Key result
An ethics rounds discussion highlighted the arguments for and against performing a high-risk, innovative in utero pulmonary valvuloplasty on a 20-week-old fetus with critical pulmonary valve stenosis.
Case Report (n=1)
This ethics rounds highlights the complex decision-making process and ethical considerations involved in offering high-risk, experimental fetal cardiac interventions.
Emphasizes need for ethics input before high-risk fetal interventions; leaves open consensus on offering experimental procedures.
A 20-week-old fetus was diagnosed with critical pulmonary valve stenosis. Given the ultrasound findings, the outcome was difficult to predict. The fetal cardiologists discussed the possibility of a pulmonary valvuloplasty (an experimental procedure) with the parents, wherein the fetal right ventricle would be punctured with a long 18G needle, and through it, a wire advanced across the pulmonary valve, allowing for balloon dilation of the valve. The experimental procedure had been performed at a handful of centers. There were some reports of success. The parents sought an opinion at one of the referral centers that had tried the procedure. The doctors there recommended against it. The doctors at the original center were unsure whether they should try the procedure. The parents wanted it. In this ethics rounds, doctors and the parents discuss the arguments for and against a high-risk, innovative in utero procedure.
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Edwards et al. (2018) conducted a case report in Critical pulmonary valve stenosis (n=1). Fetal pulmonary valvuloplasty was evaluated. An ethics rounds discussion highlighted the arguments for and against performing a high-risk, innovative in utero pulmonary valvuloplasty on a 20-week-old fetus with critical pulmonary valve stenosis.
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