Once the diagnostic evaluation has been completed, there may be several options to be considered by the patient/family. The available options depend on the specific congenital heart disease, and should be discussed with the patient by someone with training and experience in treating infants and children with heart disease. For some, fetal intervention or treatment may be an option. For some, if fetal or newborn intervention is not necessary, returning to their referring obstetrician and delivering in their local community may be preferable.
There are on the other hand a number of complex heart defects that will not benefit from intervention before birth, but will benefit greatly from prenatal diagnosis and management at an appropriate tertiary referral center. Many of these defects were life-threatening in past decades (before advances in newborn care of infants with congenital heart disease were developed) but now can be very successfully corrected shortly after birth. Some will benefit from being delivered at the tertiary center, while others can be safely transported to the tertiary center after being born elsewhere.
Many families will want to work out a plan for delivery and postnatal care with their obstetrician/perinatologist, pediatric cardiologist, and pediatric cardiac surgeon, so the baby can be stabilized and treated in the same center. Diagnosis of the heart defects before birth allows us to inform the patient/family and plan for the delivery of the baby to give the baby the best chance at a good outcome.
For fetuses earlier in gestation who have not already developed severe damage to the ventricular wall with underdevelopment of the heart on the side of the obstruction, intervention to dilate or enlarge the obstructed valve may be considered. An obstructed outlet valve can be dilated using a balloon catheter placed into the fetal heart through the mother’s abdominal wall, using Fetal Image-Guided Surgery (FIGS-IT), or through the uterine wall after opening the mother’s abdomen.
In some cases, these technically difficult procedures may require open fetal surgery. Only a few centers are developing these experimental techniques to correct fetal heart defects like aortic stenosis and pulmonary stenosis.
For more information please download our PDF Brochure about Fetal Intervention for Congenital Heart Disease
Baby Sarah Elizabeth has a very successful recovery from an SCT which is removed while she is still a fetus.