatal death is high as a result of the combination of severe pulmonary and cardiac pathology. Fetal therapy may prove beneficial in selected cases, minimizing secondary damage to the fetal myocardium and pulmonary vascular bed, and therefore may be more successful if performed early, rather than later, in pregnancy. Continued development of smaller and specialized equipment will help in this endeavor and is to be encouraged. Patient selection will best be rationalized by multicenter cooperation to establish an "intention-to-treat" database.