Introduction

This chapter will summarize the current state of trans-catheter fetal cardiac interventions (FCI) for a select group of congenital heart defects (CHDs). A more comprehensive description of the natural history, techniques, and outcomes can be found in the papers referenced. In this chapter we intend to summarize the current approach and highlight limitations and controversies. The field of FCI is fraught with ethical controversies, technical challenges, and imperfect outcomes. Despite this, it is an exciting field with the potential to dramatically alter or improve cardiac function in some patients.

Ethics

Fetal therapies, ranging from transplacental administration of medication to minimally invasive ultrasound or fetoscopic-guided procedures to more invasive open fetal surgery, are commonplace in some centers around the world. Yet despite marvelous innovations in the field, there are few studies that show clear benefit and only a handful of randomized controlled studies have been performed. If it were not for the non-trivial risk to the mother, the healthy patient, fetal therapy for otherwise correctable or even lethal defects would seem to be prudent and warrant the substantial investment in time and personnel. The ethical issues pertaining to non-cardiac defects have been discussed elsewhere and are beyond the scope of this chapter.