Mild tricuspid regurgitation: a benign fetal finding at various stages of gestation

concerns regarding the difficulty in establishing selection criteria and would encourage investigators in this area to develop further the natural history of HLHS in utero with additional imaging modalities such as three-and four-dimensional ultrasonography as well as biochemical profiling.We have followed with interest the contributions of Jouannic et al. and others regarding alternative approaches to the fetal heart in animal models.In our published series of 20 cases of ultrasound-guided direct transthorax fetal intervention for evolving HLHS we were able to increase technical success to 83% when laparotomy was an option but we agree that further work is needed 1 .While the morbidity of a maternal laparotomy is inherently greater than a percutaneous approach, we have not encountered the rate of preterm labor and preterm rupture of membranes associated with fetal surgeries performed by fetoscopy or hysterotomy.We concur that research into alternative approaches to the heart, optimization of imaging, and refinement of catheter devices is needed if this intervention is to represent a reproducible option for treatment.