Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-26T15:45:36.003Z Has data issue: false hasContentIssue false

Foetal cardiac intervention: an ethical perspective

Published online by Cambridge University Press:  13 December 2011

Constantine D. Mavroudis*
Affiliation:
Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, United States of America
*
Correspondence to C. D. Mavroudis, BA, Loyola University Chicago, Stritch School of Medicine, 1645 W Ogden Ave, Unit 815, Chicago Illinois 60612, United States of America. Tel: +1 847 910 9334; Fax: +1 216 445 3692; E-mail: [email protected]

Abstract

Although recent advances have helped identify cases where foetal cardiac surgery might reverse the development of certain lesions, the indications and measurement of success in these procedures have yet to be established. Thus, both patients and physicians have a “burden of knowledge”, whereby a diagnosis is made without a clear course of action. The profound issues raised by foetal intervention, specifically the question of how concepts such as “patient” and “success” can be used, complicate this burden further and test the limits of language and logic. Similar issues raised in postmodern philosophy are discussed and can be incorporated into foetal cardiac surgery dialogues to produce a multi-disciplinary approach that will elucidate, not obfuscate, these issues in the future.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Tworetzky, W, Wilkins-Huang, L, Jennings, RW, et al. Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique and results of successful intervention. Circulation 2004; 110: 21252131.CrossRefGoogle ScholarPubMed
2.Kohl, T, Sharland, G, Allan, LD, et al. World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction. Am J Cardiol 2000; 85: 12301233.CrossRefGoogle ScholarPubMed
3.Marshall, AC, van der Velde, ME, Tworetzky, W, et al. Creation of an atrial septal defect in utero for fetuses with hypoplastic left heart syndrome and intact or highly restrictive atrial septum. Circulation 2004; 110: 253258.CrossRefGoogle ScholarPubMed
4.Assad, RS, Lee, F-Y, Hanley, FL. Placental compliance during fetal extracorporeal circulation. J Applied Physiol 2001; 90: 18821886.CrossRefGoogle ScholarPubMed
5.Mohan, RV, Liddicoat, JR, Klein, JR, Wampler, RK, Hanley, FL. Long-term outcome after fetal cardiac bypass: fetal survival to full term and organ abnormalities. J Thorac Cardiovasc Surg 1996; 111: 536544.Google Scholar
6.Gardiner, HM. Progression of fetal heart disease and rationale for fetal intracardiac interventions. Semin Fetal Neonat Med 2005; 10: 578585.CrossRefGoogle ScholarPubMed
7.Tworetzky, W, Marshall, AC. Balloon valvuloplasty for congenital heart disease in the fetus. Clin Perinatol 2003; 30: 541550.CrossRefGoogle ScholarPubMed
8.Fyler, DC. Report of the New England Regional Infant Cardiac Program. Pediatrics 1980; 65: 375461.Google Scholar
9.Rychik, J, Rome, JJ, Collins, MH, DeCampli, WM, Spray, TL. The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome. J Am Coll Cardiol 1999; 34: 554560.CrossRefGoogle ScholarPubMed
10.Simpson, JM, Sharland, GK. Natural history and outcome of aortic stenosis diagnosed prenatally. Heart 1977; 77: 205210.CrossRefGoogle Scholar
11.Mäkikallio, K, McElhinney, DB, Levine, JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation 2006; 113: 14011405.CrossRefGoogle ScholarPubMed
12.Vida, VL, Bacha, EA, Larrazabal, A, et al. Hypoplastic left heart syndrome with intact or highly restrictive atrial septum; surgical experience from a single center. Ann Thorac Surg 2007; 84: 581586.CrossRefGoogle ScholarPubMed
13.Quinn, TM, Adzick, NS. Fetal surgery. Obstet Gynecol Clin North Am 1997; 24: 143157.CrossRefGoogle ScholarPubMed
14.Golombeck, K, Ball, RH, Lee, H, et al. Maternal morbidity after maternal-fetal surgery. Am J Obstet Gynecol 2006; 194: 834839.CrossRefGoogle ScholarPubMed
15.Chervenak, FA, McCullough, LB. Ethics of fetal surgery. Clin Perinatol 2009; 36: 237246.CrossRefGoogle ScholarPubMed
16.Lyerly, AD, Little, MO, Faden, RR. A critique of the ‘fetus as patient’. Am J Bioeth 2008; 8: 4244.CrossRefGoogle ScholarPubMed
17.Saussure, F. Course in General Linguistics (tr. Roy Harris). Open Court Publishing Company, Peru, IL, 1986.Google Scholar
18.Lyotard, J-F. The Postmodern Condition: A Report on Knowledge (tr. Geoff Bennington and Brian Massumi). University of Minnesota Press, Minneapolis, 1984.Google Scholar
19.Foucault, M. The Use of Pleasure: The History of Sexuality, Vol. 2 (tr. Robert Hurley). Random House, New York, 1985.Google Scholar
20.Habermas, J. Discourse ethics: notes on philosophical justification. In: Moral Consciousness and Communicative Action. MIT Press, Cambridge, MA, 1990.Google Scholar
21.Jancelewicz, T, Harrison, MR. A history of fetal surgery. Clin Perinatol 2009; 36: 227236.CrossRefGoogle ScholarPubMed
22.Harrison, MR, Filly, RA, Golbus, MS, et al. Fetal treatment 1982. New Engl J Med 1982; 307: 16511652.CrossRefGoogle ScholarPubMed
23.Manning, FA, Harrison, MR, Rodeck, C. Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry. New Engl J Med 1986; 315: 336340.CrossRefGoogle ScholarPubMed
24.Nietzsche, F. Aphorism 146. Beyond Good and Evil. Trans Helen Zimmern. The Macmillan Company, NY, 1907. p 97.Google Scholar